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Executive Summary
Pages 1-20

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From page 1...
... In order to respond fully and specifically to the charge, the Committee adopted the very language used by HRSA: to consider the "future of poison prevention and control services" and to develop a "systematic" approach. Therefore, we examined the role of poison control services within the context of the larger public health system, the injury prevention and control field, and the fields of general medical care and medical and clinical toxicology.1 Furthermore, we examined how poison control centers function relative to the functions performed by other health 1The term toxicologist is a general description of an individual dealing with any aspect of acute or chronic poisonings, and it does not have a specific definition or implication with regard to training or job description.
From page 2...
... Thus, in order to assess the magnitude, scope, and boundaries of the area under study, the Committee adopted an operational definition of poisoning without attempting to resolve all the classification disputes about specific elements of the definition. The second major issue concerned the historical development of the poison control centers and their position in the broader fields of public health and emergency medical services.
From page 3...
... Furthermore, definitions of a poisoning and its place among other medical diagnoses vary from the 9th to the 10th revisions of the International Classification of Diseases, the system that drives health data categorization at both the federal and state levels. Finally, the network of poison control centers has evolved its own operational definition of what constitutes an "exposure" to a poisonous substance.
From page 4...
... . · Exposure to a potential toxin without a defined clinical effect (as when par ents telephone a poison control center about a possible ingestion by their child)
From page 5...
... We envision a future Poison Prevention and Control System that is integrated with the medical care system and public health and that includes a network of poison control centers as a vital, but not exclusive, element. BACKGROUND In approaching its work, the Committee recognized that the publicaccess peer-reviewed literature on poison control centers did not provide an adequate evidentiary base to answer the charge.
From page 6...
... These centers offer a critical set of services to the public and health care professionals by providing timely, professional treatment advice in response to telephone queries concerning poisoning exposures. According to the American Association of Poison Control Centers (AAPPC)
From page 7...
... Therefore, the Committee based its report on a proposed Poison Prevention and Control System, including within it a network of poison control centers as a vital, but not exclusive, element. The Committee also concluded that in order to fulfill their pivotal role in the overall system, poison control centers must be more stable financially and better integrated and coordinated for performance of their public health roles.
From page 8...
... The Committee's recommendations form the basis for the Poison Prevention and Control System. They are grouped according to the areas listed in the Committee's charge: · Scope of core poison prevention and control activities · Coordination of poison control centers with other public health entities · Strengths and weaknesses of poison control center organizational structures · Financial support for the Poison Prevention and Control System · Assurance of high-quality poison control center services · National data system and surveillance needs Scope of Core Poison Prevention and Control Activities The Committee identified a core set of activities that constitutes the essential functions of the network of poison control centers within the larger system envisioned by the Committee.
From page 9...
... Poison control centers alone cannot fulfill the need for public and professional education related to poisoning prevention and treatment and all-hazards response. Public health agencies already have the authorities, networks, and administrative mechanisms to carry out broad educational efforts, as they do for the prevention of other injuries and for other public health campaigns.
From page 10...
... The responsible agencies would assure the accomplishment of all public health core functions or essential services as they relate to TABLE ES-1 Core Functions and Essential Services of Public Health as Applied to Poison Prevention and Control Services Core Functions 10 Essential Services Assessment 1. Monitor health status to identify community Collection, assembly, analysis, and problems.
From page 11...
... 10. Identify best practices for poison control centers.
From page 12...
... and the states should establish a Poison Prevention and Control System that integrates poison control centers with public health agencies, establishes performance measures, and holds all parties accountable for protecting the public. At the federal level, the Secretary of Health and Human Services should designate the lead agency for this purpose; at the state level, the governor of each state should formally designate the appropriate lead (e.g., injury prevention directors from the public health entity)
From page 13...
... The Committee suggests new data-gathering efforts to obtain original financial and performance data from existing poison control centers. These data are needed to guide future public funding of core activities.
From page 14...
... Congress should amend the current Poison Control Center Enhancement and Awareness Act to provide sufficient funding to support the proposed Poison Prevention and Control System with its national network of regional poison control centers. Support for the core activities at the current level of service is estimated to require more than $100 million annually.
From page 15...
... development and maintenance of quality assurance and improvement mechanisms for every component of the Poison Prevention and Control System; (2) training activities for health providers outside the poison control centers who require training in toxicology, such as emergency department workers and emergency medical technicians; (3)
From page 16...
... (For example, medical toxicologists are certified by a board that is a member of the American Board of Medical Specialties rather than by a toxicology organization.) With the continued development of poison control centers and their increased integration into the public health system, alternative certification processes will offer advantages over the current system, including greater independence of the process from the participants, wider input from the health care community, and wider recognition of the skills and contributions of poison control centers and their personnel.
From page 17...
... Using funding from CDC, AAPCC has recently developed a capability to provide real-time surveillance through TESS based on input from the poison control centers. The Committee recognizes that this system was established and has been significantly strengthened through the initiative of AAPCC.
From page 18...
... The Director of the Centers for Disease Control and Prevention should ensure that exposure surveillance data generated by the poison control centers and currently reported in the Toxic Exposure Surveillance System are available to all appropriate local, state, and federal public health units and to the poison control centers on a "real-time" basis at no additional cost to these users. These data should also be publicly accessible with oversight mechanisms and privacy guarantees and at a cost consistent with other major public use systems such as those currently managed by the National Center for Health Statistics.
From page 19...
... c. The Secretary of Health and Human Services should encourage funding by appropriate agencies, such as CDC and the Consumer Product Safety Commission, to ensure the needed flow of information from toxicology researchers in poison control centers on prevention problems and strategies to regulators from toxicology researchers in poison control centers and to encourage the study and development of new regulatory strategies and initiatives to reduce poisonings.


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