Preservation

					  C-POD Guidelines for First Responders:                         Beyond the C-POD Guidelines:
Child Deaths & Serious Physical Injury Cases
                                                                 Improving Community Response
             These are only guidelines.
                                                                      to Child Fatalities and
 Not all information may be pertinent or available.
 Follow local procedures & established protocols!                 Serious Physical Injury Cases
 These guidelines provide a quick review of                    1. Implement written Child Abuse
 recommended approaches in cases where a child                    Investigation Protocols that address
 has died suddenly & unexpectedly, or sustained                   coordination of all child abuse
 serious unexplained or suspicious physical injury.               investigations, including child fatality,
 They list important considerations for 1st responders            serious physical injury, and criminal
 (especially Law Enforcement, EMS/paramedics, and                 neglect cases; involve LE, CPS,
 CPS) during an immediate response to the scene                   prosecutors, as well as key additional
 where the dead or injured child was found.                       local professionals & agencies:
 Determination of the cause of death or mechanism of
 injury will depend on the results of a complete
                                                                   EMS & Fire District personnel
 investigation & medical evaluation. In addition to                Coroner or Medical Examiner
 considering these suggestions, please note any                    Medical providers: ER/Hospitals
 other relevant information. Keep in mind: not all                 Comm. Center/ 911 dispatchers
 items apply in all cases – each situation is different &
 the appropriate response will vary depending upon             2. Utilize a multidisciplinary approach to
 available resources & the specific facts of the case.            these investigations
         Revised in 2008 for FVTC by the WA State              3. Use the SUIDI form (Sudden
       Criminal Justice Training Commission (CJTC)                Unexplained Infant Death Investigation)
      The C-POD Guidelines were originally produced in 2006       for infant deaths
     and were compiled by Patti Toth & Ilana Guttmann, based   4. Develop your own checklists: include
        on a series of meetings with 1st responders & other       pertinent local phone #s
             professionals held throughout WA State.
     For additional resources & training information, go to:
                                                               5. Participate in local child death review
                www.fvtc.edu/childprotecttraining                 teams to plan follow-up investigations
     Patti Toth can be contacted at: ptoth@cjtc.state.wa.us       and de-brief
 .


              COLLABORATION                                       Consider:
  Ensure an immediate, coordinated                                Who may/may not have been
investigation of ALL unexpected child                              alerted
       deaths & serious injuries.                                 People necessary to ensure full
 Immediately summon EMS                                           investigation
                                                                  Cause of injury/death is often not
      Immediately call Law Enforcement                            immediately obvious
       to scene of injury or death (and to
       hospital if child has been transported)                   Exchange information:
      Immediately notify CPS (Child                              Observations of all 1st responders
       Protective Services) & consider                            Contact information for all
       summoning to scene                                          responders
 Contact/notify other key players                                History of child, family, caregivers,
  ASAP as appropriate:                                             residence, etc. (Any patterns?)
  Special Unit Detective(s)                                      Clarify roles:
  Medical Examiner/Coroner                                       Who needs what info, when & how?
  Medical Experts                                                Who has the expertise/training to…
  Crime scene processing personnel                                  Manage the scene (lead)
  Prosecutor; other involved agencies                               Gather/document information
  State or local licensing authority: if                            Interview witnesses (incl. children)
   licensed or unlicensed daycare, etc.
                                                                     Preserve evidence
  Tribal Authorities                                                Assess ongoing safety of
  Language Interpreter                                               child(ren) in home
  Counselor/ Clergy/ Chaplain                                       Determine need for protective
  Probation, parole authorities                                      custody of child(ren), identify
  Animal Control, Bldg. Inspector, etc.                              appropriate placement

                                                                                                        1
          PRESERVATION                            Disturb scene as little as possible:
Maintain scene as it was when child
                                                    Don’t move a clearly dead child
                                                    Don’t turn on/off appliances
  (or injury) was discovered until
                                                    Don’t allow garbage to be emptied
evidence is seized, is documented,
                                                    Don’t change clothes/diapers - if
     and/or circumstances are                          you do, keep the clothing/diaper
 demonstrated or reconstructed.
                                                  Prevent anyone from destroying
   Strive first to preserve life:                 potential evidence:
    Render all necessary medical aid                Don’t use or flush toilet or sink
   Disturb scene as little as possible             Don’t unnecessarily step on/into
                                                       sensitive areas
   Prevent others from disturbing                  Don’t mop up fluids or clean
    evidence                                           anything (bedding, dishes, etc.)
   Secure the scene - Keep everyone                Don’t throw anything away at or
    at scene(s) until all info. gathered               from the scene
   Clearly identify how 1st responders           Preserve all evidence at the scene(s):
    enter/exit the scene (limit                     Consider multiple scenes: Where
    contamination)                                    injury occurred, vehicle, ER, etc.
   Wear protective clothing to shield              Control/ minimize access to scene
    both scene and responder                        ID witnesses - conduct thorough
   Preserve information: Interview                   witness interviews ASAP
    witnesses (on video); take photos               Take lots of photos/videos
    (at scene of injury & at ER/hospital if         Removal of anything requires
    child there); and record detailed                 lawful authority (search warrant,
    observations ASAP                                 written consent, etc.)



           OBSERVATION                            Who rendered what aid?
Be aware and conscious of everything              Who is present/not? Other children?
      within the environment.                       Where and with whom are they?
       Use all your senses.                          Physical & emotional state(s)?
 Suspend assumptions in order to                    Demeanor, utterances, actions
  absorb maximum amount of info.                    Requests (e.g., lawyer, translator,
                                                     clergy, etc.)
   The child’s location, position,                 Impairments (visual, motor,
    observable injuries, physical state              auditory, etc.)
    (e.g., skin temp./color, lividity, etc.)
                                                  Outdoor & indoor environment:
   All people at the scene(s)                      Configuration, order/disorder,
   Demeanor of witnesses                             cleanliness, noise
   Outdoor and indoor environment                  Sleeping environment
                                                    Ventilation; are windows & doors
   Caretaker explanation(s):                         open or closed? (Un)locked?
     Consistent with injuries and/or               Temperatures and hazards:
       observations?                                  Water, toxins, weather, etc.
     Contradictory statements to                   Fluids/ odors/ discolorations
       different people?                            Pets/animals & their condition(s)
   Objects at scene(s) - possibly                Presence/lack/condition of/info from:
    involved in mechanism of injury                 Bedding, food, drugs, meds, etc.
   What’s moved/changed? What’s                    Appliances? On or off?
    odd? What’s missing?                            Computer screen, cell & other
   Cultural, religious and/or ethnic                 phones, answering machines
    factors - remedies, language, etc.              Vehicles - Note if/when (re)moved


                                                                                      2
         DOCUMENTATION                            Name, DOB, phone, current and prior
Immediately record everything about                names & addresses for:
 the scene, the child, and witnesses.               Children at scene, in family/facility
                                                    Legal custodians/ all caretakers
   Who first noted distress/injury-                Primary & collateral witnesses:
    when, where, what - their actions?                family, neighbors, teachers, etc.
   When & who called for assistance?               1st responders
    Any delay? Who else was called?               Information & observations re: child:
   Identity & contact info. for all key              Development stage; temperament
    players – present at scene or not                 Appearance, injuries, condition
   Observations of/about everyone on                 Daily routine & any differences
    scene and/or with child                           Family & health status information
   Everything said (including excited            Describe outdoor/indoor environment:
    utterances): How, when, by whom?               Measure, diagram, photos & videos
    Create timeline before & after injury:           Area layout; sleeping conditions
     48 to 72 hours (use a calendar)                  Cleanliness, temperature, odors
     All who had contact with child                  Bedding, food, drugs/alcohol
     Location(s) of child                            Furniture, stairway(s), toys, etc.
     Events, behaviors, activities, medical
      issues (& changes in these)                 Obtain vital & accessible information:
     Food & medications ingested                     EMS run sheets; crime scene log
     Sleep and awake time                            Criminal records; 911 call logs
   Full description/depiction of scene               CPS records; licensed facility logs
                                                      Medical & search consent
   Caretakers’ attitudes re: child                   Medical history & records



                  HOW:                            Don’t assume innocence or culpability
  Gather evidence carefully and                     Treat every scene as a potential
 objectively. Lay a foundation for                   crime scene
   determining what happened.                       Demonstrate respect, sensitivity,
                                                     neutrality: be non-judgmental
   Arrive as soon as possible
                                                  Separate people and interview ASAP
   Composed demeanor & approach:                  (get specialized interview training)
     Be calm - Acknowledge emotion,                Convey that a full, careful
      stress                                          investigation is standard procedure
     Establish rapport                             Open, non-confrontational
     Ask comprehensive questions                     questions (“What happened?”)
   Call on a pre-determined                        Let people talk: record verbatim
    multidisciplinary team ASAP: EMS,             Photos/videos – record as much as
    Law Enforcement (LE), CPS,                     possible! (get equipment training)
    other local resources                           Show scale in photos to indicate
   Ensure a quick response time-                     color and measurement
    avoid leaving messages                          Ask witness(es) to describe &
                                                      reconstruct what happened:
   Follow established checklists/                    record w/ video (possibly use doll)
    protocols (SUIDI, child abuse                   Document any changes to child &
    investigation, etc.)                              scene (e.g., body or items moved)
   Consider prior experience & cases:            LE: If at all possible, attend & observe
    What works/ doesn’t?                           autopsy, collect relevant evidence


                                                                                        3
                                                      INFANT HISTORY
Sudden Unexplained Infant                              Diet concerns (e.g., solids introduction)
  Death Investigations                                 Recent hospitalization(s)
                                                       Previous medical diagnosis
 SUIDI* Pathologist Summary                            History of acute life-threatening events (ALTEs:
                                                      e.g., apnea, seizures, difficulty breathing)
    Medical examiners consider this scene/case
   information critical to determining the cause &     History of medical care without diagnosis
     manner of death. It should be collected and       Recent fall or other injury
  presented to the forensic pathologist before the     History of religious, cultural or ethnic remedies
               autopsy is conducted.                   Cause of death due to natural causes other
                                                      than SIDS (e.g., birth defects, complications of
  Does preliminary investigation indicate             pre-term birth)
          any of the following?
                                                      FAMILY INFORMATION
SLEEPING ENVIRONMENT                                   Prior sibling deaths
 Asphyxia (e.g., overlying, wedging, choking,         Previous encounter(s) with police and/or social
nose/mouth obstruction, re-breathing, neck            service agencies
compression, immersion in water)                       Request for organ and/or tissue donation
 Shared sleeping surfaces (with adults, children,     Objection to autopsy
pets)
Change in sleeping conditions (e.g.,                 EXAM
unaccustomed stomach sleep position, location,         Pre-terminal resuscitative treatment rendered
or sleep surface)                                      Death due to trauma (injury), poisoning, or
Hyperthermia/hypothermia (e.g., excessive            intoxication
wrapping, blankets, clothing, hot or cold
environments)                                         INVESTIGATOR INSIGHTS
 Environmental hazards (e.g., chemicals, drugs,       Suspicious circumstances
carbon monoxide, noxious gases, devices)               Other alerts for pathologist’s attention
 Unsafe sleeping conditions (e.g., couch/sofa,
waterbed, stuffed toys, pillows, soft bedding)          *This information is from the CDC’s Sudden Unexplained Infant
                                                                  Death Investigation (SUIDI) Reporting Form.



Emergency Medical Professionals                       7. Consider & record child’s developmental level
                                                          Compare reasonableness of history given
 Responding to Sudden Unexpected                           regarding mechanism of injury to child’s age &
   Child Death or Serious Injury                           developmental abilities and scene observations
1. Insure safety and provide medical aid as           8. Know signs of possible abuse & neglect:
  needed to save or assist the child                      Physical abuse: Unexplained broken bones,
                                                           bruises, black eyes, cuts, burns, welts; pattern
2. If child is clearly dead, do not move the body
                                                           injuries, bite marks; reports of injury received
    Be careful not to destroy potential evidence
                                                           from an adult caretaker, etc.
    For an infant who has died, complete EMS
                                                          Sexual abuse: Difficulty walking or sitting,
      portion of SUIDI Reporting Form
                                                           inappropriate interest or knowledge of sexual
3. Make sure Law Enforcement has been notified
                                                           acts, reports of inappropriate touching, etc.
   (whether you stay at the scene or not)
                                                          Neglect: Obvious lack of hygiene; back of
    Provide your contact info to Law Enforcement
                                                           head flat; severe diaper rash; hungry;
4. Document all adults and children present
                                                           underweight; lack of food, formula or care;
    Include who has left                                  parent or child use of drugs or alcohol, etc.
    What they did and said; their appearance
    Their reactions to child’s death or injury       9. Immediately notify CPS (Child Protective
5. Document all statements and demeanor                  Services) to report any suspicion of abuse or
   (emotional state) of speakers                         neglect of any child present at the scene
    ASAP and verbatim                                10. Participate in local multidisciplinary team
    Explain your job is to provide medical aid           (MDT) meetings to review child abuse cases
    Ask for caretaker explanation; request details
                                                       References: CPOD 1st Responder Guidelines training –
    Record observations of both words & actions       Gary Sacha; Update, vol. 17, no. 7, Laura Rogers (2004)
6. Document all your observations of the
                                                                        Revised for FVTC by:
   environment ASAP
                                                      WA State Criminal Justice Training Commission (2008)
    Focus all your senses on the surroundings
                                                       For additional resources & training information, consult
    Describe scene accurately & completely            www.fvtc.edu/childprotecttraining or contact WA CJTC
    Possible mechanism of injury present?             Program Manager Patti Toth at ptoth@cjtc.state.wa.us


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