SUDDEN INFANT DEATH SYNDROME (SIDS)

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

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. Peer Reviewers • Marcel J. Deray 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

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

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

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

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

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.

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

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

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

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

13. Medical Findings Consistent With SIDS

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

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

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

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

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

19. 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 Emergency Responder Activity Cont.

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

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

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

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

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

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

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

27. 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 Signs & Symptoms of CIS

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

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. 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) 79-5253, 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. 19983 • National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993 • Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2

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. 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 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

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”

33. SUMMARY