Care after death, unexpected child death and family support — branching viva

Branch 1 — Confirming the death and the first-hour response

Examiner. How do you confirm this death, and what are your first actions over the next hour?^[3]

Confirm death clinically: fixed and dilated pupils, absent heart sounds and central pulse on auscultation for a full minute, absent respiratory effort, and absent brainstem reflexes. Record the time. Brain-stem death testing applies only to a ventilated child being considered for withdrawal, not here.^[3]

The first-hour actions run in parallel: report to the coroner (via police in ANZ) and do not certify; preserve the scene, clothing and bedding and do not wash the infant or remove lines; involve the SUDI team and designated paediatrician; break the news to the parents with SPIKES; offer family time and memory-making; and arrange a staff hot debrief.^[2][7]

Examiner. Why must you not certify this death?^[2]

Because it is an unexpected death — sudden, of unknown cause, not anticipated within 24 hours. An unexpected death is reportable to the coroner, who alone authorises release of the body and death registration. Issuing a death certificate for an unexpected death is a serious error and may obstruct the investigation and any safeguarding or inherited-disease work-up.^[2][3]