If you receive an emergency call
(may happen in remote and rural areas and where you are having frequent contact with a family)

1. Call the ambulance and proceed immediately to the scene.

At the scene

1. Attempt resuscitation following UK paediatirc resuscitation guidelines and continue en route to hospital.
   1. If resuscitation is inappropriate and there is evidence of criminality leave the infant as found and contact the police immediately.
2. If it is clear that the infant cannot be resuscitated Inform the parents sympathetically and await the arrival of ambulance or police.
3. The infant should be taken to the nearest paediatric Emergency Department. In all cases if available (or nearest general Emergency Department) not straight to the mortuary. This allows an immediate examination to be carried out and provides a more supportive environment for the family.
4. If the infant is a twin suggest that the surviving twin should be admitted to hospital for observation.
5. Take a brief immediate history from the parent(s)/ carer(s) »
   Record the circumstances of the death (e.g. position when found, bedding etc. Your notes will be very helpful to the paediatrician who will record information to pass onto the police. NB It is not necessary for you to directly ask these questions but it may help if you note observations.
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   1. In the event of you being the healthcare professional taking charge in a remote and rural setting you are responsible for working collaboratively with the police.
      1. It should be explained that information will be shared between healthcare staff, the paediatric pathologist and police.
6. Explain the role of the designated SUDI paediatrician. And that the SUDI paediatrician (or general paediatrician) will see the infant and parents in the Emergency Department.)
7. Spend time listening to the parents. Mention the infant by name and don’t be afraid to express your sorrow.
8. Accompany the family to the hospital.

At the Emergency Department

1. Remember that all sudden and unexpected deaths will require police notification. Reassure that this and the subsequent investigation is normal practice.
2. The parents may wish you to contact relatives or friends. You may also be asked to arrange for someone to meet them at the hospital.
3. Inform the GP and your line manager of the infant’s death. If out of hours leave a message and follow up the following morning.

If you find out later that an infant has died

1. You may be informed by the maternity unit or GP that an infant has died. You may be contacted either the same day or next day if the infant died during the night.
   1. Emergency Departments may call the out of hours GP service you will then be notified the following morning.
2. Provide background information about the infant and the mother/ father or carer. »
   There has been agreement from the General Medical Council that due to the investigations that require to be carried out by the police on behalf of the procurator fiscal, information should be shared between agencies. It is recognised that duplication of questioning of parents through lack of information sharing, would add to their upset. The wide variety of questions enables a full history to be taken as quickly as possible, to try and find any information which may help identify why the infant died.
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   1. It may be that you are contacted at several stages of the process to share relevant information.

Parent support

1. Liaise with other members of the practice, especially the GP and health visitor (if involved) to support the family and each other.
2. Visit the day the death occurs, or as soon as possible afterwards (with the GP if preferable with family and GP) to acknowledge the death and offer condolences. If the parents are out, leave a note and try again soon.
3. Spend time listening to the parents. Make sure you use the infant's name throughout conversation.
   1. Try to help the parents face their grief together and to ensure that neither is left alone for long.
   2. Ask the parents about the reactions of siblings; tell them how they can get advice if they need it.
   3. Support the parents emotionally and ask if the procedures following a SUDI have been explained.
      1. Answer any further questions the parents may have, especially the role of the Procurator Fiscal, police and post-mortem examination.
      2. Inform parents that the Child Health Record (Red Book) will be required by the police to provide background information on the infant's general health.
4. Ask whether they wish to see the infant again before the post mortem and find out how this can be arranged. Ensure that the parents know where their infant has been taken and by whom.
5. Check whether spiritual help has been offered and if required arrange appropriate contacts.
6. If mother is breast feeding discuss methods of suppression of lactation.
7. Ask if the parents would like to be put in touch with any support organisations.

Further parent support

1. Liase with other members of the practice, especially the GP or health visitor to support the family and staff.
2. Spend time listening to parents whenever they wish to talk.
   1. Tell them they are welcome to contact you at any time.
3. Discuss funeral arrangements.
   1. Mention that some funeral directors make no charge. Mention that it may be possible to claim a Funeral Payment. Advise that the child benefit book will need to be returned.
   2. Offer to attend the funeral (if you can).
4. Assess whether the parents need more help with their grief (remembering that people grieve in different ways). Discuss with GP if you have any concerns.

Communication with other professionals

1. Liaise with the GP and enquire whether the SUDI paediatrician has been involved. Make contact with them and offer to assist by providing any information they may require.
   1. Contact the obstetrician or neonatologist (if involved) to inform them of the SUDI if infant is less than 28 days old.
2. The police will request case notes for the infant. The police will require the original notes, so make copies of all to keep locally until the originals are returned. »
   These notes will be requested within a day or two of the infant’s death to allow completion of the police Sudden Death Report to be submitted to the Procurator Fiscal, and also to provide the paediatric pathologist carrying out the post-mortem examination to have as much information as possible.
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3. Inform other departments so no further computer generated appointments for immunisation or developmental checks are sent out. Also inform the hospital medical records department to ensure no clinic appointments are sent.
   
   1. Inform parents of the Baby MPS (Mailing Preference Service) online. A free site where parents can register online to stop or at least reduce baby-related mailings of samples, offers advertisements etc. www.mpsonline.org.uk/bmpsr/

After the post-mortem examination

1. In liaison with the GP visit the family as frequently as seems appropriate to offer support, answer questions and to check on the welfare of other siblings. Leave enough time for the contact to be meaningful.
2. The SUDI Review is a multi-disciplinary case discussion. »
   The meeting is held shortly after the final post-mortem examination report is available, which may be several months after the infant has died. The other main participants are the paediatrician, GP (perhaps obstetrician and neonatologist if the infant was less than 28 days old) and pathologist who did the post-mortem examination. The primary care team are essential participants and their input is invaluable. The meeting will be held at a suitably convenient time for all involved. The purpose is to discuss all aspects of the death, including possible causes or contributing factors to see what lessons can be learnt and to plan support for the family, in particular who will support the familyfor any future pregnancy.
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   1. The SUDI Review meeting will not take place if there is any suspicion of criminality or if a Significant Case Review has to take place through child protection.

Support during the next pregnancy

1. Acknowledge the previous death using the baby's name.
2. Aim for continuity of care and involvement in the choices available e.g. community care if appropriate.
3. Note anniversaries when the parents may need additional support.
4. Discuss with the health board SUDI paediatrician plans about extra support for the care of the next infant, such as provision of an apnoea monitor.
5. Whenever appropriate discuss risk factors such as sleep position and smoking.
6. In some areas a community midwife may co-ordinate the plan for additional support that a family may require for future pregnancies, »
   working with a paediatrician to ensure that additional ante-natal clinic appointments are offered and that any additional screening is offered if appropriate. The loan of an apnoea monitor may be arranged through the community midwife.
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Staff support

1. It may be of benefit to any staff involved from the primary care team to have a team debrief soon after the SUDI has occurred, especially if staff responded to an emergency call and were involved in attempted resuscitation. It may also be useful to debrief again after key points like the SUDI review meeting.
   1. Ensure that members of the team employed by the health board are aware of staff support such as occupational health if they feel they would wish to make contact.
   2. The staff support leaflet should also be available to all staff involved.