Emergency Department

1. You may be notified by the Emergency Department in advance if they are aware that an infant is being brought in, as per the Emergency Department guidance for SUDI
   1. Clarify with the Emergency Department consultant in charge whether you will take over responsibility for the support of the parents. In some Emergency Departments the staff there will have the initial contact with the family.
2. Once death has been pronounced examine the infant and record notes in the History and Examination form.
3. Inform your department that you will not be contactable by phone or pager whilst with the parents.
4. If English is not the parent’s first language and they do not speak English well, check whether the interpreter has been contacted.
5. Check the Child at Risk Register, and inform the local child protection health team in all cases.

Initial parent support (If you are involved from the outset)
Following agreement with Emergency Department staff, confirm who will undertake these tasks

1. See the parents as soon as possible to explain what is happening and what will happen with regard to the police acting on behalf of the Procurator Fiscal.
2. Explain the need for a post-mortem examination for every SUDI and the likelihood that only provisional results will be available immediately after the post-mortem examination.
3. Allow family to hold their infant and offer to take photographs of child if family wish (Be aware of differing cultural beliefs as suggesting photographing the dead is very offensive to some faiths).
   1. If there is any criminality suspected this should be under supervision by a member of staff e.g. Emergency Department nurse or police officer.
      1. Police and staff should remain sensitive to parents' needs.
4. Once they are ready and after they have spent time with their infant (if they wish) take a history (using the History and Examination form) of the circumstances of the death and including previous medical history. »
   Explain that this information will be shared with the police to provide background information to the Procurator Fiscal and pathologist to help all involved establish a cause of death if there is one.
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5. Explain to family what will happen next, »
   i.e. roles of police, Procurator Fiscal, need for post-mortem examination by a paediatric pathologist and possible transfer of baby’s body to the mortuary (perhaps in another town/ city since specialist pathology services are required). There will also be a delay in issuing death certificate.
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   1. Offer support leaflets including:
      Information for bereaved parents leaflet
      Local bereavement leaflets
   2. 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.
6. Liase with police in providing them with the opportunity to speak with the parents at an appropriate time.
7. Explain how seeing the infant’s body later can be arranged through contact with the paediatric pathologist at the mortuary. Ensure parents know where there infant is being transferred to and who is taking them.
   1. Parents may wish mementoes hand or foot prints or a lock of hair can be offered to the parents as keepsakes. This can be arranged after the post-mortem examination. This should not be done in Emergency Department as it may interfere with tests that the pathologist may want to perform.
8. Make sure parents have the contact number for the health board SUDI paediatrician and your contact name and number. You should also let the parents know when you will contact them and discuss a meeting to discuss the preliminary post-mortem examination findings before they leave.
   1. Ask the parents if they wish you to refer them to any of the support organisations.

Follow up actions (If you are involved from the outset)
Agree with the Emergency Department staff who is undertaking these tasks, and if applicable to you;

1. Inform local area Procurator Fiscal office or on the next working day if out of hours.
   1. Request in writing that you be sent a copy of the post-mortem examination report when available.
2. Inform GP immediately or next working day if out of hours. Consider telephoning NHS 24 if out of hours and asking them to contact GP the next day via mailbox number for practice or by telephoning the named GP for the infant.
   1. 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.
3. Contact family within first few days to check whether they have any further questions.
4. Contact the paediatric pathologist and ask what further information you can provide.
5. Also contact the Senior Investigating Officer and ask if they require any further information. »
   This dialogue between paediatrics, police and pathology should ensure that there is collaboration throughout the process and that the parents are supported in the best possible way without repetition of questioning from each discipline.
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After the post-mortem examination (If you have agreed to take on support of the family)

1. Meet with the parents 1-2 weeks after to discuss preliminary post-mortem examination findings and mention that a SUDI review meeting may take place. (in some cases where a natural medical cause of death is found and there are no other factors to consider, there may be no need to hold a SUDI review meeting)
   1. Be available to discuss anything mentioned in the post-mortem examination report either with the Procurator Fiscal and/ or the GP.
2. Contact the parents at 4 weeks to offer reassurance whilst waiting for ancillary post-mortem test results
3. Contact the parents at 6 weeks weeks to offer reassurance and to check whether family are being supported. Offer contact numbers again to refer the parents if required.
4. Contact when final post mortem result is available and arrange to meet to discuss to mention again that the SUDI review meeting will take place.
   1. Outcome of post-mortem examination should be made available to the Emergency Department staff involved in the resuscitation, once you are aware of them.

SUDI review meeting (if you have agreed to support the family)

1. Provide information necessary for Healthcare Improvement Scotland to inform the SUDI Review meeting
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 GP, health visitor and pathologist who did the post-mortem examination. 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 parents in 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.
3. Meet with the parents 1-2 weeks after the SUDI review meeting to discuss the outcome and also encourage them to use support available and ensure that they have the relevant contact numbers. Assure them that they are welcome to make an appointment to see you again if ever they wish.

Support during the next pregnancy

1. Arrange to see the parent’s early on in pregnancy and discuss additional clinic appointments, screening tests that may be offered.
2. Discuss with the GP and community midwife plans about extra support for the care of the next infant, such as provision of an apnoea monitor and infant resuscitation classes
3. Whenever appropriate discuss risk factors such as sleep position, smoking and be up to date with the latest research.
4. Arrange appropriate follow up clinic appointments for new infant as reassurance to parents and to check all is well.

Staff support

1. It may be of benefit to any staff involved to have a team debrief soon after the SUDI has occurred. It may also be useful to debrief again after key points like the SUDI review meeting.
   1. Ensure that staff 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.