1. PHLEMS1 SUDDEN INFANT DEATH SYNDROME (SIDS) Presented by Jackie Yates-Feller, NREMT-P, PI

2. PHLEMS2 Objectives Upon completion of this presentation, 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

3. PHLEMS3 Objectives Describe the typical scenario of a probable SIDS Describe the typical scenario of a probable SIDS Identify important actions which should be initiated by an emergency responder Identify important actions which should be initiated by an emergency responder Identify potential responses of parents to an infant death Identify potential responses of parents to an infant death Identify potential responses of emergency responders to an infant death Identify potential responses of emergency responders to an infant death

4. PHLEMS4 Objectives Identify common signs & symptoms of Critical Incident Stress (CIS) Identify common signs & symptoms of Critical Incident Stress (CIS) Identify strategies for decreasing the impact of Critical Incident Stress (CIS) Identify strategies for decreasing the impact of Critical Incident Stress (CIS) Identify community resources available to parents Identify community resources available to parents

5. PHLEMS5 Definition - SIDS 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

6. PHLEMS6 SIDS Statistics Classified as a disorder Classified as a disorder Leading cause of death in infants 1 month to 1 year old 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 95% occur between 1 & 6 months of age - peak period between 2 & 4 months 3,000 SIDS deaths per year in the U.S. 3,000 SIDS deaths per year in the U.S.

7. PHLEMS7 SIDS - What It Is Major cause of death in infants after 1st month of life Major cause of death in infants after 1st month of life Sudden & silent in an apparently healthy infant Sudden & silent in an apparently healthy infant Unpredictable & unpreventable Unpredictable & unpreventable Quick death with no signs of suffering - usually during sleep Quick death with no signs of suffering - usually during sleep

8. PHLEMS8 SIDS - What It Is Not Caused by vomiting or choking Caused by vomiting or choking Caused by external suffocation or overlaying Caused by external suffocation or overlaying Contagious or Hereditary Contagious or Hereditary Child abuse Child abuse Caused by lack of love Caused by lack of love Caused by immunizations Caused by immunizations Caused by allergy to cows milk Caused by allergy to cows milk

9. PHLEMS9 General Characteristics of SIDS Usually occurs in colder months Usually occurs in colder months Mothers younger than 20 years old Mothers younger than 20 years old Babies of smoking mothers or mothers exposed to second hand smoke Babies of smoking mothers or mothers exposed to second hand smoke 60% male Vs 40% female 60% male Vs 40% female Premature or low birth weight Premature or low birth weight Upper respiratory infections, 60% in prior weeks Upper respiratory infections, 60% in prior weeks Occurs quickly and quietly during a period of presumed sleep Occurs quickly and quietly during a period of presumed sleep

10. PHLEMS10 SIDS Research Evidence shows victims not as normal as they seem Evidence shows victims not as normal as they seem Maybe subtle but, undetectable, defects present at birth Maybe subtle but, undetectable, defects present at birth Areas presently under research Areas presently under research –Brain abnormalities –Sleep position –Multiple, non-life threatening abnormalities

11. PHLEMS11 Medical Findings Consistent With SIDS Differences seen in external appearance versus internal appearance seen on autopsy.

12. PHLEMS12 External Appearance Normal state of hydration & nutrition Normal state of hydration & nutrition Small amount of frothy fluid in or about mouth & nose Small amount of frothy fluid in or about mouth & nose Vomitus present Vomitus present Postmortem lividity &/or rigors Postmortem lividity &/or rigors Livormortis Livormortis Disfiguration/Unusual position - dependant blood pooling/pressure marks Disfiguration/Unusual position - dependant blood pooling/pressure marks

13. PHLEMS13 Internal Appearances On Autopsy Pulmonary congestion & edema Pulmonary congestion & edema Intrathoracic petechiae 90% of time Intrathoracic petechiae 90% of time Stomach contents in trachea Stomach contents in trachea Microscopic inflammation in trachea Microscopic inflammation in trachea

14. PHLEMS14 Typical SIDS Infant Scenario Almost always occurs during sleep or appearance of sleep Almost always occurs during sleep or appearance of sleep Usually healthy prior to death Usually healthy prior to death May have had a cold or recent physical stress May have had a cold or recent physical stress May have been place down for nap, found not breathing or appearing dead May have been place down for nap, found not breathing or appearing dead Parents not hearing signs of struggle Parents not hearing signs of struggle

15. PHLEMS15 Emergency Responder Activity Initiate resuscitation per department procedures and guidelines Initiate resuscitation per department procedures and guidelines

16. PHLEMS16 Emergency Responder Activity Cont. Support of Parents 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

17. PHLEMS17 Emergency Responder Activity Cont. Obtain Hx Obtain Hx –Illicit medical history –Listen to the parents –Do not ask judgmental or leading questions Use open-ended & non-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

18. PHLEMS18 Environmental Assessment Observe for Observe for –Location of infant –Presence of objects in area infant found –Unusual conditions High room temperature Odors Anything out of ordinary

19. PHLEMS19 Anticipated Parental Responses Normal responses may include: 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

20. PHLEMS20 Expected Requests From Parents Repetitive questions Repetitive questions Request to not initiate care Request to not initiate care Request to be alone with infant Request to be alone with infant Request to terminate resuscitation efforts Request to terminate resuscitation efforts Requests for cause of death Requests for cause of death

21. PHLEMS21 If Parents Interfere With Care Show empathy Show empathy Do not become angered or argumentative Do not become angered or argumentative Avoid restraining parent Avoid restraining parent Be professional - put yourself in their shoes Be professional - put yourself in their shoes

22. PHLEMS22 Emergency Personnel Responses Withdrawal, avoidance of parents Withdrawal, avoidance of parents Self-doubt Self-doubt Anger - wanting to blame someone Anger - wanting to blame someone Identification with parents Identification with parents Sadness & depression Sadness & depression

23. PHLEMS23 Emergency Responder Expectations of Parent’s Behavior Hysterical & tearful responses Hysterical & tearful responses Disbelief that not every parents will initiate CPR Disbelief that not every parents will initiate CPR Disbelief/unable to accept parents decision to not have CPR started Disbelief/unable to accept parents decision to not have CPR started Cultural differences in mourning and grieving process Cultural differences in mourning and grieving process

24. PHLEMS24 Critical Incident Stress (CIS) Management Stress is an integral part of the profession of Emergency Services

25. PHLEMS25 Signs & Symptoms of CIS Anger/irritability Anger/irritability Physical illness Physical illness Depression Depression Recurring dreams Recurring dreams Intrusive images Intrusive images Changes in sleep patterns Changes in sleep patterns Mood changes/swings Mood changes/swings Withdrawal Withdrawal Changes in eating habits Changes in eating habits Inability to concentrate Inability to concentrate Restlessness/agitat ion Restlessness/agitat ion Loss of emotional control Loss of emotional control Increased alcohol consumption Increased alcohol consumption

26. PHLEMS26 Strategies for Decreasing Impact of CIS Talk to your peers/ share your feelings Talk to your peers/ share your feelings Exercise and balanced diet Exercise and balanced diet Avoid OT & plan leisure time Avoid OT & plan leisure time Write a personal journal Write a personal journal Obtain personal or religious counseling Obtain personal or religious counseling Request dispatch tape reviews Request dispatch tape reviews Request assistance from you local CISM team, post incident Request assistance from you local CISM team, post incident

27. PHLEMS27 SIDS Resources National SIDS Resource Center (703) 821-8955 SIDS Alliance (800) 221-SIDS WWW.sidsalliance.org National Institute of Child Health & Development WWW.nih.gov/nichd/

28. 28 References California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant Death Syndrome Instructor Instructor Guide”April 1991. 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) 79-5253, 1979 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 State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990 State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990 American SIDS Institute, “SIDS: Toward an Understanding American SIDS Institute, “SIDS: Toward an Understanding Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Doctor’s Response” J Bruce Beckwith M.D. 19983 Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Doctor’s Response” J Bruce Beckwith M.D. 19983 National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993 National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993 Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2 Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2

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

30. PHLEMS30 References Cont. Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 2” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992 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 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, “Coping With Infant Loss, Grief and Bereavement”, June 1994 American SIDS Institute, “Helping A Friend Cope 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 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” Klobadans, David, “First Responders and EMS Personnel - SIDS Training Outline”

31. PHLEMS31 SUMMARY Questions?