8.5 Rapid Response Procedure
- Rapid response remit
- Designated Paediatrician
- Rapid Response timeline
- Phase 1: Usually 0 - 5 days
- Phase 2: Within 5 - 7 days
- Phase 3: Usually within 8 - 12 weeks
- Useful contact numbers
- Related Policies, Procedures, and Guidance
The vast majority of sudden child deaths are the result of natural causes and are a tragedy for any family. Every child who dies deserves to have their sudden and unexplained death fully investigated so that a cause of death can be identified.
This procedure sets a minimum standard for a rapid response service for unexpected deaths in infancy and childhood, as outlined in Chapter 5 of the statutory guidance, Working Together to Safeguard Children.
This procedure applies when a child dies unexpectedly (from birth up to the 18th birthday, excluding stillborn babies), or where there is a lack of clarity about whether a death of a child is unexpected.
It is acknowledged that each death has unique circumstances and professionals involved have their own experience and expertise, which is drawn upon in handling individual cases.
This procedure provides guidance on capturing immediate information about an unexpected child death, while also giving support to the bereaved family. This ensures that early opportunities for information-gathering are not lost.
Throughout this procedure, the term ‘parent’ is used to refer to any parent or carer, including the person with a Special Guardianship Order or Residence Order, foster parents and the local authority for those in care.
An unexpected death is defined as a the death of an infant or child which was not anticipated as a significant possibility, for example 24 hours before the death; or where there was an unexpected collapse or incident leading to, or precipitating, the events which lead to the death.
Children dying at home, or in a hospice or other setting, who had been undergoing end-of-life care will not normally be considered to have died unexpectedly, and a rapid response to such deaths is rarely necessary.
When a child with a known life-limiting and or life-threatening condition dies in a manner or at a time that was not anticipated, the rapid response team should liaise closely and promptly with a member of the medical, palliative or end-of-life care team who knows the child and family, to jointly determine how best to respond to the child’s death.
The ‘Designated Paediatrician’ responsible for child death should be consulted where professionals are uncertain about whether the death was unexpected. If in doubt, the processes for unexpected child deaths should be followed until the available evidence enables a different decision to be made (i.e. until it becomes clear that the death was expected).
Professionals need to strike a balance between the sensitivities of handling the bereaved parents, and securing and preserving evidence which may aid them in arriving at an understanding of why a child has died.
When dealing with an unexplained child death, all agencies need to follow these common principles:
Rapid response remit
The service response to an unexpected child death should be safe, consistent and sensitive to those concerned. Bereaved parents and siblings should receive a similar response across Buckinghamshire.
Professionals should be aware that, in certain circumstances, separate investigative processes may be taking place alongside those described in this procedure (e.g. murder investigations, Sudden Unexpected Death in Infancy [SUDI] processes). Professionals and agencies should liaise across processes to avoid duplication.
The purpose of a rapid response service is to ensure that the appropriate agencies are engaged and work together to:
Rapid response begins at the point of death and ends when the final meeting has been convened and chaired by the designated paediatrician or equivalent. Any records of the meeting (i.e. statutory child death reporting form, meeting notes) should be forwarded to the CDOP at the time of the review.
The area in which the death of a child has been declared must take initial responsibility for convening and co-ordinating the rapid response process, until agreement for handover can be secured with the area where the child was normally resident.
Where notified of a death abroad, the professionals responsible for child death in the local authority where the child is normally resident must consider implementing this procedure as far as is practically possible, and fully record any decisions made.
The Designated Paediatrician has responsibility for ensuring a rapid response team is formed in response to each unexpected child death and that the rapid response process is carried out by them.
In the absence of the Designated Paediatrician, the on-call senior attending doctor will take on these duties and report progress to the Designated Paediatrician at the earliest opportunity. The Designated Paediatrician therefore maintains senior oversight of all cases requiring a rapid response.
In Buckinghamshire, young people aged 16 to 18 do not normally come under the remit of paediatricians. Where there is an unexpected death in a young person aged between 16 and 18, the Accident and Emergency Consultant or other medical consultant will initiate the rapid response process, whilst consulting the Designated Paediatrician.
Rapid Response timeline
The Designated Paediatrician is responsible for ensuring all actions relating to the rapid response process are completed. The rapid response timeline involves three phases:
It is important that all agencies are clear that the rapid response process is multi-dimensional, the information flow is variable, and that a number of different processes can occur at the same time, e.g. child protection or criminal enquiries.
Phase 1: Usually 0 - 5 days
On arrival at hospital
Involvement of the coroner
Multi-agency planning discussion
Immediate support for family
The police will begin an investigation into the unexpected death of a child on behalf of the coroner. They will carry this out in accordance with College of Policing guidelines.
Potential visit to the place where the child died
Phase 2: Within 5 - 7 days
A case discussion should take place as soon as practicable and, in any case, within one week of the child’s death, in order to:
Prior to this meeting, the Designated Paediatrician should discuss the case with the pathologist (when a post-mortem has taken place and consent obtained from the coroner) and the police senior investigating officer, where appropriate.
Involvement of the coroner and pathologist
Phase 3: Usually within 8 - 12 weeks
A further case discussion meeting should be convened and chaired by the Designated Paediatrician (or other relevant professional where negotiated) following the final results of the post-mortem examination becoming available. This should involve those who knew the child and family, and those involved in investigating the death – the GP, health visitors, school nurse, paediatricians, pathologist (or pathologist report), police senior investigating officers, coroner or coroner’s office, and, where relevant, social workers.
The discussion meeting should explicitly address the possibility of abuse or neglect as causes or contributory factors in the death, and the outcomes of this should be recorded.
The meeting should agree how and by whom the parents will be informed about the post-mortem results and the outcome of the meeting. This meeting should also agree how and by whom the parents will be offered ongoing support and given the opportunity to have their views taken into account by the CDOP review.
Where other investigations are ongoing, the meeting should conclude with a record of the current situation.
An agreed record of the case discussion meeting and all reports should be sent to the coroner, to take into consideration in the conduct of the inquest and, in the cause of death, notified to the Registrar of Births and Deaths.
The record of the case discussion and the record of the core data set should also be made available to the BSCB’s CDOP Panel.
When a child dies away from their normal place of residence, a joint decision will need to be made by the rapid response teams in both areas as to which team will lead the investigation and in which LSCB area the case review meeting should be held. On occasions, separate meetings may be appropriate in both LSCB areas, but good communication between the teams is essential.
Expected child deaths
Support for staff
Useful contact numbers
- Designated Paediatrician for unexplained deaths in childhood (via hospital switchboard): 01296 315000
- Paediatric consultant on-call (via hospital switchboard): 01296 315000
- Thames Valley Police: 101
- Coroner’s office:
- High Wycombe: 01494 686180 (weekdays only)
- Aylesbury: 01296 396116 (weekdays only)
- First Response Team (social care): 01296 383962
- Out of hours (social care): 0800 999 7677
- Hospital Child Protection Team: 01296 315165 (Mon–Fri 08.00–17.00)
- Health Community Child Protection Team: 01296 566080
- Chaplains (via hospital switchboard): 01296 315000
- Bereavement Support Midwives: 07717 571919 or 07717 127740
- Child Bereavement Trust: 0845 3571000
- Health Visitors:
- High Wycombe: 0779 989 8650
- Aylesbury: 0779 981 0482
- South Bucks: 0787 6391 217
- Buckinghamshire Safeguarding Children Board:
- Department for Education. Working together to Safeguard Children – A guide to inter-agency working to safeguard and promote the welfare of children (2015). https://www.gov.uk/government/publications/working-together-to-safeguard-children--2
- Resuscitation Council (UK). Resuscitation Guidelines (2015). https://www.resus.org.uk/resuscitation-guidelines/
- See also Department for Children, Schools and Families information sheet: Deaths in Children with Life-Limiting Conditions at: http://childdeath.ocbmedia.com/public_docs/Information%20Sheet%20-%20Deaths%20in%20Children%20with%20Life-Limiting%20Conditions.pdf
- Royal College of Pathologists and Royal College of Paediatrics and Child Heath, Sudden Unexpected Death in Infancy and Childhood, 2016. https://www.rcpath.org/resourceLibrary/sudden-unexpected-death-in-infancy-and-childhood-report.html