Title: Consistent Investigation and Reporting of Sudden Unexplained Infant Death
1Consistent Investigation and Reporting of Sudden
Unexplained Infant Death
SOUTH CAROLINA INITIATIVE David Belk,
Lieutenant, SLED Cynthia Schandl, MD, PhD,
Forensic Pathologist, MUSC Bert von Herrmann,
15th Circuit 1st Asst Solicitor Rae Wooten, RN,
Charleston County Coroners Office
2SUID Sudden Unexplained Infant Death
- Definition The sudden and unexpected death of an
infant due to natural or unnatural causes. - CDC text Sudden, Unexplained Infant Death
Investigation, www.cdc.gov (CDC Center for
Disease Control)
3SIDS
- Definition 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. - Pediatr Pathol 199111(5)677-684.
4State Observations
- Sudden Infant Death Syndrome (SIDS) cases may be
over-reported - Infant death cases may be under-investigated
5Current Status
- Investigation protocols inconsistent from county
to county - Reporting protocols inconsistent from county to
county - Insufficient information provided to pathologist
- Duplication of efforts
- Lack of uniformity in death certification
- Ineffective prosecution of infant homicide cases
6An Ideal Situation
- Uniformity of investigation
- All investigative information is available to
those who need it in a timely manner - Uniformity of reporting
- All agencies can accurately report results
- Uniformity in classification
- Public health issues identified early
- Accurate and early identification of criminal
cases - Enhancement of successful prosecutions of
criminal cases
7CDCs SUIDI Program
- Sudden Unexplained Infant Death Investigation
Reporting Form - Interviews and Research
- The Scene
- Pathologist
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9Interview
- The Interview
- Introduce yourself and your purpose
- Obtain demographic information of infant and
caregiver(s) - Ask open ended questions
- What happened include previous 72 hours
- Determine person who placed infant and person who
found infant - Determine infants position when placed, last
seen alive, and found - Use a checklist to be thorough
10Research
- Child protective services
- Medical and birth history
- Recent events
11Scene Investigation
- May provide vital information for the pathologist
prior to his/her examination - Information regarding the sleeping and living
conditions will remain only BRIEFLY once the
infant is removed - Death certification CANNOT be accurate without
adequate scene investigation
12Doll Re-enactment and Photographic Documentation
- How infant is PLACED by placer
- How infant is FOUND by finder
- How infant was LAST SEEN ALIVE
- Photography as if it is a CRIME SCENE
- Overall sleep situation
- Intermediate view
- Close-up of body/doll position
13PLACED POSITION
FOUND POSITION
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15Pathologist
- Case demographics and history
- Scene information and photography
- Doll re-enactment
- Position placed, last seen alive, and found
- Any suspicions after initial investigation
- Investigator availability
16The Top 25
- National forensic pathologist survey has resulted
in a list of data required prior to autopsy - These are divided into FIVE groups
- Sleeping environment
- Infant history
- Family information
- Exam
- Investigator insight
17Sleeping Environment
- Asphyxia
- Evidence of overlying, wedging, choking,
nose/mouth obstruction, rebreathing, neck
compression, immersion in water, etc - Sharing sleep surfaces
- Changing sleep condition
- Hypo/hyperthermia
- Environmental hazards
- Unsafe sleeping conditions
18Infant History
- Diet
- Recent hospitalization
- Previous medical diagnoses
- History of acute life-threatening events
- History of medical care without diagnosis
- Recent fall or other injury
- History of religious, cultural or ethnic remedies
- Cause of death due to natural causes other than
SIDS
19Family Information
- Prior sibling deaths
- Previous encounters with police and/or social
service agencies - Request for tissue or organ donation
- Objection to autopsy
20Exam
- Pre-terminal resuscitative treatment
- Death due to trauma, poisoning or intoxication
21Investigator Insight
- Suspicious circumstances
- Other alerts for pathologists attention
22Prosecution
- In-depth interviews with written notes
- Photographs of the scene and autopsy
- Accurate death certification
- Complete research of medical history
23One way to convey scene information
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25Conclusion
- Interview
- Scene Investigation and Re-enactment
- Information Dissemination
WITH KNOWLEDGE, TEAM WORK AND COMMITMENT, WE CAN
MAKE A DIFFERENCE!!!
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