VII-34 State of North Dakota The most ly rural state of North Dakota has 53 counties; 34 of them with coroners who are physicians. This is a small state with a population of about 600,000 and about 11,00C births each year; the incidence of SIDS every year is correspondingly low. Figures for the years 1969-71 were not made available. Dr. James R. Amog, State Health Officer for North Dakota, believes that some crit deaths are duc to a fulminating infection, like pneumonia, some due to arrhythmia. He thinks it may have a multiplicity of origins, but that it is a distinct clinical entity. His department is not directly involved with SIDS, but he did report that most of the autopsies in the state are performed in the cities of Bismarck, Fargo, Grand Forks or Minot. There are very few pathologiste in the state other than those cities. Dr. Amog has received NFSID literature and expressed an interest in distributing the information to SIDS parents in the state. A new member of his staff, Dr. Catherine P. Fitzpatrick, the Maternal & Child Health Director, may personally follow-up cases in the future or train public health nurses to assist families. 24-442 O 74-41 VII-35 State of South Dakota According to Mr. Charles S. Sisk, Assistant Director of the South Dakota Department of Vital Statistics, this mostly rural state has a coroner system, and most of the coroners are morticians. He added, though, that more health professionals are becoming interested in the office. One of the members of his staff was under the impression that SIDS "comes in waves" and that the cycle was "on the upswing in South Dakota." Dr. Robert H. Hayes, Director of the State Department of Health, felt his department wouldn't get involved directly until some "concrete evidence" about the disease was uncovered by research. At present, Dr. Hayes has centered his department's involvement around Emergency Medical Technicians, who drive the ambulances around the state, and has personally spoken to trainee classes on the subject. The Vital Statistics Department provided a tabulation of infant deaths for the years 1969-71 in South Dakota. In 1969, there were 60 deaths of children under a year old; two were listed as SIDS; both were autopsied For 1970, out of 87 deaths in the age group, four are shown as SIDS; two were autopsied. In 1971, there were 73 deaths; 11 of these are shown as SIDS; two were autopsied. AN OVERVIEW OF AREA VIII by Joyce Brekke The area in which our team worked covered the following SMSA's: Chicago It is difficult to attempt any sort of ranking of how well SIDS is handled in these SMSAs because the variations seem more evident-suburban/inner-city/ rural-type comparison. St. Louis City, for example, is in the jurisdiction of Mrs. Taylor, the Coroner, who seems rather uninterested and uninformed about SIDS. In contrast, St. Louis County deaths (the county surrounds the city on three sides) are handled by Dr. George Gantner, the Medical Examiner, whom I would single out as the individual most involved in helping SIDS parents on an official level that we encountered. Though the officials were not so prominent in Chicago, one could make a similar generalization about the community. In the suburbs, the NFSID is active and physicians, while possibly aware of SIDS to no more extensive a degree than those in the city, become more involved and do a bit more counseling in a particular family's crisis. Many inner-city families have no private physician, and, if they know of NFSID, seem to consider it some sort of social or suburban organization whose meetings they cannot or would not attend. For these families, the only contacts would be with the police or fire department, the emergency room personnel, the coroner's office and possibly the health department. Since none of these groups or organizations have any existing programs on SIDS, the family is most probably alone. Awareness of SIDS as a disease seems high in some of the smaller cities we visited. In cities such as Rockford, Illinois or Wichita, Kansas, the incidence of infant deaths is high enough that most pediatricians have come into contact with it. Since the pediatricians are usually practicing in some sort of clinic with other pediatricians, group experience and communication seems to heighten awareness. Also, pathologists in both communities, usually working privately or in affiliation with a local hospital, are familiar with SIDS literature, which may or may not affect the knowledge of the coroners. In these cities, like all the others, the health departments are uninvolved, though the staff may know a little about crib death. NFSID is not active either. It should be added that the professional awareness in these communities does not necessarily affect the treatment of families unless some organized system of communication exists between the coroner, the physician and the family. Unfortunately, in Rockford we were unable to contact any parents; but in Wichita, though pathologists, physicians and the medical examiner were aware of crib deaths, explanations to the families are often not clear VIII-3 or sufficient. We were told that both physicians and the medical examiner call the deaths "flash pneumonia" or "acute pneumonitis" and one mother had never heard of crib death or SIDS before our interview. The officials and professionals may, in spite of this, help the parents somewhat with their feelings of guilt by telling them there was nothing they could have done. In rural counties and sparsely populated counties surrounding larger cities, procedures become more difficult to pin down; and much seems to depend upon the attitude of the individual professional, whether an autopsy was done, and, probably most important to even the knowledge of officials, the past incidence of and experience with sudden, unexpected infant deaths. We were unable to talk to parents in most of these areas, so the view is necessarily one-sided. A big barrier to more frequent autopsies is often the fact that the county has no resident pathologist, which means that the body would have to be moved or a pathologist "imported." Also, county funds are often meager. The coroner's familiarity with SIDS varies, but in most cases is either minimal or slightly better, which could probably be expected of a lay person who becomes involved with only one or two infant deaths per year and who is probably kep much busier in his role as funeral director or physician. When autopsies are done, in most places it appears that they are done well; and pathologists, probably more so than any other group, were knowledgeable about SIDS. One factor which may tend to distinguish some of these communities is the presence of a teaching hospital nearby. Madison County, Illinois, for example, and Columbia, Missouri, are affected by the knowledge and research of nearby institutions. In both these areas, physicians, in particular, were aware of SIDS, perhaps through seminars or publicity. Also, in Columbia, we were told that if the family really wants an autopsy, Boone County Hospital or the University of Missouri Hospital will arrange one. In some communities, taking the baby to a pediatrician in a larger city for check-ups and care is common, so these families may later receive a better explanation of the death. It appears that in these rural areas most families, unlike in the cities, receive some explanation of their child's death from the coroner or their physician, perhaps because, as several coroners stated, "We know all these people." The coroner may relay the results through the physician, or the pathologist might send autopsy reports to him, or the coroner might talk to the family directly; but families are generally notified one way or another. Counseling and help beyond this point are relatively unavailable, as the health departments have no programs dealing with SIDS and parent groups are not organized outside the largest cities. Throughout the Midwest, we found that autopsies are not routine on all infant deaths except in St. Louis County and, recently, in DuPage County, Illinois. Reasons for this vary from lack of funds, to no local pathologist, to Dr. Daniel's explanation in Wichita, "We just don't find anything." Perhaps the most limiting factor is the prevalence in most areas of the practice that autopsies are performed only when there is suspicion of foul play. Many parents are reluctant to have an autopsy anyway, and even fewer will take the initiative to demand one. In some communities, if they do request a post, it can be arranged for free by the coroner or the local hospitals; but in other places, like Kansas City, Kansas, the parents must pay before the pathologist will come in. |