Poison Control Center Lobna AL Juffali. Outline History Introduction Comparison between PCC and...

Poison Control Poison Control Center Center Lobna AL Juffali Lobna AL Juffali

OutlineOutline

HistoryHistory Introduction Introduction Comparison between PCC and DICComparison between PCC and DIC Telephone Protocol for handling Telephone Protocol for handling

Poison CallsPoison Calls

HistoryHistory

1953 1953 The establishment of the First The establishment of the First PCCPCC

19581958 Formation of American Association Formation of American Association of of Poison Control Poison Control Center (AAPCC)Center (AAPCC)

1960 600 poison center in the USA1960 600 poison center in the USA

20072007 Annual Report of the American Annual Report of the American Association of Poison Control Centers’ Association of Poison Control Centers’ National Poison Data System (NPDS): National Poison Data System (NPDS): 25th Annual Report25th Annual Report

Over 4.2 million calls were captured by NPDS Over 4.2 million calls were captured by NPDS in 2007in 2007

2,482,041 human exposure calls, 2,482,041 human exposure calls,

1,602,489 information requests, 1,602,489 information requests,

131,744 nonhuman exposure calls. 131,744 nonhuman exposure calls.

Substances involved most frequently in were Substances involved most frequently in were analgesics (12.5% of all exposures). analgesics (12.5% of all exposures).

20072007 Annual Report of the American Annual Report of the American Association of Poison Control Centers’ Association of Poison Control Centers’ National Poison Data System (NPDS): National Poison Data System (NPDS): 25th Annual Report25th Annual Report

The most common exposures in children less The most common exposures in children less than age 6 were cosmetics/personal care than age 6 were cosmetics/personal care products (10.7% of pediatric exposures). products (10.7% of pediatric exposures).

Drug identification requests comprised 66.8% Drug identification requests comprised 66.8% of all information calls.of all information calls.

NPDS documented 1,597 human fatalities.NPDS documented 1,597 human fatalities.

Poison Control CentersPoison Control Centers

PCC were established for two PCC were established for two reasonsreasons::

To provide rapid access to information To provide rapid access to information valuable in assessing and treating valuable in assessing and treating poisoningspoisonings..

To assist with poisoning preventionTo assist with poisoning prevention

FunctionsFunctions

Assess and treatment recommendations Assess and treatment recommendations during poisoning via 24-hour emergency during poisoning via 24-hour emergency telephone servicestelephone services

Provide public and professional educational Provide public and professional educational programsprograms

To collect data on poisoningsTo collect data on poisonings

To perform researchTo perform research

Assist the public and health care providers Assist the public and health care providers during hazardous material spillsduring hazardous material spills

StaffingStaffing Medical director ( physician with interest and Medical director ( physician with interest and

expertise in medical toxicology) duties includeexpertise in medical toxicology) duties include Protocol review and approvalProtocol review and approval Audit of poison center recommendationsAudit of poison center recommendations Availability for consultation on difficult casesAvailability for consultation on difficult cases

Administrative directorAdministrative director 5-6 full time specialists5-6 full time specialists

PharmacistsPharmacists NursesNurses

PhysiciansPhysicians

One year experienceOne year experience answered at least 2000 callsanswered at least 2000 calls ExamExam

Public education CoordinatorPublic education Coordinator

Poison Center Poison Center CertificationCertification

AAPCC provides a program That certifies regional AAPCC provides a program That certifies regional poison centers:poison centers:

Designation by appropriate public health officialsDesignation by appropriate public health officials

Demonstration that the center is used appropriately Demonstration that the center is used appropriately

throughout the regionthroughout the region

adequate staffing by specialist adequate staffing by specialist

Demonstration of the role of the physicianDemonstration of the role of the physician

Poison Center Poison Center CertificationCertification

Medical director in the operation of the centerMedical director in the operation of the center

Adequate training and experience of an Adequate training and experience of an administrative director administrative director

Demonstration of adequate programs in Demonstration of adequate programs in professional and public educationprofessional and public education

Participation in the AAPCC data collectionParticipation in the AAPCC data collection

Comparison Between Comparison Between DIC and PCCDIC and PCC Both have a common goal Both have a common goal ““provide comprehensive, accurate, and timely provide comprehensive, accurate, and timely

information to their clients”information to their clients” Both used the informationBoth used the information “ “to enhance the medical care of patients”to enhance the medical care of patients” Both have similar Both have similar ““information retrieval process and physical information retrieval process and physical

layouts”layouts”

Despite these similarities, there are a number Despite these similarities, there are a number of important differences between the two of important differences between the two servicesservices

Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation

Comparison Between Comparison Between DIC and PCC DIC and PCC (Cont’d)(Cont’d)

ClienteleClientele : : Public vsPublic vs. . health care professionalshealth care professionals

Eighty eight percent of PCC calls came Eighty eight percent of PCC calls came from publicfrom public

Nine to 10 perecnt of DIC calls came Nine to 10 perecnt of DIC calls came from publicfrom public


Comparison Between Comparison Between DIC and PCC DIC and PCC (Cont’d)(Cont’d)

Call VolumeCall Volume : : Exteremily large from public versus Exteremily large from public versus

health care professionalshealth care professionals.. Average is 103 calls per day Average is 103 calls per day ((human human

exposure onlyexposure only)) Range is 33 to 213 calls per dayRange is 33 to 213 calls per day


Comparison Comparison Between DIC and Between DIC and PCC PCC (Cont’d)(Cont’d) Administrative differencesAdministrative differences Hours of Operation/CostHours of Operation/Cost :: PCC operates 24 hrs a day year-round PCC operates 24 hrs a day year-round

vs. 9 AM to 5 PMvs. 9 AM to 5 PM

PCC requires large staffs compare to DICPCC requires large staffs compare to DIC

PCC is more expensive to operate than DIC PCC is more expensive to operate than DIC


Comparison Between Comparison Between DIC and PCC DIC and PCC (Cont’d)(Cont’d) Administrative differencesAdministrative differences

Staffing :Staffing : PCC relies not only on pharmacist but PCC relies not only on pharmacist but

also on other health care professionals also on other health care professionals (nurses, physicians, technicians)(nurses, physicians, technicians)

Nurses worked 52% of the total phone Nurses worked 52% of the total phone hours in 1993hours in 1993

Pharmacists and physicans worked Pharmacists and physicans worked 36% and 3% of the total hours, 36% and 3% of the total hours, respectivelyrespectively


Comparison Between DIC Comparison Between DIC and PCC and PCC (Cont’d)(Cont’d) Procedural differencesProcedural differences

Response TimeResponse Time ::

All PCC calls require an immediate responseAll PCC calls require an immediate response

Time is related to the efficacy of the therapeutic Time is related to the efficacy of the therapeutic

interventionsinterventions

The average response time is 5 minThe average response time is 5 min. . in PCC vsin PCC vs. .

1515 - - 30 min DIC 30 min DIC


Comparison Between DIC Comparison Between DIC and PCC and PCC (Cont’d)(Cont’d) Procedural differencesProcedural differences

Call complexityCall complexity : : PCC calls are less complex than DIC callsPCC calls are less complex than DIC calls

Most poisoning patients rarely have complex Most poisoning patients rarely have complex

medical historymedical history

Poisoning agents rePoisoning agents re--occur constantly from occur constantly from

yearyear--toto--yearyear

PCC is the first point of contact by public and PCC is the first point of contact by public and

health professsionalshealth professsionals


Comparison Between DIC Comparison Between DIC and PCC and PCC (Cont’d)(Cont’d) Procedural differenceProcedural difference

ReferencesReferences:: PCC assess and make treatment PCC assess and make treatment

recommendation for any potential poison recommendation for any potential poison (medication, chemical, household, biological, (medication, chemical, household, biological, natural toxin). But DIC handle medication- and natural toxin). But DIC handle medication- and pharmacy-related inquirespharmacy-related inquires

PCC will often have a broader base reference PCC will often have a broader base reference collection than DICcollection than DIC


ReferencesReferences:: PCC assess and make treatment PCC assess and make treatment

recommendation for any potential poison recommendation for any potential poison (medication, chemical, household, biological, (medication, chemical, household, biological, natural toxin). But DIC handle medication- and natural toxin). But DIC handle medication- and pharmacy-related inquirespharmacy-related inquires

PCC will often have a broader base reference PCC will often have a broader base reference collection than DICcollection than DIC

Comparison Between DIC and Comparison Between DIC and PCC PCC (Cont’d)(Cont’d) Procedural differenceProcedural difference

DocumentaionDocumentaion:: Documentation helps in developing a Documentation helps in developing a

data system data system General Epidemiological Data (date & time General Epidemiological Data (date & time

of call, reason of exposure)of call, reason of exposure) Caller characteristics (site of call)Caller characteristics (site of call) Patient characteristics (age, gender, Patient characteristics (age, gender,

pregnancy status)pregnancy status)


Comparison Between DIC and Comparison Between DIC and PCC PCC (Cont’d)(Cont’d) Procedural differenceProcedural difference

DocumentaionDocumentaion::(Cont’d)(Cont’d)

Exposure characteristics (substance, route Exposure characteristics (substance, route and site of exposure)and site of exposure)

Clinical course (Clinical manifestation, Clinical course (Clinical manifestation, medical outcomes)medical outcomes)

Medical management Medical management characteristics(Therapeutic intervention)characteristics(Therapeutic intervention)


Considerations of Considerations of PCCPCC

Facility considerationsFacility considerations : : LocationLocation ( (near ER, medical library, hospital near ER, medical library, hospital

pharmacy)pharmacy) Work space and environmentWork space and environment

EquipmentEquipment : : Telephone system Telephone system ((direct with enough linesdirect with enough lines)) PC computer system andPC computer system and//or local area network or local area network ((LANLAN)) Modem and facsimile machineModem and facsimile machine Internet accessInternet access Other Other ((such as file cabinets, refrigerators, such as file cabinets, refrigerators,

microwavemicrowave) ) Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center

(PCC).Power Point Presentation (PCC).Power Point Presentation

Considerations of Considerations of PCC PCC (Cont’d)(Cont’d)

ResourcesResources : : Two factors should be available in Two factors should be available in

PCCPCC The experience and training of the The experience and training of the

specialistspecialist The quality of the information The quality of the information

available to the specialist.available to the specialist.


Considerations of Considerations of PCC PCC (Cont’d)(Cont’d) ResourcesResources : :

Micromedex’s Poisindex (a database of more Micromedex’s Poisindex (a database of more than 800,000 household products, chemicals, than 800,000 household products, chemicals, and medications)and medications)

Clinical Toxicology of Commercial ProductsClinical Toxicology of Commercial Products General clinical toxicology textsGeneral clinical toxicology texts Specialized toxicology textsSpecialized toxicology texts Internal protocol for handling certain poisonsInternal protocol for handling certain poisons Primary literature (case report)Primary literature (case report) On-call medical support and expertsOn-call medical support and experts in the areain the area


Considerations of Considerations of PCC PCC (Cont’d)(Cont’d) Policy and ProceduresPolicy and Procedures : :

Different than DIC in almost all Different than DIC in almost all aspectsaspects

Handling intentional exposureHandling intentional exposure Long term public education programLong term public education program Release of PCC tape recordingRelease of PCC tape recording Telephone system repairTelephone system repair


Telephone Protocol For Telephone Protocol For Handling Poison CallsHandling Poison Calls

I .Initial assessment I .Initial assessment SubstanceSubstance Symptoms Symptoms What has been doneWhat has been done

II. HistoryII. History Basic informationBasic information SubstanceSubstance AmountAmount SymptomsSymptoms

III. AssessmentIII. Assessment Toxicity of the substanceToxicity of the substance Circumstances of exposureCircumstances of exposure Competency of the callerCompetency of the caller

Telephone Protocol For Telephone Protocol For Handling Poison CallsHandling Poison Calls

IV. Treatment plan (one of the following)IV. Treatment plan (one of the following) No treatmentNo treatment First aid and observe at homeFirst aid and observe at home Syrup of ipecac and observe at homeSyrup of ipecac and observe at home Refer t o MD, ER,etcRefer t o MD, ER,etc

V. Follow upV. Follow up Made at 0.5 hr,2-4hrs,12hrsor 24hrsMade at 0.5 hr,2-4hrs,12hrsor 24hrs

Has the victim remained asymptomaticHas the victim remained asymptomatic Were instructions followedWere instructions followed Was treatment effectiveWas treatment effective Poison prevention teachingPoison prevention teaching ReferralReferral

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