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SUDDEN INFANT DEATH SYNDROME (SIDS)SUDDEN INFANT DEATH SYNDROME (SIDS)

Developed byDeveloped by

Florida Association of EMS Educators Florida Association of EMS Educators in cooperation with thein cooperation with the

Florida SIDS AllianceFlorida SIDS Alliance

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Development TeamDevelopment Team

Principal DeveloperPrincipal DeveloperJohn Todaro REMT-P, RN John Todaro REMT-P, RN

Contributing DevelopersContributing DevelopersJaime S. Greene BA, EMT-BJaime S. Greene BA, EMT-B

Bunny D. Hamer MSN, RNBunny D. Hamer MSN, RN

Steve Bonwit SIDS ParentSteve Bonwit SIDS Parent

(Justin, 11/6/95 - 3/25/96)

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Peer ReviewersPeer 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

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ObjectivesObjectives

Upon completion of this course of Upon completion of this course of instruction, the student will be able to:instruction, the student will be able to: Define SIDSDefine SIDSDescribe the general population Describe the general population

characteristics of a probable SIDS infantcharacteristics of a probable SIDS infantDescribe the common physical Describe the common physical

characteristics of a probable SIDS infantcharacteristics of a probable SIDS infant

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ObjectivesObjectives

Describe the typical scenario of a probable Describe the typical scenario of a probable SIDS SIDS

Identify important actions which should Identify important actions which should be initiated by an emergency responderbe initiated by an emergency responder

Identify potential responses of parents to Identify potential responses of parents to an infant deathan infant death

Identify potential responses of emergency Identify potential responses of emergency responders to an infant deathresponders to an infant death

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ObjectivesObjectives

Identify common signs & symptoms of Identify common signs & symptoms of Critical Critical Incident Stress (CIS)Incident Stress (CIS)

Identify strategies for decreasing the Identify strategies for decreasing the impact of Critical Incident Stress (CIS)impact of Critical Incident Stress (CIS)

Identify community resources available Identify community resources available to parentsto parents

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Definition - SIDSDefinition - 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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SIDS StatisticsSIDS Statistics

Classified as a disorderClassified as a disorder Leading cause of death in infants 1 Leading cause of death in infants 1

month to 1 year oldmonth to 1 year old 95% occur between 1 & 6 months of age - 95% occur between 1 & 6 months of age -

peak period between 2 & 4 monthspeak 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.

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SIDS - What It IsSIDS - What It Is

Major cause of death in infants after Major cause of death in infants after 1st month of life1st month of life

Sudden & silent in an apparently Sudden & silent in an apparently healthy infanthealthy infant

Unpredictable & unpreventableUnpredictable & unpreventableQuick death with no signs of Quick death with no signs of

suffering - usually during sleepsuffering - usually during sleep

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SIDS - What It Is NotSIDS - What It Is Not

Caused by vomiting or chokingCaused by vomiting or choking Caused by external suffocation or overlayingCaused by external suffocation or overlaying Contagious or HereditaryContagious or Hereditary Child abuseChild abuse Caused by lack of loveCaused by lack of love Caused by immunizationsCaused by immunizations Caused by allergy to cows milkCaused by allergy to cows milk

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General Characteristics of SIDSGeneral Characteristics of SIDS

Usually occurs in colder monthsUsually occurs in colder months Mothers younger than 20 years oldMothers younger than 20 years old Babies of mothers who smoke during pregnancy or Babies of mothers who smoke during pregnancy or

are exposed to second hand smokeare exposed to second hand smoke 60% male Vs 40% female60% male Vs 40% female Premature or low birth weightPremature or low birth weight Upper respiratory infections, 60% in prior weeksUpper respiratory infections, 60% in prior weeks Occurs quickly and quietly during a period of Occurs quickly and quietly during a period of

presumed sleeppresumed sleep

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SIDS ResearchSIDS Research

Evidence shows victims not as Evidence shows victims not as normal as they seemnormal as they seem

Maybe subtle but, undetectable, Maybe subtle but, undetectable, defects present at birthdefects present at birth

Areas presently under researchAreas presently under research Brain abnormalitiesBrain abnormalities Sleep positionSleep position Multiple, non-life threatening Multiple, non-life threatening

abnormalitiesabnormalities

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Medical Findings Consistent With SIDSMedical Findings Consistent With SIDS

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External AppearanceExternal Appearance

Normal state of hydration & Normal state of hydration & nutritionnutrition

Small amount of frothy fluid in or Small amount of frothy fluid in or about mouth & noseabout mouth & nose

Vomitus presentVomitus present Postmortem lividity &/or rigorsPostmortem lividity &/or rigors Livormortis Livormortis Disfiguration/Unusual position - Disfiguration/Unusual position -

dependant blood pooling/pressure dependant blood pooling/pressure marksmarks

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Internal Appearances On AutopsyInternal Appearances On Autopsy

Pulmonary congestion & Pulmonary congestion & edemaedema

Intrathoracic petechiae Intrathoracic petechiae 90% of time90% of time

Stomach contents in Stomach contents in tracheatrachea

Microscopic inflammation Microscopic inflammation in tracheain trachea

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Typical SIDS Infant ScenarioTypical SIDS Infant Scenario

Almost always occurs during sleep or Almost always occurs during sleep or appearance of sleepappearance of sleep

Usually healthy prior to deathUsually healthy prior to death May have had a cold or recent physical May have had a cold or recent physical

stressstress May have been place down for nap, found May have been place down for nap, found

not breathing or appearing deadnot breathing or appearing dead Parents not hearing signs of struggleParents not hearing signs of struggle

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Emergency Responder ActivityEmergency Responder Activity

Initiate Initiate resuscitation per resuscitation per EMS System EMS System Practice Practice Parameters & Parameters & ProtocolsProtocols

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Emergency Responder Activity Cont.Emergency Responder Activity Cont.

Support of ParentsSupport of Parents Use calm directive voiceUse calm directive voice Be clear in instructionsBe clear in instructions Provide explanations about Tx & transportProvide explanations about Tx & transport Reassure that there was nothing that they could Reassure that there was nothing that they could

have donehave done Do not be afraid of tears & angerDo not be afraid of tears & anger Allow parents to accompany infant to hospital if Allow parents to accompany infant to hospital if

situation permitssituation permits

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Emergency Responder Activity Cont.Emergency Responder Activity Cont.

Obtain HxObtain Hx Illicit medical historyIllicit medical history Listen to the parentsListen to the parents Do not ask judgmental Do not ask judgmental

or leading questionsor leading questions

Use open-ended & Use open-ended & non-leading questionsnon-leading questions Had infant been sickHad infant been sick

What happened What happened Who found the infant & Who found the infant &

where where What did (s)he doWhat did (s)he do Had the infant been Had the infant been

movedmoved What time was infant What time was infant

last seen & by whomlast seen & by whom How was infant that dayHow was infant that day Last feedingLast feeding

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Environmental AssessmentEnvironmental Assessment

Observe forObserve for Location of infantLocation of infant Presence of objects in area Presence of objects in area

infant foundinfant found Unusual conditionsUnusual conditions

High room temperatureHigh room temperatureOdorsOdorsAnything out of ordinaryAnything out of ordinary

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Anticipated Parental ResponsesAnticipated Parental Responses

Normal responses may include:Normal responses may include: Denial, shock and disbeliefDenial, shock and disbelief Anger, rage and hostilityAnger, rage and hostility Hysteria or withdrawalHysteria or withdrawal Intense guiltIntense guilt Fear, helplessness and confusionFear, helplessness and confusion No visible responseNo visible response May or may not accept infants deathMay or may not accept infants death

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Expected Requests From ParentsExpected Requests From Parents

Repetitive questionsRepetitive questionsRequest to not initiate careRequest to not initiate careRequest to be alone with infantRequest to be alone with infantRequest to terminate resuscitation Request to terminate resuscitation

effortseffortsRequests for cause of deathRequests for cause of death

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If Parents Interfere With CareIf Parents Interfere With Care

Show empathyShow empathyDo not become angered or Do not become angered or

argumentativeargumentativeAvoid restraining parentAvoid restraining parentBe professional - put yourself in Be professional - put yourself in

their shoestheir shoes

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Emergency Personnel ResponsesEmergency Personnel Responses

Withdrawal, Withdrawal, avoidance of parentsavoidance of parents

Self-doubtSelf-doubt Anger - wanting to Anger - wanting to

blame someoneblame someone Identification with Identification with

parentsparents Sadness & depressionSadness & depression

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Emergency Responder Expectations of Parents BehaviorEmergency Responder Expectations of Parents Behavior

Hysterical & tearful responsesHysterical & tearful responsesDisbelief that not every parents will Disbelief that not every parents will

initiate CPRinitiate CPRDisbelief/unable to accept parents Disbelief/unable to accept parents

decision to not have CPR starteddecision to not have CPR startedCultural differences in mourning Cultural differences in mourning

and grieving processand grieving process

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Critical Incident Stress (CIS) ManagementCritical Incident Stress (CIS) Management

Stress is an Stress is an integral part of integral part of the profession the profession of Emergency of Emergency

ServicesServices

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Signs & Symptoms of CISSigns & Symptoms of CIS

Anger/irritabilityAnger/irritability Physical illnessPhysical illness DepressionDepression Recurring dreamsRecurring dreams Intrusive imagesIntrusive images Changes in sleep Changes in sleep

patternspatterns Mood changes/swingsMood changes/swings

WithdrawalWithdrawal Changes in eating habitsChanges in eating habits Inability to concentrateInability to concentrate Restlessness/agitationRestlessness/agitation Loss of emotional Loss of emotional

controlcontrol Increased alcohol Increased alcohol

consumptionconsumption

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Strategies for Decreasing Impact of CISStrategies for Decreasing Impact of CIS

Talk to your peers/ share your feelingsTalk to your peers/ share your feelings Exercise and balanced dietExercise and balanced diet Avoid OT & plan leisure timeAvoid OT & plan leisure time Write a personal journalWrite a personal journal Obtain personal or religious counselingObtain personal or religious counseling Request dispatch tape reviewsRequest dispatch tape reviews Request assistance from you local CISM Request assistance from you local CISM

team, post incidentteam, post incident

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SIDS ResourcesSIDS 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/

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ReferencesReferences California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant

Death Syndrome Instructor Instructor Guide”April 1991.Death Syndrome Instructor Instructor Guide”April 1991. Department of Health, Education & Welfare, Public Health Service Department of Health, Education & Welfare, Public Health Service

Administration, Bureau of Community Health Services “Training Emergency Administration, Bureau of Community Health Services “Training Emergency Responders: SIDS An Instructor Manual, DEW Publications No (HAS) 79-5253, Responders: SIDS An Instructor Manual, DEW Publications No (HAS) 79-5253, 19791979

State of California EMS Authority, “SIDS Training Packet For Emergency State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990Medical Responders and Firefighters”, September 1990

American SIDS Institute, “SIDS: Toward an UnderstandingAmerican SIDS Institute, “SIDS: Toward an Understanding Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Doctor’s Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Doctor’s

Response” J Bruce Beckwith M.D. 19983Response” J Bruce Beckwith M.D. 19983 National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993National SIDS Resource Center, “Information Sheet: What is SIDS, May 1993 Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2

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References Cont.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 1988David Lawrence, “SIDS Handle With Care” JEMS, December 1988 Seasonality in SIDS-U.S. 1980-1987”, MMWR, December 14, 1990, Seasonality in SIDS-U.S. 1980-1987”, MMWR, December 14, 1990,

Vol..39., No. 49Vol..39., No. 49 From the CDC, Atlanta, Georgia, “Seasonality in SIDS” JAMA, From the CDC, Atlanta, Georgia, “Seasonality in SIDS” JAMA,

February,13, 1991, Vol. . 265, o. 6.February,13, 1991, Vol. . 265, o. 6. From The National Health Institute< ‘Chronic Fetal Hypoxia Predispose From The National Health Institute< ‘Chronic Fetal Hypoxia Predispose

Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. 21.Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. 21. Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Syndrome” Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Syndrome”

Pediatric review, Vol.. 14, No. 3., March 1993Pediatric review, Vol.. 14, No. 3., March 1993 Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust

SIDS PART 1” Definitions & Classification of SIDS”, Midwifery SIDS PART 1” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992Chronicles & Nursing Notes, August 1992

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References Cont.References Cont. Jackson, & Community Midwifery, United Leeds Teaching Hospital Jackson, & Community Midwifery, United Leeds Teaching Hospital

Trust SIDS PART 2” Definitions & Classification of SIDS”, Midwifery Trust SIDS PART 2” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992Chronicles & Nursing Notes, August 1992

Florida Emergency Medicine Foundation & California EMS Authority, Florida Emergency Medicine Foundation & California EMS Authority, “Pediatric Education for Paramedics” 1997“Pediatric Education for Paramedics” 1997

American SIDS Institute, “Coping With Infant Loss, Grief and American SIDS Institute, “Coping With Infant Loss, Grief and Bereavement”, June 1994Bereavement”, June 1994

American SIDS Institute, “Helping A Friend Cope With Infant Loss, American SIDS Institute, “Helping A Friend Cope With Infant Loss, Grief and Bereavement, June 1994Grief and Bereavement, June 1994

Parrott, Carol, “Parent’s Grief Help & Understanding After The Death of Parrott, Carol, “Parent’s Grief Help & Understanding After The Death of a Baby”, Medic Publishing Company, 1992a Baby”, Medic Publishing Company, 1992

Klobadans, David, “First Responders and EMS Personnel - SIDS Klobadans, David, “First Responders and EMS Personnel - SIDS Training Outline” Training Outline”

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SUMMARYSUMMARY