Poison control center

A poison control center is a medical service that is able to provide immediate, free, and expert treatment advice and assistance over the telephone in case of exposure to poisonous or hazardous substances. Poison control centers answer questions about potential poisons in addition to providing treatment management advice about household products, medicines, pesticides, plants, bites and stings, food poisoning, and fumes. In the US, more than 72% of poison exposure cases are managed by phone, greatly reducing the need for costly emergency department and doctor visits.[1][2]

History

After World War II there was a proliferation of new drugs and chemicals in the marketplace, and consequently suicide and childhood poisonings from 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. In Europe in the late 1940s special toxicology wards were set up; initial wards were started in Copenhagen and Budapest, and the Netherlands began 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 at St. 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 with Edward 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 the American 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 of toxicology to 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

A similar movement evolved in Europe but unlike the American movement the majority were centralized toxicology treatment centers with integrated poison information centers. The French developed an inpatient unit for the treatment of poisoned patients in the late 1950s. In England the National Poison Information Service was developed at Guy's Hospital under Dr Roy Goulding.[4] At around the same time Dr Henry Mathew started a poison treatment center in Edinburgh.[12] In 1964 the European Association for Poison Control Centers was formed at Tours, France.[4][13] Australasian centers were also established in the 1960s. The New Zealand center started in Dunedin in December 1964, while in Australia, the New South Wales Poisons Information Center was established in 1966.[14][15]

Article 45 of the CLP Regulation places 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 the EEA, since 2020–2025, hazardous product manufacturers are required to send the formulation of their products to the European Chemicals Agency (ECHA) and to print a Unique 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

Australia

In Australia, New South Wales, Victoria, Western Australia, and Queensland have dedicated Poisons Information Centres staffed by specially-trained pharmacists.[16][17][18][19] The Western Australia centre also provides services to South 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)

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 a database with formulas of dangerous mixtures provided by the industry, and a database of relevant scientific literature in the field of toxicology. The Antipoison Centre is also responsible for keeping a stock of certain rare or expensive antidotes, and managing a network of hospital pharmacies that also have certain antidotes in stock. Lastly, the Antipoison Centre has a mission of toxicovigilance, meaning it warns relevant authorities (such as the FPS Public Health, Food Chain Safety and Environment or the FAMHP) about new and emerging risks of chemicals and pharmaceuticals involved in cases of poisoning. Since 2015, the Grand Duchy of Luxembourg has 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

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

German states designate poison control centers. There are currently 8 different centers, some of them serving several states.[22]

India

In April 2018, a Poison Information Center was established in Kolkata, in the Department of Forensic Medicine and Toxicology at R. G. Kar Medical College. The Center usually caters to patients as well as the doctors from the entire state of West Bengal, in addition to other parts of India. The toll free number is 1800 345 0033.[23]

Italy

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

Netherlands

The National Poisons Information Centre (NVIC) of the University Medical Center Utrecht provides 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 until 2011. It was then transferred to the University Medical Center Utrecht.

Palestinian Territories

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

Saudi Arabia

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

Sweden

Giftinformationscentralen (Swedish Wikipedia) is responsible for poison control in Sweden.[27]

United Kingdom

The National 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-emergency 111 number for specific information on poisons, or 999 in an emergency.[30]

United States

The American Association of Poison Control Centers manages 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 a TTY/TDD number 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]

Other countries

A worldwide directory of poison centers is available from the World Health Organization's website.[32]

See also

Footnotes
  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. PMID 9018189.
  3. Grayson R (1962). "The poison control movement in the United States". Ind Med Surg. 31: 296–7. PMID 13901334.
  4. Govaerts M (1970). "Poison control in Europe". Pediatr Clin North Am. 17 (3): 729–39. doi:10.1016/s0031-3955(16)32463-4. PMID 5491436.
  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. ISSN 0002-9289. PMID 1529987.
  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 31 July 2022). Retrieved 17 June 2018.{{cite journal}}: CS1 maint: DOI inactive as of July 2022 (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. PMC 1621008. PMID 13207477.
  8. Ford MD, Delaney KA, Ling LJ, Erickson T, eds. (2001). Clinical toxicology. WB Saunders Company. ISBN 978-0-7216-5485-0.
  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. PMID 18163234. S2CID 28841177.
  10. The Lewin Group, Inc. "Final Report on the Value of the Poison Center System" (PDF). p. 3. Archived from the original (PDF) on 15 August 2019. Retrieved 25 March 2021.
  11. "webPOISONCONTROL®". NCPC. Retrieved 2 June 2015.
  12. Proudfoot A (1988). "Clinical toxicology—past, present and future". Hum Toxicol. 7 (5): 481–487. doi:10.1177/096032718800700516. PMID 3056845. S2CID 2078304.
  13. Persson H (1992). "European Association of Poison Centres and Clinical Toxicologists". J. Toxicol. Clin. Toxicol. 30 (2): v–vii. doi:10.3109/15563659209038627. PMID 1588665.
  14. "History of the New Zealand Poison Centre". New Zealand National Poison Centre. Retrieved 20 January 2008.
  15. "About the NSW Poisons Information Centre". NSW Poisons Information Centre. 14 January 2008. Retrieved 20 January 2008.
  16. "Poisons Information Centre". Department of Health. 16 July 2019. Retrieved 28 September 2020.
  17. "Victorian Poisons Information Centre". Department of Health and Human Services. Retrieved 28 September 2020.
  18. "WA Poisons Information Centre". Sir Charles Gairdner Hospital. 3 August 2020. Retrieved 28 September 2020.
  19. "Queensland Poisons Information Centre". Children's Health Queensland Hospital and Health Service. 18 October 2017. Retrieved 28 September 2020.
  20. "À propos de nous" [About us]. www.centreantipoisons.be (in French). Antipoison Centre. Retrieved 7 July 2018.
  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. ISSN 1687-1030.
  22. "BVL - Liste der Giftnotrufzentralen". www.bvl.bund.de. Retrieved 14 November 2021.
  23. "Poison Information Centre". R G Kar Medical College and Hospital (in Indonesian). Retrieved 2 August 2019.
  24. "Italian National Institute of Health". Alleanza contro il cancro. 10 March 2017. Retrieved 2 August 2019.
  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. PMID 19070281.
  27. "Giftinformationscentralen". Giftinformationscentralen (in Swedish). Giftinformationscentralen. Retrieved 5 August 2020.
  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. Retrieved 2 August 2019.
  31. "American Association of Poison Control Centers". AAPCC. Archived from the original on 29 November 2008. Retrieved 1 December 2008.
  32. "World directory of poison centres". World Health Organization. Retrieved 8 March 2022.

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