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EMS: Courage and Compassion in Action: Coping with the UnthinkableBy Shawn Godfrey - October 29, 2007
 | | Shawn Godfrey |
As emergency medical technicians, we are often the first on the scene following the discovery of a lifeless infant. There is no amount of training or experience that can prepare us for the emotional distress of the family, or the personal feelings that may affect us as caregivers.
Speaking for all emergency medical providers, I can safely say a scenario like this can trump our worst nightmare, often making us burn from the inside out. In most cases, critical incident stress debriefing, whether an emergency provider wants to admit or not, is necessary and beneficial.
Responding to a SIDS (Sudden Infant Death syndrome) call is especially difficult and emotionally wrenching, and presents both professional and personal challenges for the EMT.
While working to hopefully revive the infant, the EMT may be responsible for consoling the parent, guardian or other caregiver, as well as assessing and recording information about the scene. Moreover, infants — especially seemingly healthy infants — are not supposed to die. It is not surprising that local officials and the community pay much more attention to the death of a baby than incidents involving adult fatalities.
What is Sudden Infant Death syndrome?
It was once believed that death was caused by suffocation as the infant slept, however, we now know that suffocation is not the cause. According to the National SIDS Resource Center, SIDS is "the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history."
What Are the Most Common Characteristics of SIDS?
Most researchers now believe that infants who die of SIDS are born with one or more conditions that make them especially vulnerable to stresses that occur in the normal life of an infant, including both organic and environmental influences.
It is very important that all those touched by a SIDS death understand that SIDS has no specific symptoms, that SIDS occurs in the best of families and to the most capable, careful and loving parents. Even if the baby had recently shown symptoms of a cold and had been taken to a doctor, there were no signs leading anyone to suspect that the baby would die. No one can tell ahead of time whether a baby will die of SIDS; and no one can stop SIDS from happening.
SIDS occurs in all types of families and is largely indifferent to race or socioeconomic level. SIDS is unexpected, usually occurring in otherwise apparently healthy infants from 1 month to 1 year of age. Most deaths from SIDS occur by the end of the sixth month, with the greatest number taking place between 2 and 4 months of age.
A SIDS death occurs quickly and is often associated with sleep, with no apparent signs of suffering. More deaths are reported in the fall and winter (in both the Northern and Southern Hemispheres) and there is a 60- to 40-percent male-to-female ratio. A death is diagnosed as SIDS only after all other alternatives have been eliminated; therefore, it is a diagnosis of exclusion.
What Are Risk Factors for SIDS?
Risk factors are those environmental and behavioral influences that can provoke ill health. Any risk factor may be a clue to finding the cause of a disease, but risk factors in and of themselves are not causes.
Researchers now know that the mother's health and behavior during her pregnancy and the baby's health before birth seem to influence the occurrence of SIDS, but these variables are not reliable in predicting how, when, why, or if SIDS will subsequently occur.
Maternal risk factors include cigarette smoking during pregnancy; maternal age less than 20 years; poor prenatal care; low weight gain; anemia; use of illegal drugs; and history of sexually transmitted disease or urinary tract infection. These factors, which often may be subtle and undetected, suggest that SIDS is somehow associated with a harmful prenatal environment.
How Many Infants Die From SIDS?
From year to year, the number of SIDS deaths tends to remain constant despite fluctuations in the overall number of infant deaths. The National Center for Health Statistics (NCHS) reported that, in 1988 in the United States, 5,476 infants under 1 year of age died from SIDS; in 1989, the number of SIDS deaths was 5,634 (NCHS, 1990, 1992). However, other sources estimate that the number of SIDS deaths in this country each year may actually be closer to 7,000. The larger estimate represents additional cases that are unreported or underreported (i.e., cases that should have been reported as SIDS but were not).
When considering the overall number of live births each year, SIDS remains the leading cause of death in the United States among infants between 1 month and 1 year of age and second only to congenital anomalies as the leading overall cause of death for all infants less than 1 year of age.
How Do Professionals Diagnose SIDS?
Often the cause of an infant death can be determined only through a process of collecting information, conducting sometimes complex forensic tests and procedures, and talking with parents and physicians. When a death is sudden and unexplained, investigators, including medical examiners and coroners, use the special expertise of forensic medicine (application of medical knowledge to legal issues). SIDS is no exception.
Health professionals make use of three avenues of investigation in determining a SIDS death:
1. The autopsy,
2. Death scene investigation; and,
3. Review of victim and family case history.
Autopsy
The autopsy provides anatomical evidence through microscopic testing of tissue samples and vital organs. An autopsy is important because SIDS is a diagnosis of exclusion. A definitive diagnosis cannot be made without a thorough postmortem examination that fails to point to any other possible cause of death. Also, if a cause of SIDS is ever to be uncovered, scientists will most likely detect that cause through evidence gathered from a thorough pathological examination.
Death Scene Investigation
A thorough death scene investigation involves interviewing the parents, other caregivers and family members; collecting items from the death scene and evaluating that information. Although painful for the family, a detailed scene investigation may shed light on the cause, sometimes revealing a recognizable and possibly preventable cause of death.
Review of the Victim and Family Case History
A comprehensive history of the infant and family is especially critical to determine a SIDS death. Often, a careful review of documented and anecdotal information about the victim's or family's history of previous illnesses, accidents, or behaviors may further corroborate what is detected in the medical treatment, autopsy, or death scene investigation.
Although well intentioned, emergency providers and investigators understand that the family may view this process as an intrusion, even a violation of their grief. It should be noted that, although stressful, a careful investigation and assessment that reveals no preventable cause of death may actually be a means of giving solace to a grieving family.
What SIDS Is and What SIDS Is Not
SIDS Is:
●The major cause of death in infants from 1 month to 1 year of age, with most deaths occurring between 2 and 4 months.
●Sudden and silent - the infant was seemingly healthy.
●Currently, unpredictable and unpreventable.
●A death that occurs quickly, often associated with sleep and with no signs of suffering.
●Determined only after an autopsy, an examination of the death scene, and a review of the clinical history.
●Designated as a diagnosis of exclusion
●Recognized medical disorder listed in the International Classification of Diseases, 9th Revision (ICD-9).
●An infant death that leaves unanswered questions, causing intense grief for parents and families.
SIDS Is Not:
●Caused by vomiting and choking, or minor illnesses such as colds or infections.
●Caused by the diphtheria, pertussis, tetanus (DPT) vaccines, or other immunizations.
●Contagious.
●Child abuse.
●The cause of every unexpected infant death.
Confronting Mortality
No matter what your profession, any sudden, unexpected death threatens one's sense of safety and security. As emergency providers we are likely to confront our own mortality every time the call alarm sounds.
This is particularly true in a sudden infant death. Quite simply, babies are not supposed to die. Because the death of an infant is a disruption of the natural order, it is traumatic for parents, family, friends, and, believe it or not, paramedics. The lack of a discernible cause, the suddenness of the tragedy, and the involvement of the legal system make a SIDS death especially difficult, leaving a great sense of loss and a need for understanding.
Handling Grief as an Emergency Provider
There is no doubt that a sudden and unexpected infant death is especially tragic. Although experienced in dealing with death resulting from illness, accidents, or even homicide, we are often surprised at the depth of our feelings regarding an infant’s death.
Even "veteran" emergency providers report reacting emotionally to an infant death. It is not unusual to feel symptoms of grief and guilt similar to those of the parents/caregivers. Some emergency providers express regret and frustration at being unable to revive the baby.
Other common reactions include anger, blame, self-doubt, sadness, and depression.
It is often helpful to discuss the circumstances surrounding the death in a critical incident stress debriefing or support group. These debriefing sessions usually are conducted within 24 to 72 hours after the death, and consist of an open forum discussion between all emergency workers involved with the death. Many EMS agencies have found that debriefing sessions help confirm that the emergency provider(s) did everything that he or she could have done.
SIDS: A Mother's Story
By Deborah Mihalko
"SIDS: A Mother’s Story" was published in the fall 1996 edition of The Gold Cross, the magazine of the New Jersey State First Aid Council, as the follow-up article to the cover story, "SIDS: The Anonymous Killer" written by John Zasowski, MS, MICP, a paramedic at Hackensack University Medical Center.
Mihalko's story appears on SIDS-Network.org, with the request it be shared with first responders to give them a parent's perspective on SIDS.
On September 15, 1989, all my dreams became reality with the birth of my daughter, Margaret Joy. Our little girl had finally arrivedafter a very difficult pregnancy and delivery. Meg was a very content and happy baby. Her brothers Jay, 10, and Jon, 5,loved their new roles as big brothers. They played with their newsister, and even took turns changing her diapers. Life in our household seemed charmed.
About a month later, I nursed Meg around midnight and put her in the same crib that both her brothers had slept in. At 6:30 a.m., I woke as I heard my husband Chuck getting ready to go to work. I became concerned when I realized that Meg had slept through her usual 2 a.m. feeding. My husband, certain that his little girl had just slept through the night for the first time, went to get our baby.
Chuck suddenly yelled: "Quick! Call 911! She's not breathing!" Hethen began CPR.
I dialed the numbers 911. I heard myself say: "My baby is not breathing." The local EMS unit responded within minutes and the paramedics were close behind. A paramedic grabbed Meg and ran with her to the ambulance. I was relieved; everything that could be done was being done.
A neighbor drove Chuck to the hospital. I couldn't leave as our sons were still asleep. I was thankful that a few of the responders had remained behind to assist me in any way possible. One woman asked if there was anything she could do to help. I asked her to put her arms around me and hold me. She cried with me. Her embrace gave me the strength to continue what I had to do. I will always remember her kindness.
I made arrangements for a friend to care for my boys and I began the longest, saddest journey of my life. When I arrived at the emergency room, it seemed unusually quiet. Across the room I saw a young doctor. To me he appeared very small, maybe because he was diminished with his own grief. He had tears in his eyes as he struggled to find the words to tell me what happened. In my heart I knew our precious Meg was dead.
"You don't have to tell me," I said. "I already know. Please take me to her."
On a very large table lay my sweet little girl. She seemed so small, so lost and all alone in that cold, silent place. I picked her up and sang to her. With all my heart I wished for her to cry out or draw a breath, all the time knowing that I would never again share in what so many parents take for granted.
Months later we received a request from our local emergency medical service group to share our experience, and more important, meet with those who had responded to our call. We were deeply honored by the request since we wanted to personally thank everyone who had fought for the life of our precious little girl. The meeting gave us the opportunity to embrace and cry with those whose lives had touched ours at a time when we needed them most. They had handled the situation in a non-judgmental, loving manner which set the tone for our recovery. Their support set us on a positive road to reaching the grief destination of "resolution" finding a way to incorporate the event in life and moving on. This does not mean forgetting but remembering with love.
I have told Meg’s story hundreds of times in many different settings, but this is the first time I have put it into words on paper. I was unprepared for the emotional impact this process would have, even seven years later. Since you allowed me to share Meg's story, you, too, hold a special piece of her in your heart. You will carry her with you if you are ever called upon to respond to an infant death.
If there is such a thing as a positive scenario to such a tragedy, my family had one. The emergency personnel who responded to our call were kind and caring. They strived to attend to the needs of the entire family, and we are grateful to each and every one. This gratitude extends to all emergency responders who dedicate themselves to serving others in their time of greatest need. From the bottom of my heart and the depth of my soul, thank you for all you do, and all the lives you have touched.
Sources: The National SIDS/Infant Death Resource Center, www.sidscenter.org
"SIDS: A Mother's Story," SIDS Network Inc.; www.SIDS-Network.org |
| The story at the end is heartwrenching. The parents are true heroes to want to help others. | | from: Alex | on: 11-02-2007 |
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| Shawn as an EMS provider these types of critical pediatric calls can be very stressfull because of a lot of issues my arise. Thank god for Critical Stress Debriefing if we do encounter these types of calls. I have a 5 y/o child and these calls just make the hair on my neck stand straight up. Great article for this week and keep up the writing.. til next week | | from: Beaker | on: 10-31-2007 |
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| Compelling. Thanks for all the information you provide us on a weekly basis. These are certainly topics we take for granted. | | from: Peter Sclerise | on: 10-30-2007 |
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| Looking forward to next week. This one was tough to get through. | | from: Jorge | on: 10-29-2007 |
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| Sad, but good article. It must be frustrating to have a child pass and not know why. I couldn't imagine it. | | from: Stephan | on: 10-29-2007 |
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| Your story this week touched me deeply. As a mother, the fear of SIDS was always in the back of mind. I can remember many nights checking on my little daughter to make sure the reason she was quiet was because she was sleeping soundly. I cannot imagine the grief and pain felt by those who lose their child to something they can't explain or understsand. I sometimes don't appreciate the scope of the things you have seen in your profession, Shawn. I can say I do not envy you, but appreciate the dedication and compassion of those in your field. ;) | | from: wendy | on: 10-29-2007 |
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