A First Response to Safe Sleep Habits

Thousands of infants die each year in unsafe sleep conditions. Sadly, the majority of sleep-related deaths are preventable. One innovative and successful approach to reduce these tragedies is to train law enforcement, fire rescue squads and other first responders to educate families about safe sleep habits.

“We have access to homes that no one else has,” says Lieutenant James Carroll of the Fort Lauderdale Fire and Rescue Department in Florida. “When people call 911, they are asking for our help. Social workers cannot just walk into peoples’ homes. We have an opportunity to look for safe sleep risks and save lives.”

Concerned for the growing number of sleep-related deaths reported in Broward County, Fla., Carroll, in conjunction with Jennifer Combs of Healthy Mothers, Healthy Babies Coalition of Broward Inc., created in 2012 the Direct On-Scene Education (D.O.S.E) program for first responders. When responding to an emergency or non-emergency call from a household with a pregnant woman or infant, and after attending to the patient, first responders are trained to do four things:

  1. Look for possible unsafe sleep conditions
  2. Remove any hazards in the crib such as blankets, pillows, bumpers and stuffed animals 
  3. Talk to families about safe sleep habits
  4. Offer a safe sleep kit with educational information about safe sleep habits

Their efforts are working. In 2011, more than seven babies died in Fort Lauderdale due to accidental suffocation or strangulation while sleeping. In 2012 and 2013, this number decreased to three, and in 2014 to one. More than 600 kits were given out in 2013 alone.

“Each safe sleep kit is an opportunity to save a life,” says Carroll. “We want to get the number of deaths to zero.”

The concept of training first responders is spreading across the nation. SIDS of Illinois, Inc., goes beyond training on safe sleep practices to sensitivity training about sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS). Executive Director of SIDS of Illinois, Inc., Nancy Maruyama, RN, BSN, heard many families say they were often accused of harming their child before the investigation into the baby’s death was complete. Through the organization, Maruyama began a sensitivity training for law enforcement departments. The trainings stress the following:

  • It is important to use gentle, layperson language. Using jargon such as “collecting evidence” can feel impersonal and blaming to the family.
  • Many mothers may act guilty when they are not. 

“As a mother, your job is to keep your baby safe. When that doesn’t happen, many mothers blame themselves, even if it wasn’t their fault. It is important for law enforcement to understand this,” says Maruyama. She lost her son, Brendan, to SIDS in 1985.

To get her program started, Maruyama reached out to the training departments of the local police, fire rescue, child abuse investigators, medical examiners and coroners. These trainings often affect the attendees personally.

“I heard one cop call home and say ‘Get those bumpers out of the crib right now.’ Ten minutes can save a life,” says Maruyama.

To start a safe sleep training program for first responders in your state, Maruyama and Carroll suggest the following:

  • Look at hospitals’ pediatric codes (available from the local health department) and find out where the most deaths are occurring. Then target the organizations that serve that area.
  • Write out a training plan. It is important that the same training approach be used across the agencies. 
  • Reach out to fire rescue chiefs, police chiefs, EMS chiefs, hospitals, public health departments, WIC clinics and non-profit organizations that deal with pediatric issues. Many have training departments. Show them the death rates and your training plan. Suggest ways that training can easily become part of their schedule.
  • Conduct train-the-trainer sessions as well as staff trainings. 
  • Speak at and attend relevant conferences.

In addition to her work with SIDS of Illinois, Maruyama is a co-leader for the Illinois safe sleep team in the NICHQ-led Collaborative Improvement and Innovation Network to Reduce Infant Mortality (Infant Mortality CoIIN). IM CoIIN is a federally funded, multiyear national movement engaging federal, state and local leaders, public and private agencies, professionals and communities to employ quality improvement, innovation and collaborative learning to reduce infant mortality and improve birth outcomes. Improving safe sleep practices is one of the six strategies of the IM CoIIN. “

Many parents never think it will happen to them. They need to hear the message more than once,” says Maruyama. “First responders are in a unique position to spread the message and save babies’ lives.”