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

Presented byPresented by

Jackie Yates-Feller, NREMT-P, PIJackie Yates-Feller, NREMT-P, PI

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ObjectivesObjectivesUpon completion of this presentation, Upon completion of this presentation,

the student will be able to:the student will be able to: – Define SIDSDefine SIDS– Describe the general population Describe the general population

characteristics of a probable SIDS characteristics of a probable SIDS infantinfant

– Describe the common physical Describe the common physical characteristics of a probablecharacteristics of a probable SIDS SIDS infantinfant

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ObjectivesObjectives Describe the typical scenario of a Describe the typical scenario of a

probable SIDS probable SIDS Identify important actions which Identify important actions which

should be initiated by an emergency should be initiated by an emergency responderresponder

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

Identify potential responses of Identify potential responses of emergency responders to an infant emergency responders to an infant deathdeath

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ObjectivesObjectives Identify common signs & Identify common signs &

symptoms of Critical Incident symptoms of Critical Incident Stress (CIS)Stress (CIS)

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

Identify community resources Identify community resources available to parentsavailable to parents

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Definition - SIDSDefinition - 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

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SIDS StatisticsSIDS Statistics

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

infants 1 month to 1 year oldinfants 1 month to 1 year old 95% occur between 1 & 6 95% occur between 1 & 6

months of age - peak period months of age - peak period between 2 & 4 monthsbetween 2 & 4 months

3,000 SIDS deaths per year in 3,000 SIDS deaths per year in the U.S.the U.S.

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SIDS - What It IsSIDS - What It Is

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

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

Unpredictable & unpreventableUnpredictable & unpreventable Quick 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 Caused by external suffocation or

overlayingoverlaying 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 General Characteristics of SIDSSIDS Usually occurs in colder monthsUsually occurs in colder months Mothers younger than 20 years oldMothers younger than 20 years old Babies of smoking mothers or mothers Babies of smoking mothers or mothers

exposed to second hand smokeexposed 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 Upper respiratory infections, 60% in

prior weeksprior weeks Occurs quickly and quietly during a Occurs quickly and quietly during a

period of presumed sleepperiod of presumed sleep

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SIDS ResearchSIDS Research

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

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

Areas presently under Areas presently under researchresearch– Brain abnormalitiesBrain abnormalities– Sleep positionSleep position– Multiple, non-life Multiple, non-life

threatening abnormalitiesthreatening abnormalities

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Medical Findings Medical Findings Consistent With SIDSConsistent With SIDS

Differences seen in Differences seen in external external appearance appearance versus internal versus internal appearance seen appearance seen on autopsy.on autopsy.

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External AppearanceExternal Appearance

Normal state of hydration & nutritionNormal state of hydration & nutrition Small amount of frothy fluid in or about mouth & noseSmall amount of frothy fluid in or about mouth & nose Vomitus presentVomitus present Postmortem lividity &/or rigorsPostmortem lividity &/or rigors Livormortis Livormortis Disfiguration/Unusual position - dependant blood Disfiguration/Unusual position - dependant blood

pooling/pressure markspooling/pressure marks

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Internal Appearances On Internal Appearances On AutopsyAutopsy

Pulmonary congestion Pulmonary congestion & edema& edema

Intrathoracic petechiae Intrathoracic petechiae 90% of time90% of time

Stomach contents in Stomach contents in tracheatrachea

Microscopic Microscopic inflammation in inflammation in tracheatrachea

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Typical SIDS Infant Typical SIDS Infant ScenarioScenario

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 May have had a cold or recent

physical stressphysical stress May have been place down for nap, May have been place down for nap,

found not breathing or appearing found not breathing or appearing deaddead

Parents not hearing signs of struggleParents not hearing signs of struggle

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Emergency Responder Emergency Responder ActivityActivity

Initiate Initiate resuscitation resuscitation per per department department procedures procedures and guidelinesand guidelines

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Emergency Responder Emergency Responder Activity Cont.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 & Provide explanations about Tx &

transporttransport– Reassure that there was nothing that Reassure that there was nothing that

they could have donethey could have done– Do not be afraid of tears & angerDo not be afraid of tears & anger– Allow parents to accompany infant to Allow parents to accompany infant to

hospital if situation permitshospital if situation permits

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Emergency Responder Emergency Responder Activity Cont.Activity Cont. Obtain HxObtain Hx

– Illicit medical Illicit medical historyhistory

– Listen to the Listen to the parentsparents

– Do not ask Do not ask judgmental or judgmental or leading questionsleading questions

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

sicksick

– What happened What happened – Who found the Who found the

infant & whereinfant & where– What did (s)he doWhat did (s)he do– Had the infant Had the infant

been movedbeen moved– What time was What time was

infant last seen & infant last seen & by whomby whom

– How was infant How was infant that daythat day

– Last feedingLast feeding

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Environmental Environmental AssessmentAssessment

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

area infant foundarea infant found– Unusual conditionsUnusual conditions

High room temperatureHigh room temperature OdorsOdors Anything out of Anything out of

ordinaryordinary

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Anticipated Parental Anticipated Parental ResponsesResponses 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 May or may not accept infants

deathdeath

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Expected Requests From Expected Requests From ParentsParents

Repetitive questionsRepetitive questions Request to not initiate careRequest to not initiate care Request to be alone with Request to be alone with

infantinfant Request to terminate Request to terminate

resuscitation effortsresuscitation efforts Requests for cause of deathRequests for cause of death

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If Parents Interfere With If Parents Interfere With CareCare Show empathyShow empathy Do not become angered or Do not become angered or

argumentativeargumentative Avoid restraining parentAvoid restraining parent Be professional - put Be professional - put

yourself in their shoesyourself in their shoes

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Emergency Personnel Emergency Personnel ResponsesResponses Withdrawal, Withdrawal,

avoidance of avoidance of parentsparents

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

blame someoneblame someone Identification with Identification with

parentsparents Sadness & Sadness &

depressiondepression

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Emergency Responder Emergency Responder Expectations of Parent’s Expectations of Parent’s BehaviorBehavior Hysterical & tearful responsesHysterical & tearful responses Disbelief that not every Disbelief that not every

parents will initiate CPRparents will initiate CPR Disbelief/unable to accept Disbelief/unable to accept

parents decision to not have parents decision to not have CPR startedCPR started

Cultural differences in Cultural differences in mourning and grieving processmourning and grieving process

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

Stress is an Stress is an integral part integral part

of the of the profession profession

of of Emergency Emergency

ServicesServices

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Signs & Symptoms of Signs & Symptoms of CISCIS Anger/irritabilityAnger/irritability Physical illnessPhysical illness DepressionDepression Recurring Recurring

dreamsdreams Intrusive imagesIntrusive images Changes in sleep Changes in sleep

patternspatterns Mood Mood

changes/swingschanges/swings

WithdrawalWithdrawal Changes in eating Changes in eating

habitshabits Inability to Inability to

concentrateconcentrate Restlessness/Restlessness/

agitationagitation Loss of emotional Loss of emotional

controlcontrol Increased alcohol Increased alcohol

consumptionconsumption

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Strategies for Decreasing Strategies for Decreasing Impact of CISImpact 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 Obtain personal or religious

counselingcounseling Request dispatch tape reviewsRequest dispatch tape reviews Request assistance from you local Request assistance from you local

CISM team, post incidentCISM team, post incident

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SIDS ResourcesSIDS ResourcesNational SIDS Resource Center

(703) 821-8955SIDS Alliance (800) 221-SIDS

WWW.sidsalliance.orgNational Institute of Child Health &

DevelopmentWWW.nih.gov/nichd/

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ReferencesReferences California Fire Chiefs Association, Emergency Medical Section, California Fire Chiefs Association, Emergency Medical Section,

“Sudden Infant Death Syndrome Instructor Instructor Guide”April “Sudden Infant Death Syndrome Instructor Instructor Guide”April 1991.1991.

Department of Health, Education & Welfare, Public Health Service Department of Health, Education & Welfare, Public Health Service Administration, Bureau of Community Health Services “Training Administration, Bureau of Community Health Services “Training Emergency Responders: SIDS An Instructor Manual, DEW Emergency Responders: SIDS An Instructor Manual, DEW Publications No (HAS) 79-5253, 1979Publications No (HAS) 79-5253, 1979

State of California EMS Authority, “SIDS Training Packet For State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990Emergency Medical 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 Colorado SIDS Program, “Commonly Asked Questions About SIDS: A

Doctor’s Response” J Bruce Beckwith M.D. 19983Doctor’s Response” J Bruce Beckwith M.D. 19983 National SIDS Resource Center, “Information Sheet: What is SIDS, National SIDS Resource Center, “Information Sheet: What is SIDS,

May 1993May 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 National SIDS Clearing House, “Fact Sheet: SIDS Information The

EMT”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 From The National Health Institute< ‘Chronic Fetal Hypoxia

Predispose Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. Predispose Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. 21.21.

Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Syndrome” Pediatric review, Vol.. 14, No. 3., March 1993Syndrome” Pediatric review, Vol.. 14, No. 3., March 1993

Jackson, & Community Midwifery, United Leeds Teaching Hospital Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 1” Definitions & Classification of SIDS”, Midwifery Trust 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 Jackson, & Community Midwifery, United Leeds Teaching

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

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

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

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

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

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

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SUMMARYSUMMARYQuestions?Questions?