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Poison control center

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Apoison control centeris a medical service that is able to provide immediate, free, and expert treatment advice and assistance over thetelephonein case of exposure topoisonousor hazardous substances. Poison control centers answer questions about potential poisons in addition to providing treatment management advice about household products,medicines,pesticides,plants,bitesandstings,food poisoning,andfumes.In the US, more than 72% of poison exposure cases are managed by phone, greatly reducing the need for costlyemergency departmentand doctor visits.[1][2]

History

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AfterWorld War IIthere was a proliferation of newdrugsandchemicalsin the marketplace, and consequently suicide and childhoodpoisoningsfrom these agents drastically increased. Around this time up to half of all accidents in children were poisonings with a substantial number of fatalities.[3]These factors led to the medical community developing a response to both unintentional and intentional poisonings. InEuropein the late 1940s special toxicology wards were set up; initial wards were started inCopenhagenandBudapest,and theNetherlandsbegan a poison information service.[4]

In the United States during the 1930s,Louis Gdalman,a pharmacist knowledgeable in the chemistry of harmful substances, set up a poison information service atSt. Luke's Hospital (Chicago, Illinois).[5]He became known around Chicago and the country as the person to contact in a poisoning case and would take calls at home around the clock. In the late 1940s, Gdalman began to organize the poison information onto note cards and created a standardized form to collect new information on new toxic substances. By 1953 he had collected an extensive library of information on thousands of poisons and he established the first Poison Control Center along withEdward Press.[6][7]By 1957 there were 17 poison control centers in the U.S., with the Chicago center serving as a model; these centers dealt mainly with physician enquiries by giving ingredient and toxicity information about products, along with treatment recommendations. Over time the poison control centers started taking calls from the general public. The majority of poison centers were not part of a patient treatment facility; they strictly provided information.

In 1958 theAmerican Association of Poison Control Centers(AAPCC) was founded to promote cooperation between poison centers in different cities and to standardize the operation of these centers. An additional part of the AAPCC's activities was poison prevention and education programs for both physicians and the general public. In 1968 the American Academy of Clinical Toxicologists (AACT) was established by a group of medical doctors. The AACT's main objective was to apply principles oftoxicologyto patient treatment and improve the standard of care on a national basis. In the 1960s and 1970s a rapid proliferation of poison centers emerged and by 1978 there were 661 centers in the USA. This trend reversed during the 1980s and 1990s with a number of centers closing or merging. In 2000 there were 51 certified centers in the USA.[8]As of 2006 there are 55 centers operating in the US.[9]

A 2019 study conducted for the AAPCC showed that every dollar invested in the poison center system saves $13.39 in health care costs and productivity.[10]

While poison control centers have traditionally provided expert consultations by telephone, on 30 December 2014 an online option was launched by a group of U.S. poison centers to meet the growing demand for accurate web-based health information.[11]Based on age, weight, amount, route, symptom status and substance implicated, it provides case-specific guidance for poison exposures. The webPOISONCONTROL application uses ingredient-based algorithms to generate a recommendation including whether an emergency department visit or call to poison control is required. If it's safe to stay home, then home treatment recommendations, specific symptoms to expect, and symptoms of greater concern that would require a call to poison control or a visit to an emergency department are outlined.

Europe

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A similar movement evolved in Europe but unlike the American movement the majority were centralized toxicology treatment centers with integrated poison information centers. TheFrenchdeveloped an inpatient unit for the treatment of poisoned patients in the late 1950s. In England the National Poison Information Service was developed atGuy's Hospitalunder Dr Roy Goulding.[4]At around the same time Dr Henry Mathew started a poison treatment center inEdinburgh.[12]In 1964 the European Association for Poison Control Centers was formed atTours,France.[4][13]Australasiancenters were also established in the 1960s. The New Zealand center started inDunedinin December 1964, while in Australia, theNew South WalesPoisons Information Center was established in 1966.[14][15]

Article 45 of theCLP Regulationplaces the duty upon Member States to appoint "bodies responsible for receiving information relating to emergency health response". These appointed bodies are often known as Poison Centres.

In theEEA,since 2020–2025, hazardous product manufacturers are required to send the formulation of their products to theEuropean Chemicals Agency(ECHA) and to print aunique formula identifier(UFI) code on their products. This code lets poison centers know the exact formulation of a product, while the formulation is only shared to the ECHA and attached poison control centers.

Countries

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Australia

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In Australia,New South Wales,Victoria,Western Australia,andQueenslandhave dedicated Poisons Information Centres staffed by specially-trained pharmacists.[16][17][18][19]The Western Australia centre also provides services toSouth Australia.[18]In Tasmania and other Australian territories, the NSW centre provides equivalent services.[16]All centres are accessed through one number, 13 11 26, and are available 24/7.

Belgium and Luxembourg

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The Belgian Antipoison Centre (Centre Antipoisons in French, Antigifcentrum in Dutch) is tasked with receiving and answering urgent calls for medical advice regarding cases of poisoning 24/7 and throughout the year. Its hotline can be reached on the telephone number 070 245 245 in Belgium and is available to both medical professionals and the general public. To be able to answer the calls qualitatively, the Antipoison Centre manages adatabasewithformulasofdangerous mixturesprovided by the industry, and a database of relevantscientific literaturein the field of toxicology. The Antipoison Centre is also responsible for keeping a stock of certain rare or expensiveantidotes,and managing a network ofhospital pharmaciesthat also have certain antidotes in stock. Lastly, the Antipoison Centre has a mission oftoxicovigilance,meaning it warns relevant authorities (such as theFPS Public Health, Food Chain Safety and Environmentor theFAMHP) about new and emerging risks of chemicals andpharmaceuticalsinvolved in cases of poisoning. Since 2015, theGrand Duchy of Luxembourghas an agreement with Belgium to have the Antipoison Centre also function as the poison control center for Luxembourg. Medical professionals and members of the public from Luxembourg can reach the Antipoison Centre on the telephone number 8002 5500.[20]

Egypt

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The Poison Control Centre of Ain Shams University (PCC-ASU) was established in 1981. It is one of the earliest poisoning treatment facilities to be established in the Middle East. It has its own inpatient department, ICU and Analytical Toxicology unit.[21]It serves between 20 and 25 thousand cases a year.

Germany

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Germany has seven designated poison control centers, some serving several states.[22]Calling the centers is free of charge for members of the public. Some centers charge a fee for calls by hospitals or other medical professionals.

  • Baden-Württemberg: Poison Information Center of the Medical Center - University of Freiburg: (0761) 19 240
  • Bavaria: Poison Control Center - University Hospital rechts der Isar (Munich): (089) 19 240
  • Berlin, Brandenburg: Charité Poison Control Center (Berlin): (030) 19 240
  • Bremen, Hamburg, Lower Saxony, Schleswig-Holstein: Poison Information Center Nord (Göttingen): (0551) 19 240
  • Hesse, Rhineland-Palatinate, Saarland: Poison Information Center of the University Medical Center Mainz: (06131) 19 240
  • Mecklenburg-Vorpommern, Saxony, Saxony-Anhalt, Thuringia: Joint Poison Information Center Erfurt:(0361) 730 730
  • North Rhine-Westphalia: Poison Information Center Bonn:(0228) 19 240

India

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Italy

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TheIstituto Superiore di Sanità(ISS) (National Institute of Health) is responsible for poison control in Italy.[24]

Netherlands

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The National Poisons Information Centre (NVIC) of theUniversity Medical Center Utrechtprovides a 24/7 hotline service (030-2748888), staffed by poison information specialists (SPIs). It is open to medical professionals only and is not available to the general public.

Since 2011 the NVIC also provides a web-based exposure analysis and poison information system.[25]As with the webPOISONCONTROL system, this is a free-of-charge, fully confidential web application that enables medical professionals to quickly and efficiently assess the potential risks of (mixed) exposures, as well as their clinical signs and symptoms, and possible therapeutic interventions. As with the other online options worldwide, it remains advisable to consult the NVIC if the exposure is to a larger number of substances.

The NVIC can, on request, also provide specific training to emergency medical personnel (GMTs), emergency departments, physicians and their assistants, and other interested parties with regards to exposure prevention and management.

The NVIC was part of the National Institute for Public Health and the Environment[1]until 2011. It was then transferred to theUniversity Medical Center Utrecht.

Palestine

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The Palestinian Poison Control and Drug Information Centre was established in 2006, byAnsam Sawalha.[26]

Saudi Arabia

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The poison control department in King Fahad Medical City provides its service for healthcare professionals 24/7 throughout the year.

Sweden

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Giftinformationscentralen[sv]is responsible for poison control in Sweden.[27]

United Kingdom

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TheNational Poisons Information Service(NPIS) provides toxicological information to health professionals to ensure patients receive appropriate treatment.[28]NPIS do not take calls from the general public,[29]who are instead advised to contact the non-emergency111number for specific information on poisons, or 999 in an emergency.[30]

United States

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TheAmerican Association of Poison Control Centersmanages a 24-hour hotline (1-800-222-1222), which is continuously staffed by pharmacists, physicians, nurses, and poison information specialists who have received dedicated training in the field of toxicology. Calls to the number are automatically routed to the poison control center that covers the territory from which the call is placed. It has aTTY/TDDnumber for the hearing impaired. Poison educators across the country also offer poison prevention training and education sessions to community institutions, along with educational materials.[31]

See also

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Footnotes

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  1. ^"American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS) Annual Report".2009.
  2. ^Miller T, Lestina D (1997). "Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis".Annals of Emergency Medicine.29(2): 239–245.doi:10.1016/S0196-0644(97)70275-0.PMID9018189.
  3. ^Grayson R (1962). "The poison control movement in the United States".Ind Med Surg.31:296–7.PMID13901334.
  4. ^abcGovaerts M (1970). "Poison control in Europe".Pediatr Clin North Am.17(3): 729–39.doi:10.1016/s0031-3955(16)32463-4.PMID5491436.
  5. ^Botticelli, J. T.; Pierpaoli, P. G. (1992). "Louis Gdalman, pioneer in hospital pharmacy poison information services".American Journal of Hospital Pharmacy.49(6): 1445–1450.doi:10.1093/ajhp/49.6.1445.ISSN0002-9289.PMID1529987.
  6. ^Wyckoff, Alyson Sulaski (October 2013)."AAP had hand in first poison control center".AAP News.34(10): 45.doi:10.1542/aapnews.20133410-45(inactive 12 September 2024).Retrieved17 June2018.{{cite journal}}:CS1 maint: DOI inactive as of September 2024 (link)
  7. ^Press E, Mellins R (1954)."A poisoning control program".Am J Public Health.44(12): 1515–1525.doi:10.2105/AJPH.44.12.1515.PMC1621008.PMID13207477.
  8. ^Ford MD, Delaney KA, Ling LJ, Erickson T, eds. (2001).Clinical toxicology.WB Saunders Company.ISBN978-0-7216-5485-0.
  9. ^Bronstein AC, Spyker DA, Cantilena LR, Green J, Rumack BH, Heard SE (December 2007)."2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS)".Clin Toxicol.45(8): 815–917.doi:10.1080/15563650701754763.PMID18163234.S2CID28841177.
  10. ^The Lewin Group, Inc."Final Report on the Value of the Poison Center System"(PDF).p. 3. Archived fromthe original(PDF)on 15 August 2019.Retrieved25 March2021.
  11. ^"webPOISONCONTROL® ".NCPC.Retrieved2 June2015.
  12. ^Proudfoot A (1988). "Clinical toxicology—past, present and future".Hum Toxicol.7(5): 481–487.doi:10.1177/096032718800700516.PMID3056845.S2CID2078304.
  13. ^Persson H (1992). "European Association of Poison Centres and Clinical Toxicologists".J. Toxicol. Clin. Toxicol.30(2): v–vii.doi:10.3109/15563659209038627.PMID1588665.
  14. ^"History of the New Zealand Poison Centre".New Zealand National Poison Centre.Retrieved20 January2008.
  15. ^"About the NSW Poisons Information Centre".NSW Poisons Information Centre. 14 January 2008.Retrieved20 January2008.
  16. ^ab"Poisons Information Centre".Department of Health.16 July 2019.Retrieved28 September2020.
  17. ^"Victorian Poisons Information Centre".Department of Health and Human Services.Retrieved28 September2020.
  18. ^ab"WA Poisons Information Centre".Sir Charles Gairdner Hospital.3 August 2020.Retrieved28 September2020.
  19. ^"Queensland Poisons Information Centre".Children's Health Queensland Hospital and Health Service.18 October 2017.Retrieved28 September2020.
  20. ^"À propos de nous"[About us].centreantipoisons.be(in French). Antipoison Centre.Retrieved7 July2018.
  21. ^Halawa, Heba; Nageeb, Saad; Guindi, El (1 July 2013)."Annual Report of the Poison Control Centre, Ain Shams University Hospitals, Cairo, Egypt, 2012".Ain Shams Journal of Forensic Medicine and Clinical Toxicology.21(2): 27–34.doi:10.21608/ajfm.2013.19165.ISSN1687-1030.
  22. ^"BVL - Liste der Giftnotrufzentralen".bvl.bund.de.Retrieved14 November2021.
  23. ^"Poison Information Centre".R G Kar Medical College and Hospital(in Indonesian).Retrieved2 August2019.
  24. ^"Italian National Institute of Health".Alleanza contro il cancro.10 March 2017.Retrieved2 August2019.
  25. ^"Home".vergiftigingen.info.
  26. ^Sawalha, Ansam F. (1 November 2008). "Poison Control and the Drug Information Center: the Palestinian experience".Isr. Med. Assoc. J.10(11): 757–760.PMID19070281.
  27. ^"Giftinformationscentralen".Giftinformationscentralen(in Swedish).Retrieved5 August2020.
  28. ^"Home".npis.org.
  29. ^"National Poisons Information Service - submitting information for mixtures placed on the GB market - Chemical classification".
  30. ^"Information for Members of the Public".National Poisons Information Service.Retrieved2 August2019.
  31. ^"American Association of Poison Control Centers".AAPCC. Archived fromthe originalon 29 November 2008.Retrieved1 December2008.
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