SUDDEN INFANT DEATH SYNDROME (SIDS)Presented byJackie Yates-Feller, NREMT-P, PI

ObjectivesUpon completion of this presentation, the student will be able to: Define SIDSDescribe the general population characteristics of a probable SIDS infantDescribe the common physical characteristics of a probable SIDS infant

ObjectivesDescribe the typical scenario of a probable SIDS Identify important actions which should be initiated by an emergency responderIdentify potential responses of parents to an infant deathIdentify potential responses of emergency responders to an infant death

ObjectivesIdentify 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

Definition - SIDSthe 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

SIDS StatisticsClassified as a disorderLeading cause of death in infants 1 month to 1 year old95% occur between 1 & 6 months of age - peak period between 2 & 4 months3,000 SIDS deaths per year in the U.S.

SIDS - What It IsMajor cause of death in infants after 1st month of lifeSudden & silent in an apparently healthy infantUnpredictable & unpreventableQuick death with no signs of suffering - usually during sleep

SIDS - What It Is NotCaused by vomiting or chokingCaused by external suffocation or overlayingContagious or HereditaryChild abuseCaused by lack of loveCaused by immunizationsCaused by allergy to cows milk

General Characteristics of SIDSUsually occurs in colder monthsMothers younger than 20 years oldBabies of smoking mothers or mothers exposed to second hand smoke60% male Vs 40% femalePremature or low birth weightUpper respiratory infections, 60% in prior weeksOccurs quickly and quietly during a period of presumed sleep

SIDS ResearchEvidence shows victims not as normal as they seemMaybe subtle but, undetectable, defects present at birthAreas presently under researchBrain abnormalitiesSleep positionMultiple, non-life threatening abnormalities

Medical Findings Consistent With SIDSDifferences seen in external appearance versus internal appearance seen on autopsy.

External AppearanceNormal state of hydration & nutritionSmall amount of frothy fluid in or about mouth & noseVomitus presentPostmortem lividity &/or rigorsLivormortis Disfiguration/Unusual position - dependant blood pooling/pressure marks

Internal Appearances On AutopsyPulmonary congestion & edemaIntrathoracic petechiae 90% of timeStomach contents in tracheaMicroscopic inflammation in trachea

Typical SIDS Infant ScenarioAlmost always occurs during sleep or appearance of sleepUsually healthy prior to deathMay have had a cold or recent physical stressMay have been place down for nap, found not breathing or appearing deadParents not hearing signs of struggle

Emergency Responder ActivityInitiate resuscitation per department procedures and guidelines

Emergency Responder Activity Cont.Support of ParentsUse calm directive voiceBe clear in instructionsProvide explanations about Tx & transportReassure that there was nothing that they could have doneDo not be afraid of tears & angerAllow parents to accompany infant to hospital if situation permits

Emergency Responder Activity Cont.Obtain HxIllicit medical historyListen to the parentsDo not ask judgmental or leading questionsUse open-ended & non-leading questionsHad infant been sick

What happened Who found the infant & where What did (s)he doHad the infant been movedWhat time was infant last seen & by whomHow was infant that dayLast feeding

Environmental AssessmentObserve forLocation of infantPresence of objects in area infant foundUnusual conditionsHigh room temperatureOdorsAnything out of ordinary

Anticipated Parental ResponsesNormal responses may include:Denial, shock and disbeliefAnger, rage and hostilityHysteria or withdrawalIntense guiltFear, helplessness and confusionNo visible responseMay or may not accept infants death

Expected Requests From ParentsRepetitive questionsRequest to not initiate careRequest to be alone with infantRequest to terminate resuscitation effortsRequests for cause of death

If Parents Interfere With CareShow empathyDo not become angered or argumentativeAvoid restraining parentBe professional - put yourself in their shoes

Emergency Personnel ResponsesWithdrawal, avoidance of parentsSelf-doubtAnger - wanting to blame someoneIdentification with parentsSadness & depression

Emergency Responder Expectations of Parents BehaviorHysterical & tearful responsesDisbelief that not every parents will initiate CPRDisbelief/unable to accept parents decision to not have CPR startedCultural differences in mourning and grieving process

Critical Incident Stress (CIS) ManagementStress is an integral part of the profession of Emergency Services

Signs & Symptoms of CISAnger/irritabilityPhysical illnessDepressionRecurring dreamsIntrusive imagesChanges in sleep patterns Mood changes/swingsWithdrawalChanges in eating habitsInability to concentrateRestlessness/agitationLoss of emotional controlIncreased alcohol consumption

Strategies for Decreasing Impact of CISTalk to your peers/ share your feelingsExercise and balanced dietAvoid OT & plan leisure timeWrite a personal journalObtain personal or religious counselingRequest dispatch tape reviewsRequest assistance from you local CISM team, post incident

SIDS ResourcesNational SIDS Resource Center (703) 821-8955SIDS Alliance (800) 221-SIDS WWW.sidsalliance.orgNational Institute of Child Health & DevelopmentWWW.nih.gov/nichd/

ReferencesCalifornia Fire Chiefs Association, Emergency Medical Section, Sudden Infant Death Syndrome Instructor Instructor GuideApril 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, 1979State of California EMS Authority, SIDS Training Packet For Emergency Medical Responders and Firefighters, September 1990American SIDS Institute, SIDS: Toward an UnderstandingColorado SIDS Program, Commonly Asked Questions About SIDS: A Doctors Response J Bruce Beckwith M.D. 19983 National SIDS Resource Center, Information Sheet: What is SIDS, May 1993Center for Pediatric Emergency Medicine, TRIPP 1998, Version 2

References Cont.National SIDS Clearing House, Fact Sheet: SIDS Information The EMTDavid Lawrence, SIDS Handle With Care JEMS, December 1988Seasonality in SIDS-U.S. 1980-1987, MMWR, December 14, 1990, Vol..39., No. 49From 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 1993Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 1 Definitions & Classification of SIDS, Midwifery Chronicles & Nursing Notes, August 1992

References Cont.Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 2 Definitions & Classification of SIDS, Midwifery Chronicles & Nursing Notes, August 1992Florida Emergency Medicine Foundation & California EMS Authority, Pediatric Education for Paramedics 1997American SIDS Institute, Coping With Infant Loss, Grief and Bereavement, June 1994American SIDS Institute, Helping A Friend Cope With Infant Loss, Grief and Bereavement, June 1994Parrott, Carol, Parents Grief Help & Understanding After The Death of a Baby, Medic Publishing Company, 1992Klobadans, David, First Responders and EMS Personnel - SIDS Training Outline

SUMMARYQuestions?

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