1. Consistent Investigation in the Sudden Unexpected Death of Infants Team Minnesota Andrew Baker, Medical Examiner George Bergin, Sheriff’s Detective Mark Hudson, Pediatrician Lora Kibbee, Medicolegal Death Investigator Kim Nguyen, Social Worker – Child Protective Services Bobbi Jo O’Neal – facilitator and honorary Gopher

2. Sudden Infant Death Syndrome (SIDS) The 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

3. Sudden Infant Death Syndrome (SIDS) The 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

4. Sudden Infant Death Syndrome (SIDS) The 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

5. Sudden Unexpected Infant Death The sudden and unexpected death of an infant due to a variety of natural or unnatural causes Examples –SIDS –Natural diseases –Unsafe sleeping environments –Trauma –Poisons and other toxins –Homicide –Unknown causes

6. Where are we today? 4600 sudden unexpected infant deaths per year SIDS accounts for 2300 deaths per year SIDS has declined by 50% since the 1990s Other unexplained deaths have increased No national standards regarding infant death investigations

7. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

8. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

9. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

10. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

11. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

12. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

13. Case Information

14. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

15. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

17. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

20. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

22. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

24. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

26. Sleeping Environment Asphyxia Sharing of the sleep surface Change in sleep condition Hypothermia or hyperthermia Environmental hazards Unsafe sleep conditions

29. Infant History Diet Recent hospitalization Previous medical diagnosis History of acute life-threatening events (ALTEs) History of medical care without diagnosis Recent falls or other injuries History of religious, cultural, or other remedies Cause of death due to natural causes other than SIDS

30. Infant History Diet Recent hospitalization Previous medical diagnosis History of acute life-threatening events (ALTEs) History of medical care without diagnosis Recent falls or other injuries History of religious, cultural, or other remedies Cause of death due to natural causes other than SIDS

31. Infant History Diet Recent hospitalization Previous medical diagnosis History of acute life-threatening events (ALTEs) History of medical care without diagnosis Recent falls or other injuries History of religious, cultural, or other remedies Cause of death due to natural causes other than SIDS

32. Infant History Diet Recent hospitalization Previous medical diagnosis History of acute life-threatening events (ALTEs) History of medical care without diagnosis Recent falls or other injuries History of religious, cultural, or other remedies Cause of death due to natural causes other than SIDS

34. Infant History Diet Recent hospitalization Previous medical diagnosis History of acute life-threatening events (ALTEs) History of medical care without diagnosis Recent falls or other injuries History of religious, cultural, or other remedies Cause of death due to natural causes other than SIDS

36. Infant History Diet Recent hospitalization Previous medical diagnosis History of acute life-threatening events (ALTEs) History of medical care without diagnosis Recent falls or other injuries History of religious, cultural, or other remedies Cause of death due to natural causes other than SIDS

38. Family Information Prior sibling deaths Previous encounters with police or social service agencies Requests for tissue or organ donation Objection to autopsy

39. Family Information Prior sibling deaths Previous encounters with police or social service agencies Requests for tissue or organ donation Objection to autopsy

40. Family Information Prior sibling deaths Previous encounters with police or social service agencies Requests for tissue or organ donation Objection to autopsy

41. Family Information Prior sibling deaths Previous encounters with police or social service agencies Requests for tissue or organ donation Objection to autopsy

42. Family Information Prior sibling deaths Previous encounters with police or social service agencies Requests for tissue or organ donation Objection to autopsy

44. Exam Preterminal resuscitative treatment Death due to trauma, poisoning, or intoxication

45. Exam Preterminal resuscitative treatment Death due to trauma, poisoning, or intoxication

46. Exam Preterminal resuscitative treatment Death due to trauma, poisoning, or intoxication

50. Investigator insights Description of circumstances Suspicious circumstances Other alerts for pathologists attention

51. Investigator insights Description of circumstances Suspicious circumstances Other alerts for pathologists attention

55. Investigator insights Description of circumstances Suspicious circumstances Other alerts for pathologists attention

57. “The Top 25” Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

58. How do we accomplish this? Interviews Scene investigation Doll reenactment Communication

66. GOAL: Consistent, accurate certification of all infant deaths

67. Summary Interviews Scene investigation Doll reenactment Communication Case Information Asphyxia Sharing sleep surfaces Change in sleep conditions Hyperthermia/hypothermia Environmental hazards (CO, chemicals, etc) Unsafe sleeping condition Diet Recent hospitalizations Previous medical diagnosis 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 Prior sibling deaths Previous encounters with police or social service agencies Request for tissue or organ donation Objection to autopsy Pre-terminal resuscitative treatment Death due to trauma (injury), poisoning, or intoxication Suspicious circumstances Other alerts for pathologist’s attention Description of circumstances (what happened?) Pathologist Information (name/agency/phone)

68. Team Minnesota Consistent Complete Competent Compassionate