Protection for the innocent

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Abstract
New procedures The protocol, which establishes a standard routine for a collaborative multiagency response to every sudden unexpected infant death, details what is expected from ambulance crews, accident and emergency staff, child protection coordinators, coroners, coroners' officers, general practitioners, health visitors, midwives, paediatricians, pathologists, police, and social workers. It emerged out of the Avon cot death studies, which began in the early '80s.10 11 Fleming and colleagues had introduced their first structured arrangements for home visits and multiagency review of sudden unexpected infant deaths in 1984, and the benefits quickly became apparent: “Every one of the major risk factors for cot death was first identified here in the '80s, and it was through that approach,” says Professor Fleming, who believes that not only will the protocol ensure more robust and reliable investigations of sudden unexpected infant deaths but that it could also lead to a halving in the number of deaths from sudden infant death syndrome. One of the responsibilities of the new boards will be to collate data on deaths in their regions and report important factors to the Confidential Enquiry into Maternal and Child Health. The inquiry will in turn aggregate the regional data and draw nationally applicable conclusions. The protocol fundamentally changes the way sudden unexpected infant deaths are investigated. A key shift is that the investigating police officer should visit the home with a paediatrician. “If your child was ill, you wouldn't ask a policeman to tell you what was wrong with it,” says Professor Fleming. It also calls for a change of attitude among the police, who traditionally have treated sudden infant deaths like any other unexplained deaths—with suspicion. This contrasts with the Kennedy report, which stressed that “An important starting point is the acknowledgement that in the vast majority of cases where babies suddenly die, nothing unlawful has taken place.” Professor Fleming, having worked on the protocol for the past four years with every police force in the Southwest, is convinced that forces nationwide will embrace the concept of investigating sudden infant deaths in partnership with a paediatrician. “Initially, many of them were suspicious and concerned but once they'd become engaged they recognised that in a sense it takes a lot of the pressure off them as well. They are no longer having to look for medical clues and there's no question that two sets of eyes and ears pick up a lot more information.” Instead of treating the scene of death as a crime scene and arriving in the small hours of the morning to seize potential evidence, trained, plain clothed officers attend the house at a civilised hour and in partnership with a paediatrician. The parents benefit from post-traumatic debriefing in the setting in which the trauma occurred and the investigators benefit because “when you talk to people about what's happened in the place where it has happened, they remember much more of the detail and, indeed, they want to give us the information.” Geared to the importance of the first “golden hour” of any investigation, police were concerned initially that vital evidence would be lost, but the Avon researchers found that the information gathered in this way often pointed them in the direction of particular tests that needed to be done on the baby and which might not have given valid results if the pathologist did not examine the body for two or three days.