SUDDEN INFANT DEATH SYNDROME SIDS Developed by Florida

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

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) FAEMSE 2

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

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 FAEMSE 4

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 FAEMSE 5

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 FAEMSE 6

Definition - SIDS 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 FAEMSE 7

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. FAEMSE 8

SIDS - What It Is ä Major cause of death in infants after 1 st 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 FAEMSE 9

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 FAEMSE 10

General Characteristics of SIDS ä ä ä ä FAEMSE 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 11

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

Medical Findings Consistent With SIDS FAEMSE 13

External Appearance ä ä ä FAEMSE 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 14

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

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 FAEMSE 16

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

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 FAEMSE 18

Emergency Responder Activity Cont. ä Obtain Hx ä ä Use open-ended & non-leading questions ä FAEMSE Illicit medical history Listen to the parents Do not ask judgmental or leading questions Had infant been sick ä ä ä ä 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 19

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 FAEMSE 20

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 FAEMSE 21

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 FAEMSE 22

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 FAEMSE 23

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

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 FAEMSE 25

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

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

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 FAEMSE team, post incident 28

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/ FAEMSE 29

References ä ä ä ä California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant Death Syndrome 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 FAEMSE 30

References Cont. ä ä ä ä FAEMSE 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 31

References Cont. ä ä ä FAEMSE 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” 32

SUMMARY FAEMSE 33