Developed by
Florida Association of EMS Educators in cooperation with the
Florida SIDS Alliance
FAEMSE 1

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)
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 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
FAEMSE
 Floyd Livingston MD

Pediatric Pulmonologist, Nemours Children’s
Clinic, Orlando, Florida
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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
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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
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 Identify potential responses of emergency responders to an infant death
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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
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FAEMSE
 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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 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.
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 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
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 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
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 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
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 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
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 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
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 Pulmonary congestion & edema
 Intrathoracic petechiae
90% of time
 Stomach contents in trachea
 Microscopic inflammation in trachea
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 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
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 Initiate resuscitation per
EMS System
Practice
Parameters &
Protocols
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 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
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 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
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 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
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 Observe for
 Location of infant
 Presence of objects in area infant found
 Unusual conditions
 High room temperature
 Odors
 Anything out of ordinary
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 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
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 Repetitive questions
 Request to not initiate care
 Request to be alone with infant
 Request to terminate resuscitation efforts
 Requests for cause of death
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 Show empathy
 Do not become angered or argumentative
 Avoid restraining parent
 Be professional - put yourself in their shoes
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 Withdrawal, avoidance of parents
 Self-doubt
 Anger - wanting to blame someone
 Identification with parents
 Sadness & depression
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Emergency Responder
Expectations of Parents Behavior
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 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
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 Anger/irritability
 Physical illness
 Depression
 Withdrawal
 Changes in eating habits
 Inability to concentrate
 Recurring dreams  Restlessness/agitation
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Intrusive images
Changes in sleep patterns
Mood changes/swings
 Loss of emotional control
 Increased alcohol consumption
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 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
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 Request assistance from you local CISM team, post incident
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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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
California Fire Chiefs Association, Emergency Medical Section, “Sudden
Infant Death Syndrome Instructor Instructor Guide”April 1991.
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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
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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
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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
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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”
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