2. Consistent 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, 15 th Circuit 1 st Asst Solicitor Rae Wooten, RN, Charleston County Coroner’s Office

3. SUID = Sudden Unexplained Infant Death Definition: The sudden and unexpected death of an infant due to natural or unnatural causes. 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) www.cdc.gov

4. SIDS 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.” 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 1991;11(5):677-684.

5. State Observations Sudden Infant Death Syndrome (SIDS) cases may be over-reported Sudden Infant Death Syndrome (SIDS) cases may be over-reported Infant death cases may be under- investigated Infant death cases may be under- investigated

6. Current Status Investigation protocols inconsistent from county to county Investigation protocols inconsistent from county to county Reporting protocols inconsistent from county to county Reporting protocols inconsistent from county to county Insufficient information provided to pathologist Insufficient information provided to pathologist Duplication of efforts Duplication of efforts Lack of uniformity in death certification Lack of uniformity in death certification Ineffective prosecution of infant homicide cases Ineffective prosecution of infant homicide cases

7. An Ideal Situation Uniformity of investigation Uniformity of investigation –All investigative information is available to those who need it in a timely manner Uniformity of reporting Uniformity of reporting –All agencies can accurately report results Uniformity in classification Uniformity in classification –Public health issues identified early Accurate and early identification of criminal cases Accurate and early identification of criminal cases –Enhancement of successful prosecutions of criminal cases

8. CDCs SUIDI Program Sudden Unexplained Infant Death Investigation Reporting Form Sudden Unexplained Infant Death Investigation Reporting Form –Interviews and Research –The Scene –Pathologist

10. Interview The Interview 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

11. Research Child protective services Child protective services Medical and birth history Medical and birth history Recent events Recent events

12. Scene Investigation May provide vital information for the pathologist prior to his/her examination 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 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 Death certification CANNOT be accurate without adequate scene investigation

13. Doll Re-enactment and Photographic Documentation How infant is PLACED – by placer How infant is PLACED – by placer How infant is FOUND – by finder How infant is FOUND – by finder How infant was LAST SEEN ALIVE How infant was LAST SEEN ALIVE Photography: as if it is a CRIME SCENE Photography: as if it is a CRIME SCENE –Overall sleep situation –Intermediate view –Close-up of body/doll position

14. PLACED POSITION FOUND POSITION

16. Pathologist Case demographics and history Case demographics and history Scene information and photography Scene information and photography –Doll re-enactment –Position placed, last seen alive, and found Any suspicions after initial investigation Any suspicions after initial investigation Investigator availability Investigator availability

17. The “Top 25” National forensic pathologist survey has resulted in a list of data required prior to autopsy National forensic pathologist survey has resulted in a list of data required prior to autopsy These are divided into FIVE groups These are divided into FIVE groups –Sleeping environment –Infant history –Family information –Exam –Investigator insight

18. Sleeping Environment Asphyxia Asphyxia –Evidence of overlying, wedging, choking, nose/mouth obstruction, rebreathing, neck compression, immersion in water, etc Sharing sleep surfaces Sharing sleep surfaces Changing sleep condition Changing sleep condition Hypo/hyperthermia Hypo/hyperthermia Environmental hazards Environmental hazards Unsafe sleeping conditions Unsafe sleeping conditions

19. Infant History Diet Diet Recent hospitalization Recent hospitalization Previous medical diagnoses Previous medical diagnoses History of acute life-threatening events History of acute life-threatening events History of medical care without diagnosis History of medical care without diagnosis Recent fall or other injury Recent fall or other injury History of religious, cultural or ethnic remedies History of religious, cultural or ethnic remedies Cause of death due to natural causes other than SIDS Cause of death due to natural causes other than SIDS

20. Family Information Prior sibling deaths Prior sibling deaths Previous encounters with police and/or social service agencies Previous encounters with police and/or social service agencies Request for tissue or organ donation Request for tissue or organ donation Objection to autopsy Objection to autopsy

21. Exam Pre-terminal resuscitative treatment Pre-terminal resuscitative treatment Death due to trauma, poisoning or intoxication Death due to trauma, poisoning or intoxication

22. Investigator Insight Suspicious circumstances Suspicious circumstances Other alerts for pathologist’s attention Other alerts for pathologist’s attention

23. Prosecution In-depth interviews with written notes In-depth interviews with written notes Photographs of the scene and autopsy Photographs of the scene and autopsy Accurate death certification Accurate death certification Complete research of medical history Complete research of medical history

24. One way to convey scene information www.mdilog.net www.mdilog.net

26. Conclusion Interview Interview Scene Investigation and Re-enactment Scene Investigation and Re-enactment Information Dissemination Information Dissemination WITH KNOWLEDGE, TEAM WORK AND COMMITMENT, WE CAN MAKE A DIFFERENCE!!! AND COMMITMENT, WE CAN MAKE A DIFFERENCE!!!