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

2. Development Team Principal Developer Contributing Developers
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)
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3. Peer Reviewers Marcel J. Deray MD William Munios MD
Director Sleep Disorders Center, Miami Children’s Hospital, Miami, Florida
William Munios MD
Pediatric Gastroenterologist, Miami, Florida
Board Member, Florida SIDS Alliance
Floyd Livingston MD
Pediatric Pulmonologist, Nemours Children’s Clinic, Orlando, Florida
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4. Objectives
Upon completion of this course of instruction, the student will be able to:
Define SIDS
Describe the general population characteristics of a probable SIDS infant
Describe the common physical characteristics of a probable SIDS infant
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5. Objectives Describe the typical scenario of a probable SIDS
Identify important actions which should be initiated by an emergency responder
Identify potential responses of parents to an infant death
Identify potential responses of emergency responders to an infant death
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6. Objectives
Identify common signs & symptoms of Critical Incident Stress (CIS)
Identify strategies for decreasing the impact of Critical Incident Stress (CIS)
Identify community resources available to parents
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7. Definition - SIDS
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
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8. SIDS Statistics Classified as a disorder
Leading cause of death in infants 1 month to 1 year old
95% occur between 1 & 6 months of age - peak period between 2 & 4 months
3,000 SIDS deaths per year in the U.S.
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9. SIDS - What It Is
Major cause of death in infants after 1st month of life
Sudden & silent in an apparently healthy infant
Unpredictable & unpreventable
Quick death with no signs of suffering - usually during sleep
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10. SIDS - What It Is Not Caused by vomiting or choking
Caused by external suffocation or overlaying
Contagious or Hereditary
Child abuse
Caused by lack of love
Caused by immunizations
Caused by allergy to cows milk
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11. General Characteristics of SIDS
Usually occurs in colder months
Mothers younger than 20 years old
Babies of mothers who smoke during pregnancy or are exposed to second hand smoke
60% male Vs 40% female
Premature or low birth weight
Upper respiratory infections, 60% in prior weeks
Occurs quickly and quietly during a period of presumed sleep
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12. SIDS Research Evidence shows victims not as normal as they seem
Maybe subtle but, undetectable, defects present at birth
Areas presently under research
Brain abnormalities
Sleep position
Multiple, non-life threatening abnormalities
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13. Medical Findings Consistent With SIDS
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14. External Appearance Normal state of hydration & nutrition
Small amount of frothy fluid in or about mouth & nose
Vomitus present
Postmortem lividity &/or rigors
Livormortis
Disfiguration/Unusual position - dependant blood pooling/pressure marks
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15. Internal Appearances On Autopsy
Pulmonary congestion & edema
Intrathoracic petechiae 90% of time
Stomach contents in trachea
Microscopic inflammation in trachea
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16. Typical SIDS Infant Scenario
Almost always occurs during sleep or appearance of sleep
Usually healthy prior to death
May have had a cold or recent physical stress
May have been place down for nap, found not breathing or appearing dead
Parents not hearing signs of struggle
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17. Emergency Responder Activity
Initiate resuscitation per EMS System Practice Parameters & Protocols
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18. Emergency Responder Activity Cont.
Support of Parents
Use calm directive voice
Be clear in instructions
Provide explanations about Tx & transport
Reassure that there was nothing that they could have done
Do not be afraid of tears & anger
Allow parents to accompany infant to hospital if situation permits
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19. Emergency Responder Activity Cont.
Obtain Hx
Illicit medical history
Listen to the parents
Do not ask judgmental or leading questions
Use open-ended & non-leading questions
Had infant been sick
What happened
Who found the infant & where
What did (s)he do
Had the infant been moved
What time was infant last seen & by whom
How was infant that day
Last feeding
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20. Environmental Assessment
Observe for
Location of infant
Presence of objects in area infant found
Unusual conditions
High room temperature
Odors
Anything out of ordinary
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21. Anticipated Parental Responses
Normal responses may include:
Denial, shock and disbelief
Anger, rage and hostility
Hysteria or withdrawal
Intense guilt
Fear, helplessness and confusion
No visible response
May or may not accept infants death
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22. Expected Requests From Parents
Repetitive questions
Request to not initiate care
Request to be alone with infant
Request to terminate resuscitation efforts
Requests for cause of death
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23. If Parents Interfere With Care
Show empathy
Do not become angered or argumentative
Avoid restraining parent
Be professional - put yourself in their shoes
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24. Emergency Personnel Responses
Withdrawal, avoidance of parents
Self-doubt
Anger - wanting to blame someone
Identification with parents
Sadness & depression
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25. Emergency Responder Expectations of Parents Behavior
Hysterical & tearful responses
Disbelief that not every parents will initiate CPR
Disbelief/unable to accept parents decision to not have CPR started
Cultural differences in mourning and grieving process
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26. Critical Incident Stress (CIS) Management
Stress is an integral part of the profession of Emergency Services
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27. Signs & Symptoms of CIS Anger/irritability Physical illness Depression
Recurring dreams
Intrusive images
Changes in sleep patterns
Mood changes/swings
Withdrawal
Changes in eating habits
Inability to concentrate
Restlessness/agitation
Loss of emotional control
Increased alcohol consumption
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28. Strategies for Decreasing Impact of CIS
Talk to your peers/ share your feelings
Exercise and balanced diet
Avoid OT & plan leisure time
Write a personal journal
Obtain personal or religious counseling
Request dispatch tape reviews
Request assistance from you local CISM team, post incident
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29. SIDS Resources National SIDS Resource Center (703) 821-8955
Florida SIDS Alliance
(800) SIDS-FLA
SIDS Alliance
(800) 221-SIDS
National Institute of Child Health & Development
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30. References
California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant Death Syndrome Instructor Instructor Guide”April 1991.
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) , 1979
State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990
American SIDS Institute, “SIDS: Toward an Understanding
Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Doctor’s Response” J Bruce Beckwith M.D
National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993
Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2
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31. References Cont.
National SIDS Clearing House, “Fact Sheet: SIDS Information The EMT”
David Lawrence, “SIDS Handle With Care” JEMS, December 1988
Seasonality in SIDS-U.S ”, MMWR, December 14, 1990, Vol..39., No. 49
From the CDC, Atlanta, Georgia, “Seasonality in SIDS” JAMA, February,13, 1991, Vol , o. 6.
From The National Health Institute< ‘Chronic Fetal Hypoxia Predispose Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. 21.
Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Syndrome” Pediatric review, Vol.. 14, No. 3., March 1993
Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 1” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992
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32. References Cont.
Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 2” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992
Florida Emergency Medicine Foundation & California EMS Authority, “Pediatric Education for Paramedics” 1997
American SIDS Institute, “Coping With Infant Loss, Grief and Bereavement”, June 1994
American SIDS Institute, “Helping A Friend Cope With Infant Loss, Grief and Bereavement, June 1994
Parrott, Carol, “Parent’s Grief Help & Understanding After The Death of a Baby”, Medic Publishing Company, 1992
Klobadans, David, “First Responders and EMS Personnel - SIDS Training Outline”
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33. SUMMARY
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