1.3 Identify the physical changes that take place after death and how this may affect laying out and moving individuals

This guide will help you answer 1.3 Identify the physical changes that take place after death and how this may affect laying out and moving individuals.

Skin changes and cooling (algor mortis)

After death the body starts to cool. This is called algor mortis. Skin temperature falls until it matches the surrounding air. Cooling speed varies with room temperature, clothing and body size.

Effects on laying out and moving:

• Work quickly but calmly; cooling makes skin more fragile.
• Avoid dragging; lift to prevent tearing of skin or clothing.
• Use gloves to maintain hygiene and protect from cold surfaces.

Colour changes and settling of blood (livor mortis)

Blood stops circulating and settles in the lowest parts of the body. This causes purple or red patches on the skin. These patches start within 30 minutes to a few hours and become fixed after about 6–12 hours.

Effects on laying out and moving:

• Handle areas of lividity gently to avoid bruising-like marks.
• Document the position of lividity prior to moving. It can help with investigations.
• Avoid placing pressure on fixed areas that would cause new marks.

Stiffening of muscles (rigor mortis)

Muscles stiffen after death. Rigor mortis usually starts 2–6 hours after death, becomes strongest at 12 hours and then resolves over 24–48 hours. Small muscles, such as the jaw, stiffen first.

Effects on laying out and moving:

• Plan movements to use natural joint positions. Forcing joints can cause damage to ligaments and skin.
• If rigor prevents desired positioning, wait until stiffness passes or use gentle, gradual manoeuvres.
• Work with colleagues for heavier or awkward bodies to reduce strain and risk of dropping.

Decomposition and tissue breakdown

Micro-organisms and enzymes break down tissues. Decomposition begins within 24–72 hours but timing depends on temperature and environment. Early signs include odour, skin slippage and bloating.

Effects on laying out and moving:

• Use barrier protection and PPE: gloves, apron, and mask where odour or fluid leakage is present.
• Place absorbent pads under the body to protect surfaces.
• Move the body to a suitable area quickly for containment and cleaning.

Skin slippage and blistering

As decomposition advances the outer skin layer separates and may blister or peel. This is called skin slippage.

Effects on laying out and moving:

• Support the body from beneath; avoid pulling on loose skin.
• Use towels or sheets under fragile areas to prevent tearing.
• Report and document any skin loss, as it may affect identification and care records.

Purging of fluids

Liquids from the lungs, stomach or blood vessels may leak from mouth, nose or wounds. This is more likely in advanced decomposition or if the body has been moved.

Effects on laying out and moving:

• Position a receptacle under the mouth and nose when moving.
• Use waterproof sheet and absorbent pads beneath the body.
• Clean and disinfect surfaces promptly after transfer.

Odour

Chemical breakdown of tissues releases strong odours. Odour intensity depends on time since death and environmental temperature.

Effects on laying out and moving:

• Reduce exposure time in communal areas.
• Move the body in a closed sheet or cover.
• Ventilate the room and use odour control methods approved by the employer.

Eye and mouth changes

Eyes may remain open or partially open. Cloudiness or opaqueness of the cornea develops if eyes are not closed. The jaw may relax or become fixed in rigor.

Effects on laying out and moving:

• Close eyelids gently, using eye pads if needed to keep them in place.
• Support the jaw when lifting to avoid sudden movements.
• Use soft material to close the mouth if required for dignity.

Fractures, wounds and medical devices

Pre-existing injuries, surgical wounds or implanted devices remain. These may leak or be fragile.

Effects on laying out and moving:

• Inspect for tubes, drains or dressings before moving.
• Secure or remove devices only if authorised by procedures.
• Support injured limbs to prevent further tissue damage.

Temperature effects on posture and skin

Heat accelerates decomposition and odour. Cold slows many changes but makes skin brittle.

Effects on laying out and moving:

• Store body at an appropriate temperature as soon as possible.
• When moving a cold body, use caution to avoid cracking or skin splitting.
• When moving a body from a warm environment, expect possible fluid leakage and odour.

Cultural and religious considerations affecting laying out

Different faiths have specific rituals for washing, dressing and positioning. Some require the body to be moved only by certain people or placed on a particular surface.

Effects on laying out and moving:

• Ask family or authorised person about wishes before proceeding.
• Follow organisational policies that balance respect and safety.
• Where ritual care is requested, provide guidance on safe handling for those performing the care.

Practical guidance for lifting and transferring

Always follow your employer’s moving and handling policy. Use manual handling aids when available.

Key steps:

• Plan the move. Check the environment and any obstructions.
• Use at least two people for heavier or awkward transfers.
• Keep the body supported at natural joints.
• Use bed sheets, sliding sheets or transfer boards to reduce friction.
• Lift with your legs, not your back. Keep the load close to your body.
• Communicate with colleagues. Move smoothly and steadily.

Infection control and PPE

Bodies can carry infectious agents. Standard precautions apply.

PPE and measures:

• Gloves, apron and eye protection as needed.
• Hand hygiene before and after contact.
• Clean and disinfect equipment and surfaces after use.
• Dispose of contaminated linen and absorbents per policy.

Documentation and reporting

Record observations about the body before and after moving. Note skin changes, wounds, lividity, odour and any device removal.

Why record:

• Provides clinical and legal evidence.
• Helps with continuity of care and coronial enquiries.
• Protects staff and organisation.

Working with families and colleagues

Families may want to see the body or help with care. Colleagues may provide cultural or clinical expertise.

How to respond:

• Explain what you will do in simple terms.
• Offer the option to view at a distance or with certain supports in place.
• Allow time for questions and respect privacy.

Final thoughts

You will meet a range of physical changes after death. Recognising these changes helps you to care for the body safely and respectfully. Handling with attention keeps the body intact and protects staff and others from harm.

Follow your organisation’s procedures at every step. When in doubt, stop and ask a senior colleague. Documentation and clear communication protect the deceased, the family and your team.