If you receive an emergency call

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

At the scene

1. Attempt resuscitation following UK 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. You may confirm death in the home or you can leave this to the hospital.
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 immediate examination and investigations 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. The History and Examination forms used by staff in the hospital show the sort of information that they will require to know. 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 then the history and examination form can be used to ask questions in order to gather all the necessary information when working collaboratively with the police.
      1. It should be explained that information will be shared between other healthcare staff, 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.

If you find out later that an infant has died

1. You may be informed by a member of staff from the Emergency Department. The department the infant was admitted to may contact you 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 as full a history as possible 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.

Immediate parent support

1. Try to see the family as soon as possible. Parents greatly appreciate the contact and time taken.
2. Ensure that the parents understand the legal position regarding the Procurator Fiscal and the arrangements for registering the death.
   1. Ensure any questions parents have about police involvement are answered as they may have not taken in all the explanations given in the Emergency Department. »
      Reassure that the police involvement is normal for SUDI and that this does not imply suspicion of wrong–doing by the parents. Inform them that bedding and other items may be taken away for testing. This again is to try and find out if there is any known cause for why the infant died.
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   2. Discuss the need and legal requirement for a post-mortem examination. Reassure the parents that their baby will look presentable afterwards.
      1. The paediatric pathology post-mortem is a specialist service; therefore the infant will be transferred to another mortuary for this examination.
3. Discuss the care of siblings; explain the need to involve them according to their age.
4. Enquire whether mementoes have been requested and encourage if not. For example the taking of photographs, lock of hair, or hand and foot prints. Try to also take into account any cultural sensitivity.
5. Check whether spiritual help is required, and arrange appropriate contacts through local hospital chaplain if appropriate.
6. Ask if the parents would like to be put in touch with any support organisations.
7. If mother is breast feeding discuss methods of suppression of lactation.

Further parent support

1. Liase with other members of the practice, especially the health visitor or midwife (if involved) to support the family and staff.
2. Spend time listening to parents and ask them to tell you what happened.
   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).

Communication with other professionals

1. Make contact with the nominated SUDI paediatrician as soon as possible, if they have not already contacted you.
2. The police will request the medical case notes for the infant and possibly the mother and/ or father. In particular any maternity notes for the mother. »
   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.

After the post-mortem examination

1. Discuss with the paediatrician (may be the SUDI paediatrician) who should meet with the family to explain the findings of the post-mortem examination.
2. Be available to discuss anything mentioned in the post-mortem examination report either with the Procurator Fiscal and/ or the paediatric pathologist.
3. In liaison with the health visitor 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.
4. 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, health visitor 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.
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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 in the longer term

1. Remember anniversaries will be difficult for the family and make appropriate contact.
2. Discuss the possibility of future pregnancies advising that it is usually best to allow time first for grieving for the baby who died.
3. Discuss the support available for future pregnancies and babies, such as the use of apnoea monitors.

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. Click to find out local contact details. For staff not employed by the health board each practice should have appropriate staff support available, should it be required.
   2. The staff support leaflet should also be available to all staff involved.