EMS Agencies: please help us improve our pediatric readiness and care for children by completing the national EMSC and Florida EMS Agency surveys.

Reminder: EMSC Day is May 20, 2020
It's never too early to start planning for EMS Week and EMSC Day (Wednesday, May 20). Florida PEDReady is interested in your ideas and suggestions for EMSC Day themes, products and activities. Email pedready@jax.ufl.edu with your feedback!

EMS Week Daily Themes:
  • Monday: Education Day
  • Tuesday: Safety Day
  • Wednesday: EMSC Day
  • Thursday: Save-A-Life Day (CPR and Stop the Bleed)
  • Friday: EMS Recognition

Find additional information here:
Quick Links:
Encourage others to sign up for the PEDReady weekly newsbrief, the PE 2 ARL, by sharing this link: http://bit.ly/flpearl
February 13, 2020
Preventing Sleep-Related Infant Deaths: The Role of EDs and EMS Agencies
Special thanks to Nichole “Niki” Shimko, MSN, CCRN for contributing to this issue of the PEARL. Niki is the Pediatric Critical Care Transport Coordinator at Golisano Children’s Hospital, a member of the Florida EMSC Advisory Committee, and leads the committee’s infant mortality and safe sleep working group. 
1. Preventing Sleep-Related Infant Deaths
Did you know?
  • Sleep-related infant deaths occur every day and are the leading cause of death for children one month to one year of age
  • There are about 3,500 sleep-related deaths among U.S. babies each year! These deaths are included in the classification of sudden unexplained infant deaths (SUID)
  • The average age of these deaths is one to four months
  • The risk of suffocation in infants who are sleeping in an adult bed is 40 times higher than when sleeping in a crib
  • Bed-sharing increased from 6.5% in 1993 to 12.8% in 2010
  • The Florida EMS State Plan includes an objective to increase the percentage of EMS agencies conducting or participating in programs to reduce infant mortality
  • According to Florida’s 2019 Child Abuse Death Review (CADR) annual report:
  • Sleep-related infant death is the leading cause of preventable child death in Florida and represents 40.3% of all preventable child fatalities called into the Florida Abuse Hotline.
All first responders, EMS and ED providers play a role in decreasing this tragedy. Find out why and how:
Confusing Terminology: SIDS, SUID and More
The terminology of sleep-related infant deaths has changed over the last decade. Many deaths previously classified as sudden infant death syndrome ( SIDS) were really due to suffocation or other causes. SIDS is a subcategory of SUID and is a cause assigned to infant deaths that cannot be explained after a thorough case investigation, including a scene investigation, autopsy, and review of the clinical history.

Sleep-related deaths include SIDS, unintentional suffocation, strangulation in bed, ill-defined deaths, and undetermined or unknown causes. See the AAP 2016 definition of terms below. The term bed-sharing is likely a better descriptor and is replacing the term cosleeping in some organizations. 
AAP 2016 Definitions of Terms:

  • Bed-sharing: Parent(s) and infant sleeping together on any surface (bed, couch, chair)
  • Caregivers: Throughout the document, “parents” are used, but this term is meant to indicate any infant caregivers.
  • Cosleeping: This term is commonly used, but the task force finds it confusing, and it is not used in this document. When used, authors need to clarify whether they are referring to sleeping in close proximity (which does not necessarily entail bed-sharing) or bed-sharing.
  • Room-sharing: Parent(s) and infant sleeping in the same room on separate surfaces
  • Sleep-related infant death: SUID that occurs during an observed or unobserved sleep period
  • Sudden infant death syndrome (SIDS): Cause assigned to infant deaths that cannot be explained after a thorough case investigation, including a scene investigation, autopsy, and review of the clinical history.
  • Sudden unexpected infant death (SUID), or sudden unexpected death in infancy (SUDI): A sudden and unexpected death, whether explained or unexplained (including SIDS), occurring during infancy.
In 1994, the National Institute of Child Health and Development launched the “Back to Sleep” campaign, which reduced sleep-related deaths by 50%. The campaign was later renamed “Safe to Sleep” to incorporate other aspects of safe sleep. The Safe to Sleep campaign includes a variety of tips:

ABCs:  A LONE, on B ACK, in C RIB
  • No bed-sharing—sleep in the same room, not in the same bed!
  • No co-sleeping
  • The safest place for an infant to sleep is on a separate sleep surface designed for infants, close to the parents’ bed.
  • Back to sleep for every sleep
  • Use a firm surface
  • Keeping the crib in the parents' room is recommended for the first 6 months.
  • Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment and strangulation.

Why the BACK? When babies sleep on their stomach, they have longer periods of deep sleep, are less reactive to noise, experience less movements, and can experience decreases in blood pressure and heart rate control.  
Other suggestions for parents and caregivers:
  • Consider offering a pacifier at nap time and bedtime
  • Avoid alcohol and drug use
  • Avoid overheating and head covering in infants
  • Avoid smoke exposure
  • Infants need “tummy time” when they are awake and when someone is watching them. Supervised tummy time strengthens muscles in the shoulders and neck that help infants achieve developmental milestones. It also helps to prevent flat spots on the infant’s head. 
What is your role and what can you do?
Safe sleep instructions are provided to new mothers and caregivers soon after birth when they are exhausted from the labor process and exhilarated about the birth of their new baby. Often, the safe sleep message is lost in the chaos. This is where emergency providers come in to play: w e have an opportunity every time we see an infant, caregiver of an infant, or enter the home of an infant.
  • Make it part of your routine to share safe infant sleep messages with parents and caregivers on every encounter, even if the visit or interaction is related to another complaint.
  • Share resources with all who care for the infant: grandparents, babysitters, etc. (see resources below and stay tuned for future resources provided by FL EMSC).
  • When on-scene for a sleep-related resuscitation, try to take a quick look at the home and sleep environment. Determine where the baby was when found and the sleep position, and document this information. Usually the scene has changed by the time law enforcement arrives.
  • Review the infant mortality statistics in your area. You can review your county information here.
  • Begin a safe sleep initiative in your agency or ED
  • Not sure what to do or say? Review these two excellent resources:
  • MCHD Paramedic Podcast Episode 71: Safe Sleep Pearls with Dr. Lisa Owens 
  • Recognizing and Addressing Unsafe Sleep Hazards by Dr. Bruce McIntosh, Florida Statewide Medical Director of Child Protection Team (FDOH)
Additional Safe Sleep Resources and Websites:


Email pedready@jax.ufl.edu if you have suggestions for decreasing infant mortality and promoting safe sleep.
2. Upcoming Events
Emergency & Trauma Symposium: New Vision in Emergency and Trauma Care
Feb. 13-14, 2020 from 7:00-5:00 pm
Hosted by: UF Health Jacksonville

Learn about the latest updates in trauma and emergency medicine (adult and pediatrics) while earning free CME/CEUs, including trauma-related credits. This conference caters to the entire spectrum of providers: physicians, PAs, NPs, nurses and pre-hospital personnel.
2020 Annual EMS Today Conference
March 4-6, 2020 in Tampa, FL

EMS Today offers networking with 4,600+ EMS professionals, 200+ CEH opportunities, and access to the most innovative products and services by over 250 exhibiting companies. Registration is now open.
Emerald Coast Emergency Care Symposium
March 11-13, 2020 in Destin, FL

Nationally-recognized speakers in the morning and hands-on training in the afternoon, plus a Cadaver Lab on Friday. Significant discount for groups. See Flyer
NASEMSO Annual Meeting
June 15-18, 2020 in Reno, NV

Abstracts are being accepted until May 15. Submit your abstract now and see the schedule at a glance here.
Thanks for being a Pediatric Champion!
The Florida PEDReady Program
pedready@jax.ufl.edu | 904-244-8617