The Sudden Unexplained Child Death Act, signed into law in May 2001 and amended in April 2002, states that all first responders must receive training on handling cases of sudden, unexplained infant death as part of their basic and continuing training requirements (Tenn. Code Ann. §68-1-1102, 2002). The law mandates that the Tennessee Departments of Health and Children’s Services develop the program, with the cooperation and expertise of the state Medical Examiner’s office.

The welfare of Tennessee’s children is important to all of us, and the death of even one child is a tragedy. By developing a more uniform approach to infant death investigation, we can more accurately determine the cause, manner, and circumstances of sudden unexpected infant deaths. Prevention Through Understanding will provide emergency medical technicians, firefighters, and law enforcement the information they need to respond appropriately and respectfully to one of the most professionally and personally challenging situations faced in death scene investigation.

Development of the Program

The program was developed and coordinated by the Department of Continuing Studies and Public Service, the Center for Health and Human Services, and the College of Education and Behavioral Science at Middle Tennessee State University. An advisory group provided invaluable assistance in making this program possible.

Purpose & Overview

The purpose of this program is to help reduce the incidence of injury and death to infants by accurately identifying the cause and manner of death of infants under one (1) year of age. This will be accomplished by requiring that a death investigation be performed in all cases of sudden, unexpected infant death. According to the law, all emergency medical technicians (EMTs) and professional firefighters shall receive training on the handling of cases of sudden, unexplained child death – including being sensitive to the grief of family members – as part of their basic and continuing training requirements. In addition, the chief medical examiner for Tennessee shall develop and implement a program for training child death pathologists. For every sudden, unexplained death of an infant under one year old, the attending physician or coroner shall notify the county medical examiner who will coordinate the death investigation. The county medical examiner shall also contact local law enforcement personnel to conduct the death scene investigation, according to the protocol developed by the chief medical examiner (see generally Tenn. Code § 68-1-1102, and supp. 2002). The chief medical examiner’s protocol is presented through this in-service program.

Like any other emergency situation, it is important to prepare for responding to a sudden infant death scene. This preparation should include an evaluation component to guide future performance. For example, if the infant death is due to Sudden Infant Death Syndrome (SIDS), it is important that first responders handle those tragedies with great care, giving families and care providers the empathy and support they deserve. Conversely, despite the presence of grieving parents and the lack of visual trauma, occasionally an infant's death can be the result of a criminal act or negligence. First responders have the difficult task of balancing the need for a thorough investigation with the concerns of the family and others involved in the event by recognizing that only a complete autopsy, medical history, and review of the death scene can determine the cause of a questionable infant death.

Prevention Through Understanding: Investigating Unexpected Infant Death provides an educational video presentation as well as written information for trainers and trainees. The program manual includes:

• Program objectives
• Suggested program format
• Materials needed for presenting the program
• A section focused on teaching the program
• A post-test questionnaire
• In-service evaluation form and participant tracking form
• Appendices and References

Objectives of the In-service Program

Upon completion of this program, the participant should be able to:

1. Discuss the Tennessee law requiring: (a) an investigation of all sudden unexplained infant deaths in the state, and (b) training of current and future EMT, firefighter, and police personnel.
     
2. Define Sudden Infant Death Syndrome or SIDS and be able to describe what SIDS is and what SIDS is not.
     
3. Identify specific risk factors for Sudden Infant Death.
     
4. Describe the role of EMTs, firefighters, and law enforcement personnel as witnesses and investigators at a scene and describe how to respond appropriately and obtain information as required by the state Medical Examiner.
     
5. Identify the critical surroundings and environment when responding to a scene.
     
6. Demonstrate sensitivity and a nonjudgmental approach to family members and care givers.
     
7. Describe the role of the Child Protective Services (CPS) and their investigations relating to abuse and neglect.
     
8. Describe the importance of the Child Fatality Review (CFR) Team.
     
9. Identify resources for grieving families and care providers, and support for professionals.