1. FAEMSE1 SUDDEN INFANT DEATH SYNDROME (SIDS) Developed by Florida Association of EMS Educators in cooperation with the Florida SIDS Alliance

2. FAEMSE 2 Development Team Principal Developer John Todaro REMT-P, RN Contributing Developers Jaime S. Greene BA, EMT-B Bunny D. Hamer MSN, RN Steve Bonwit SIDS Parent (Justin, 11/6/95 - 3/25/96)

3. FAEMSE 3 Peer Reviewers ä ä Marcel J. Deray MD ä ä Director Sleep Disorders Center, Miami Children’s Hospital, Miami, Florida ä ä William Munios MD ä ä Pediatric Gastroenterologist, Miami, Florida ä ä Board Member, Florida SIDS Alliance ä ä Floyd Livingston MD ä ä Pediatric Pulmonologist, Nemours Children’s Clinic, Orlando, Florida

4. FAEMSE 4 Objectives Upon completion of this course of instruction, the student will be able to: ä Define SIDS ä Describe the general population characteristics of a probable SIDS infant ä Describe the common physical characteristics of a probable SIDS infant

5. FAEMSE 5 Objectives ä Describe the typical scenario of a probable SIDS ä Identify important actions which should be initiated by an emergency responder ä Identify potential responses of parents to an infant death ä Identify potential responses of emergency responders to an infant death

6. FAEMSE 6 Objectives ä Identify common signs & symptoms of Critical Incident Stress (CIS) ä Identify strategies for decreasing the impact of Critical Incident Stress (CIS) ä Identify community resources available to parents

7. FAEMSE 7 Definition - SIDS ä - ä Sudden Infant Death Syndrome (crib death) - the sudden death of an infant, usually under 1 year of age, which remains unexplained after a complete postmortem investigation, including an autopsy, examination of the death scene and review of the case history

8. FAEMSE 8 SIDS Statistics ä Classified as a disorder ä Leading cause of death in infants 1 month to 1 year old ä 95% occur between 1 & 6 months of age - peak period between 2 & 4 months ä 3,000 SIDS deaths per year in the U.S.

9. FAEMSE 9 SIDS - What It Is ä Major cause of death in infants after 1st month of life ä Sudden & silent in an apparently healthy infant ä Unpredictable & unpreventable ä Quick death with no signs of suffering - usually during sleep

10. FAEMSE 10 SIDS - What It Is Not ä Caused by vomiting or choking ä Caused by external suffocation or overlaying ä Contagious or Hereditary ä Child abuse ä Caused by lack of love ä Caused by immunizations ä Caused by allergy to cows milk

11. FAEMSE 11 General Characteristics of SIDS ä Usually occurs in colder months ä Mothers younger than 20 years old ä Babies of mothers who smoke during pregnancy or are exposed to second hand smoke ä 60% male Vs 40% female ä Premature or low birth weight ä Upper respiratory infections, 60% in prior weeks ä Occurs quickly and quietly during a period of presumed sleep

12. FAEMSE 12 SIDS Research ä Evidence shows victims not as normal as they seem ä Maybe subtle but, undetectable, defects present at birth ä Areas presently under research ä Brain abnormalities ä Sleep position ä Multiple, non-life threatening abnormalities

13. FAEMSE 13 Medical Findings Consistent With SIDS

14. FAEMSE 14 External Appearance ä Normal state of hydration & nutrition ä Small amount of frothy fluid in or about mouth & nose ä Vomitus present ä Postmortem lividity &/or rigors ä Livormortis ä Disfiguration/Unusual position - dependant blood pooling/pressure marks

15. FAEMSE 15 Internal Appearances On Autopsy ä Pulmonary congestion & edema ä Intrathoracic petechiae 90% of time ä Stomach contents in trachea ä Microscopic inflammation in trachea

16. FAEMSE 16 Typical SIDS Infant Scenario ä Almost always occurs during sleep or appearance of sleep ä Usually healthy prior to death ä May have had a cold or recent physical stress ä May have been place down for nap, found not breathing or appearing dead ä Parents not hearing signs of struggle

17. FAEMSE 17 Emergency Responder Activity ä Initiate resuscitation per EMS System Practice Parameters & Protocols

18. FAEMSE 18 Emergency Responder Activity Cont. ä Support of Parents ä Use calm directive voice ä Be clear in instructions ä Provide explanations about Tx & transport ä Reassure that there was nothing that they could have done ä Do not be afraid of tears & anger ä Allow parents to accompany infant to hospital if situation permits

19. FAEMSE 19 Emergency Responder Activity Cont. ä Obtain Hx ä Illicit medical history ä Listen to the parents ä Do not ask judgmental or leading questions ä Use open-ended & non-leading questions ä Had infant been sick ä What happened ä Who found the infant & where ä What did (s)he do ä Had the infant been moved ä What time was infant last seen & by whom ä How was infant that day ä Last feeding

20. FAEMSE 20 Environmental Assessment ä Observe for ä Location of infant ä Presence of objects in area infant found ä Unusual conditions ä High room temperature ä Odors ä Anything out of ordinary

21. FAEMSE 21 Anticipated Parental Responses ä Normal responses may include: ä Denial, shock and disbelief ä Anger, rage and hostility ä Hysteria or withdrawal ä Intense guilt ä Fear, helplessness and confusion ä No visible response ä May or may not accept infants death

22. FAEMSE 22 Expected Requests From Parents ä Repetitive questions ä Request to not initiate care ä Request to be alone with infant ä Request to terminate resuscitation efforts ä Requests for cause of death

23. FAEMSE 23 If Parents Interfere With Care ä Show empathy ä Do not become angered or argumentative ä Avoid restraining parent ä Be professional - put yourself in their shoes

24. FAEMSE 24 Emergency Personnel Responses ä Withdrawal, avoidance of parents ä Self-doubt ä Anger - wanting to blame someone ä Identification with parents ä Sadness & depression

25. FAEMSE 25 Emergency Responder Expectations of Parents Behavior ä Hysterical & tearful responses ä Disbelief that not every parents will initiate CPR ä Disbelief/unable to accept parents decision to not have CPR started ä Cultural differences in mourning and grieving process

26. FAEMSE 26 Critical Incident Stress (CIS) Management Stress is an integral part of the profession of Emergency Services

27. FAEMSE 27 Signs & Symptoms of CIS ä Anger/irritability ä Physical illness ä Depression ä Recurring dreams ä Intrusive images ä Changes in sleep patterns ä Mood changes/swings ä Withdrawal ä Changes in eating habits ä Inability to concentrate ä Restlessness/agitation ä Loss of emotional control ä Increased alcohol consumption

28. FAEMSE 28 Strategies for Decreasing Impact of CIS ä Talk to your peers/ share your feelings ä Exercise and balanced diet ä Avoid OT & plan leisure time ä Write a personal journal ä Obtain personal or religious counseling ä Request dispatch tape reviews ä Request assistance from you local CISM team, post incident

29. FAEMSE 29 SIDS Resources National SIDS Resource Center (703) 821-8955 Florida SIDS Alliance (800) SIDS-FLA SIDS Alliance (800) 221-SIDS WWW.sidsalliance.org National Institute of Child Health & Development WWW.nih.gov/nichd/

30. FAEMSE 30 References ä California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant Death Syndrome Instructor Instructor Guide”April 1991. ä Department of Health, Education & Welfare, Public Health Service Administration, Bureau of Community Health Services “Training Emergency Responders: SIDS An Instructor Manual, DEW Publications No (HAS) 79-5253, 1979 ä State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990 ä American SIDS Institute, “SIDS: Toward an Understanding ä Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Doctor’s Response” J Bruce Beckwith M.D. 19983 ä National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993 ä Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2

31. FAEMSE 31 References Cont. ä National SIDS Clearing House, “Fact Sheet: SIDS Information The EMT” ä David Lawrence, “SIDS Handle With Care” JEMS, December 1988 ä Seasonality in SIDS-U.S. 1980-1987”, MMWR, December 14, 1990, Vol..39., No. 49 ä From the CDC, Atlanta, Georgia, “Seasonality in SIDS” JAMA, February,13, 1991, Vol.. 265, o. 6. ä From The National Health Institute< ‘Chronic Fetal Hypoxia Predispose Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. 21. ä Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Syndrome” Pediatric review, Vol.. 14, No. 3., March 1993 ä Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 1” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992

32. FAEMSE 32 References Cont. ä Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 2” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992 ä Florida Emergency Medicine Foundation & California EMS Authority, “Pediatric Education for Paramedics” 1997 ä American SIDS Institute, “Coping With Infant Loss, Grief and Bereavement”, June 1994 ä American SIDS Institute, “Helping A Friend Cope With Infant Loss, Grief and Bereavement, June 1994 ä Parrott, Carol, “Parent’s Grief Help & Understanding After The Death of a Baby”, Medic Publishing Company, 1992 ä Klobadans, David, “First Responders and EMS Personnel - SIDS Training Outline”

33. FAEMSE 33 SUMMARY