Initial Steps

Pediatric calls can be some of the toughest cases for EMS providers and first responders. For most EMS providers, pediatric emergencies are uncommon and can often cause considerable stress for everyone involved.  Occasionally, first responders will be called for one of the worst-case situations; an infant who is not breathing. As medical providers, it is part of the culture to want to protect children from harm and save lives, so when a Sudden Unexpected Infant Death (SUID) case presents itself, it can be difficult to understand and cope with the situation. 

It is important to recognize the role that first responders play in the care of a SUID case. They hold responsibility for providing needed medical care, assessing and documenting the scene, and offering support to the family. Each aspect plays an important role in the care of the infant. 

Medical Care

When a child presents with a potential life-threat, such as apnea, they should be treated aggressively based on local treatment protocols and transported rapidly. If there are any potential complications with ABCs, it should be ensured that ALS has been dispatched. 

Depending on when the child was last seen normal, it is possible to find signs of obvious death. If rigor mortis, dependent lividity, or other obvious signs are determined, it is possible for the responding providers to withhold resuscitation efforts, as these signs appear at least three hours after the child has died. If no obvious signs of death are found, or it is unclear if any of these signs are present, resuscitative efforts should be initiated. 

Assessing and Documenting the Scene

Since EMS is typically one of the first responders on scene, it is crucial to document the scene and any findings. This becomes critical for the future investigations that will occur to determine if there was a specific cause of death for the infant. 

Important things to ask include open-ended questions regarding how and when the baby was found. Ask questions about current and previous illnesses or recent changes in behavior. Find out the family or caregiver's story about what happened and what they did when they found the child to gain a clearer picture of the circumstances. 

Additionally, EMS personnel are mandated reporters of child abuse in every state in the US. If there are indications of potential abuse, such as broken bones, facial trauma (like a black eye), signs of malnourishment, or welts, first responders should maintain a high index of suspicion for abuse and report it properly. 

Family Support

The loss of a child is a devastating event for families. There is often a strong reliance on EMS and first responders for support, as they are often the first people that may have answers or a sense of what is happening.  As with any pediatric call, the family itself can quickly become a secondary patient that needs care and attention, as there are many different responses to emotional shock and stress. It is important to stay calm, and it is alright if you do not have answers. 

Some families may insist that resuscitative efforts be initiated, and it is important to find a balance between complying with this request and maintaining a scene for law enforcement investigations.  If there are obvious signs of death, it is important to compassionately let the family know that the child is beyond resuscitative efforts.

If resuscitative efforts are initiated, it is possible to let the family know that you will provide the best care for the child that you can and that their child will be brought to hospital.  Keep the family informed about what is happening, especially if there any delays in providing care. A true SIDS case, which is a type of SUID case that has no known cause of death after a full medical examination, is unpredictable and is not the fault of the family or caregiver. 

Families will present with many different reactions to finding a child who is not breathing or pulseless. Some may be angry, or overwhelmed with sadness. Some may want emotional and physical support, while others want to be left alone. Encourage the family to reach out to their support network of family, friends, and religious leaders, and encourage families in Massachusetts to reach out to The Massachusetts Center for Unexpected Infant and Child Death at directly or to expect contact from the Center if the infant dies.

It is important to note that SUID cases have very low rates of survival. However, it is difficult to make that kind of call any easier to process. As a provider, it is normal to experience symptoms of grief and stress, as it is never easy to lose a patient, no matter how young or old.  It is important to make sure that your emotions are properly addressed. Make sure to reach out to your support network of family, friends, and coworkers to help express your feelings. A SUID call is always a tough call. If your service offers Crisis Incident Stress Management, and it works well for you, reach out for additional support to help process the case. 

Recovery for EMS and First Responders

For additional information, Journal of Emergency Medical Services (JEMS) has an article on SIDS that can be accessed here