When a child dies in the ED
This is one of the most stressful events an emergency worker may face. The department endeavor to run a debrief soon after any unexpected child death within ED. If you have been involved in the case you will be invited & encouraged to attend this. You should also feel able to discuss the case with either the consultant involved or your clinical supervisors.
All deaths of babies & children under the age of 18 in England are investigated according to a set process. It is vital that all child deaths are carefully reviewed so that we may learn as much as possible from them to try to prevent future deaths & support to families.
Within ED there is a file that contains all the paperwork required for the review process. The medical team need to complete the review process (unless the child is under the care of a paediatrician for a chronic condition that is likely to be related to the death). Checklist:
A PM will be required & results of this should be fed back to the ED consultant on for the day. A local case discussion meeting will be held once the results of the PM are known. This is a multi-professional meeting with all of those involved in the child’s care up to & immediately after the death. Recommendations are made during this meeting & fed back to the Child Death Overview Panel as well as the coroner to help inform the inquest process.
All deaths of babies & children under the age of 18 in England are investigated according to a set process. It is vital that all child deaths are carefully reviewed so that we may learn as much as possible from them to try to prevent future deaths & support to families.
Within ED there is a file that contains all the paperwork required for the review process. The medical team need to complete the review process (unless the child is under the care of a paediatrician for a chronic condition that is likely to be related to the death). Checklist:
- If not already involved the police MUST be informed of the death
- Social care must be contacted for background information about the family & any siblings.
- The child must be examined:
- If suspected homicide the police must be involved
- If possible suicide remember to look for bruising, self-harm, goitre, rashes
- If an RTC an orthopaedic surgeon may be asked for an opinion
- ALWAYS discuss investigations with the coroner; they can be contacted out of hours.
- Toxicology should be considered, there is an agreed set of tests for this but you might want to add to that, for example anti-epileptic drug levels.
- Take samples for blood cultures and consider viral screen or TFTs.
- Speak to the parents. A joint interview with the police is best practice. Try to get a full a history as possible& document on the sheets provided within the protocol.
- Inform the rapid response team. They will attend ED if possible during working hours & will visit the home within 48 hours to provide ongoing support for the family.
- A strategy discussion MUST take place between the ED doctor, police & social care to agree what the next action should be. This might well be very straightforward & may simply occur in a corner of rests if the case is an RTC.
A PM will be required & results of this should be fed back to the ED consultant on for the day. A local case discussion meeting will be held once the results of the PM are known. This is a multi-professional meeting with all of those involved in the child’s care up to & immediately after the death. Recommendations are made during this meeting & fed back to the Child Death Overview Panel as well as the coroner to help inform the inquest process.
