Forging a Poison Prevention and Control System (2004) / Chapter Skim
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5 Poison Center Activities, Personnel, and Quality Assurance
5 Poison Center Activities, Personnel, and Quality Assurance
Pages 106-135
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From page 106... ...
Other activities are offered by only some poison control centers, depending on their interests, capabilities, affiliations, and the funding initiatives of sponsoring agencies. For example, centers affiliated with medical toxicology training programs serve as clinical training sites for medical toxicology residents.
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From page 107... ...
. These services depend on the rapid, efficient call handling by specialists with training in clinical toxicology, supported by medical toxicologists, consultants in subspecialty areas, and poison information databases.
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From page 108... ...
consultation on syndromal case clustering with public health officials. Calls from the Public Poison control centers provide information to the public regarding poisoning exposures and respond to requests for information about poisons -- defined as calls in which there is no actual exposure discussed (Hoffman, 2002)
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From page 109... ...
ACTIVITIES, PERSONNEL, AND QUALITY ASSURANCE 109 TABLE 5-1 Poison Control Center Direct Service Matrix Service Recipient Office, Clinic, Patient/ or Emergency County and Family EMS Department In-Hospital Regional Service Type Member Personnel Personnel Personnel Public Health Comfort and yes -- -- -- - reassure Identify products yes yes yes yes -Determine potential yes yes yes yes - toxicity Assist 911 response yes yes -- -Direct poisoning yes yes yes -- - first aid Guide prehospital yes yes -- -- - triage decisions Provide advance -- yes yes -- - notification if care transferred Offer continued care yes yes yes yes - guidance and monitoring Provide poison yes -- -- -- - prevention education Guide advanced -- -- yes yes - patient management and diagnostics Guide caregiver -- yes yes yes - protective actions Supply reference -- -- yes yes - materials related to patient management Link provider with -- -- yes yes - special toxicology resources Guide hazardous -- yes yes yes yes materials management Consult on -- -- yes yes yes syndromal case clustering Participate in -- -- -- yes yes public health notifications as health threats emerge
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From page 110... ...
Calls from Health Care Professionals Poison control centers provide information to a wide variety of health care providers regarding exposures and potential exposures. As the focus
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From page 111... ...
. TABLE 5-3 Information Call Content to Poison Control Centers (most common topics involved in 1,110,635 information calls*
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From page 112... ...
Approximately 20 percent of the human exposure calls made to poison control centers come from health care facilities (Poison Control Center Annual Reports, 20002002)
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From page 113... ...
that is advertised by all U.S. poison control centers.
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From page 114... ...
. In this capacity, poison control centers work in close collaboration with local public health agencies and other agencies with responsibilities in this area, such as fire and police departments.
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From page 115... ...
In addition to a national toxicosurveillance effort performed in conjunction with AAPCC, poison control centers participate in local syndromic surveillance and report notifiable conditions affecting multiple individuals to local and/or state health officials. · Continuing education and research and preparation for bioterrorism through effective training programs: Poison control centers provide training to various groups (e.g., the public, emergency medicine residents, medical toxicology
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From page 116... ...
Centers also serve as a repository for specialized databases regarding agents of bioterrorism and chemical terrorism. Event and Response activities include the following: · Poison control centers can provide assistance with early recognition and notification of bioterrorism and chemical terrorism events; coordinate antidote distribution and guide appropriate antidote use; assist health care professionals with management of exposed patients and rescue personnel; disseminate threat and preventive/therapeutic information to the public; and provide consultative support to public health and law enforcement authorities.
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From page 117... ...
Systematic Reporting of Exposures to a Collective Poison Control Center Database Poison control centers currently report all exposure data to the TESS database (Watson et al., 2003)
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From page 118... ...
Access to center data and familiarity with the health care delivery issues facing poison control centers provide staff with a unique perspective on issues surrounding the delivery of center services, and the means to study strategies for improving these services. Despite these opportunities, the research output of poison control centers is generally modest.
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From page 119... ...
Case series/report 110 93 93 296 40.1% Descriptive database review 38 58 64 160 21.7% Pharmacokinetic 8 2 3 13 1.8% Survey 0 2 11 13 1.8% Cohort analysis 26 19 19 64 8.7% Case-control study 4 5 5 14 1.9% Uncontrolled clinical trial 2 0 3 5 0.7% Historically controlled clinical trial 0 1 1 2 0.3% Nonrandomized controlled clinical trial 2 1 3 6 0.8% Randomized controlled clinical trial 1 1 0 2 0.3% Survey or administration 24 22 28 74 10.0% Education 1 5 5 11 1.5% Cell culture/biochemical 5 2 1 8 1.1% Whole organ or whole animal study 12 13 9 34 4.6% Laboratory research/product analysis 4 12 20 36 4.9% Total 237 236 265 (%) 32.1% 32.0% 35.9% SOURCES: Journal of Toxicology, Clinical Toxicology (2001, 2002, 2003)
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From page 120... ...
Moreover, the training of poison control center staff is predominantly clinical. Public Education The following is a general statement of the types of public education currently provided by the poison control centers.
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From page 121... ...
HEALTH CARE PROFESSIONALS AND THEIR TRAINING BY POISON CONTROL CENTERS Poison control centers provide education for many categories of health care professionals. A critical component of this education is the training of the health care professionals who actually work in or with centers.
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From page 122... ...
Common roles for medical toxicologists outside poison control centers include direct care or consultation regarding poisoned patients, teaching of medical toxicology fellows and other health care professionals, toxicology research, and medicolegal consultation. A smaller number of medical toxicologists work in various capacities in public health or government agencies, including CDC and the U.S.
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From page 123... ...
PIPs differ from SPIs in that they lack training as nurses, pharmacists, or physicians, but rather have a variety of other health-related backgrounds. Because they have less advanced training in health care, PIPs working in AAPCCcertified poison control centers are required to do so under the onsite supervision of a CSPI or the managing or medical director of the center.
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From page 124... ...
Clinical experience in the setting of a center is required for the training of medical toxicologists, and centers affiliated with such training programs are involved extensively in the education of these physicians. Thus, poison control centers play an essential role in the education of each of the major categories of center personnel and they also provide continuing medical education in their service area to health care professionals and to groups such as fire or police departments.
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From page 125... ...
. Medical Toxicologists Poison control centers provide an essential part of the training of medical toxicology fellows.
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From page 126... ...
Poison control center staff also contribute to professional continuing education via publications, including editing toxicology textbooks, writing book chapters or review articles, contributing sections to references such as Poisindex®, and preparing review or teaching documents for government agencies such as ATSDR. Education of Other Health Care Professionals Poison control centers contribute to the education of a wide variety of health care professionals, including medical, nursing, pharmacy, and dental students; medical and pharmacy residents and fellows; and EMTs.
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From page 127... ...
To be eligible for this certification, a SPI must be trained as a nurse, pharmacist, or physician, and must acquire experience at a poison control center, consisting of 2,000 hours answering poison information or exposure calls, and 2,000 calls answered. One AAPCC requirement of certified poison control centers is that all SPIs acquire CSPI certification within 2 years of achieving eligibility.
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From page 128... ...
Internally, poison control centers have instituted programs consisting of case reviews, call monitoring, and other measures designed to evaluate
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From page 129... ...
Most such data (reviewed in Chapter 6) focus on poison center utilization or cost-effectiveness, specifically the role of poison control centers in reducing health care costs by reducing unneeded emergency department or primary care visits.
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From page 130... ...
With the continued development of poison control centers and their increased integration into the public health system, alternative certification processes may offer advantages over the current system. Certification of centers, SPIs, and PIPs by an independent organization would offer greater independence of the process from the participants, wider input from the health care community, and wider recognition of their skills and contributions.
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From page 131... ...
Poison control centers have evolved a common set of activities to deal with these needs, primarily centered around telephone lines staffed by specialists with training in clinical toxicology and backed up by medical toxicologists, a wide range of consultants, and extensive collaborations with public health agencies and first responders. Complementary educational efforts are also offered by most poison control centers.
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From page 132... ...
ROCKY MOUNTAIN POISON AND DRUG CENTER: INTEGRATION INTO PUBLIC HEALTH SYSTEM The Rocky Mountain Poison and Drug Center (RMPDC) is the designated regional poison control center for Colorado; Montana; Las Vegas, Nevada; Idaho; and Hawaii.
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From page 133... ...
Forrester.) The Texas Poison Control Center's (TPCC's)
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From page 134... ...
One hour later, the hospital called the NNEPC staff on the poison control center hotline for information regarding the possibility that this incident involved poisoning -- not an infectious disease or foodborne illness outbreak. The staff reviewed potential causes and requested that the beverage and foods potentially linked to the exposures be secured for later evaluation, and paged the center's two boarded toxicologists for consultation.
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From page 135... ...
The center staff followed these patients over subsequent weeks. During this time, the poison control center continued to manage approximately 100 other hotline calls daily, and the publicity of the cases led to an increased number of calls about food poisoning and potential chronic heavy metal exposure.
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