9. London Rapid Response Procedure

• A decision has been made that a death of a child is unexpected; or
• There is a lack of clarity about whether a death of a child is unexpected.

• Initiate immediate resuscitation unless clearly inappropriate. Resuscitation once commenced should be continued according to the UK Resuscitation Guidelines (2005) until an experienced doctor (usually the consultant paediatrician on call) has made a decision that it is appropriate to stop;
• Notify the police if they are not already present. Once the death has been confirmed as unexpected (see definition in section 2.5), London Ambulance Service crew attending the death should contact Ambulance Communications Centre, who in turn will inform police (ambulance staff should follow the Joint Royal Colleges Ambulance Liaison Committee Guidelines and the London Ambulance Service Child Protection Procedures);
• Arrange for the body to go to an accident and emergency department (rather than a mortuary) by ambulance, unless the circumstances of the death require the body to remain at the scene for forensic examination;
• Prior to arrival at the accident and emergency department, provide relevant information and history to accident and emergency staff.

• Respond quickly to the unexpected death of a child;
• Make immediate enquiries into and evaluate the reasons for and circumstances of the death, in agreement with the coroner;
• Undertake the types of enquiries that relate to the current responsibilities of each organisation when a child dies unexpectedly;
• Collate information in a standard format (see the Child Death Information Gathering and Evaluation Booklet in appendix 4);
• Engage appropriately post death, maintaining contact at regular intervals with family members and other professionals who have ongoing responsibilities to the family, to ensure that they are appropriately informed.

• Leading the co-ordination of multi-agency activity and information sharing throughout the rapid response process;
• Ensuring all agencies are notified and actions are agreed;
• Completing the initial notification form (see Notification Proforma in appendix 1);
• Co-ordinating a case discussion or meeting within 5-7 days of the death;
• Co-ordinating a formal case discussion meeting 8-12 weeks following the death; and
• Ensuring that a full and accurate report is provided to the Local Safeguarding Children Board's Child Death Overview Panel (using the child death information gathering and evaluation booklet, and additional papers as appropriate).

• The trauma - unexpected losses, particularly if the parent/sibling was not present or able to hold or touch the lost child, are difficult to make real.
• Grieving - numbness as protection from overwhelming mental pain may be so pronounced that the family member cannot think clearly, become confused, loses their bearings, and/or may be unable to express feelings of any kind
  
  Grief can get stuck in self-blame, this is most likely to arise if it is a child who has died.
• Anger and self-reproach - anger is a very natural reaction to outrageous loss, particularly if it was caused by human agency. It may be directed appropriately against the perpetrators of the trauma or inappropriately against all authorities or against the people nearest to hand.
• Change - when disaster strikes, all in a moment the world becomes a dangerous place because the family's assumptions about the world cannot be taken for granted any more.

See Services Available From Cruse Bereavement Care in appendix 5.

1. Care of the bereaved family:
   Ensuring at every phase that the needs of the bereaved family are considered. This includes the welfare and protection of remaining siblings, spiritual needs and possible involvement of the extended family (see section 6.3).
2. Deciding on response:
   Deciding on whether the death is unexpected and whether to implement the rapid response procedure. The designated paediatrician responsible for unexpected deaths in childhood is responsible for making the decision about whether a death is unexpected.
3. Notification to the Single Point of Contact (SPOC):
   The SPOC will be notified of all child deaths by the attending paediatrician, using the notification form (see Notification Proforma in appendix 1).
   
   Notification must be immediate in order for the rapid response to commence. The attending paediatrician (or delegated senior health professional) will make this notification and make arrangements for multi-agency co-ordination and information sharing. This will remain the responsibility of the attending paediatrician until s/he is able to hand over to the designated paediatrician for unexpected deaths in childhood.
   
   The police and LA children's social care (through out-of-hours emergency duty teams (EDTs) if necessary) must be notified by the attending paediatrician immediately.
   
   The coroner and Director of Public Health must be notified by the SPOC on the next working day.
4. Child protection:
   Emerging information giving rise to child protection concerns about remaining siblings and/or other children in the household or peer group will require formal referral to LA children's social care in line with section 6. Referral and assessment. See also section 5. Children in specific circumstances.
   
   See also section 8.2.3.
5. Serious case review:
   All agencies need to be mindful of any emerging information giving rise to the need for the LSCB to consider conducting a Serious Case Review in line with section 19. Serious case reviews of the London Child Protection Procedures (LSCB, 2007) (Chapter 19. Serious case reviews is in accordance with Chapter 8 of government guidance Working Together to Safeguard Children (DCSF, 2006).). A review of this nature would be conducted using chapter 8 of Working Together and will operate simultaneously to the rapid response procedure.
   
   The decision to undertake a serious case review must be taken by the Chair of the LSCB where the child normally resides.
6. Media issues:
   All Local Safeguarding Children Boards should have a process for managing media interest. Staff must be enabled to proceed with their functions without intrusion and the family provided with privacy.
   
   Media attention and enquiries will be managed by the Local Safeguarding Children Board in collaboration with the Metropolitan Police press office.
7. Support to staff:
   Child deaths will have varying degrees of impact on staff. Agencies need to be aware that clear procedures, effective communication and leadership will provide staff with confidence and enable them to respond appropriately to families. Staff may respond to the emotions involved and agencies should have arrangements in place to manage this.

• Phase one (usually 0-5 days): the management of information sharing from the point at which the child's death becomes known to any agency until the initial results of the post-mortem have been completed;
• Phase two (usually 5-7 days): the management of information sharing once the initial post mortem results are available; and
• Phase three (usually 8-12 weeks): the management of information sharing through the case discussion meeting when the final post-mortem report is available.

See also Rapid Response Flowchart in appendix 3.

8.1   Phase I: usually 0 - 5 days

Immediate response:

Immediate Notification

• The coroner;
• The police;
• LA children's social care;

And, in a timely manner, will notify:

• The Child Death Overview Panel (using the Child death information gathering and evaluation booklet, in appendix 4)
• The Director of Public Health

Information sharing

Potential visit to the place where the child died

8.2  Phase II: within 5 - 7 days

8.3   Phase III: within 8 - 12 weeks

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