Management of the Societal Impact of Poisoning
Early Warning System
The Network participates in early warning surveillance by notifying each other of local trends, personal hazards, hazardous material incidents, and product recalls. In addition, the New York State Network shares and reviews this information with centers nationwide through the American Association of Poison Control Centers.
Each center has conducted a survey of hospitals, their services and their antidote availability.
An example of how the early warning system can be effective in detecting sentinel cases:
- A 74-year-old male presented to the Emergency Department (ED) after ingesting a free sample of Uroprin (yohimbe) that he received in the mail. On presentation to the ED, he was found to be clammy and complained of feeling dizzy. The poison center was contacted and advised the treating physician to observe the patient (in the ED) for 8 hours and discharged once his symptoms had resolved.
- A 75-year-old male presented to another Emergency Department (ED) after ingesting a free sample of Uroprin (yohimbe) that he received in the mail. On presentation to the ED, he was found to have a heart rate of 134 beats per minute, and a blood pressure of 186/110 mmHg. His chief complaint was of feeling dizzy. The poison center was contacted and recommended that the patient receive general supportive care and was admitted overnight for observation.
Both of these cases occurred on the same day but were reported from two different hospitals in two different counties. The poison center staff noticed a trend and immediately advised their director who put a call into the distributor of the product Uroprin. It was discovered that a massive nationwide mailing of these free samples of Uroprin had been conducted over the previous week. The poison center staff alerted the New York State Department of Health, the other New York State poison centers within the Network, and the American Association of Poison Control Centers (AAPCC) national office regarding these exposures and mailings.
Toxic Exposure Surveillance System (TESS)
Administered by the American Association of Poison Control Centers (AAPCC), all poison centers nationwide contribute to the TESS database. During 2001, the AAPCC initiated an auto upload program that immediately collects and categorizes all cases entered into each poison center's database. The data is immediately analyzed and monitored for trends in poisoning as well as chemical and/or bioterroristic events. In case of a recognized sentinel event, the AAPCC will notify the local poison center that, in turn, will notify the proper governmental agencies.
Other information or feedback that is recovered can be used to monitor product safety and can provide an early opportunity to consider product reformulation or repackaging. The information collected by the AAPCC is distributed to poison centers, governmental agencies and industry.
An example of the value of this database was shown during the events of September 11, 2001. At that time, portions of the state (and country) were activated on the auto-upload system. The AAPCC was able to track Anthrax calls throughout the nation and observe for additional small pockets of cases. In addition, the poison centers in New York State monitor both pesticide exposures and West Nile Virus, and the data collected is distributed to the New York State Pesticide Agency. The auto upload feature continues to assist in monitoring for sentinel cases, such as food poisoning and carbon monoxide.
The following is an example of a case that highlights the benefit of the auto upload feature:
A local emergency department called the poison center with a patient who was suffering form a heroin overdose. The patient's status, included vital signs, were collected and entered into the Tozicall database. It was discovered that this particular patient had similar signs and symptoms as other cases found in New Jersey and Pennsylvania. At its conclusion, it was determined that a heroin supply was adulterated with a pharmaceutical and was potentially lethal to the user. We were able to work with local Health Departments and put out alerts to various emergency departments to prevent further morbidity and mortality.
Centers continue to provide training and education to the 911 dispatchers. Protocol stipulates that all 911 calls involving a poison exposure are called into the poison center prior to dispatching an ambulance. With 911 on the line, the centers triage the calls and then determine if the patient needs to be transported. If the patient is unconscious or experiencing life-threatening problems, 911 dispatches an ambulance and the EMTs on the scene contact the poison center for recommendations during transport. If the patient is asymptomatic and no serious effects are expected from the exposure, 911 are advised that a transport is not necessary and the poison center handles the case, including follow-up.
Each center in the Network reports information on pesticide poisonings to the New York State Department of Health, which maintains a registry that monitors both the acute and chronic effects of pesticide exposure. It investigates occurrences of pesticide poisoning and may perform environmental monitoring to determine the source and circumstances of exposure. Both occupational and environmental incidents are followed. Appropriate acute and long-term interventions (changes in work practice/protective equipment) work to prevent pesticide poisoning.
West Nile Virus (WNV) encephalitis transmission via mosquitoes continued in the greater New York metropolitan area during the summer and fall of 2002, 2003 and 2004. Consistent with prior years, ground and aerial application of pesticides were used to control the adult mosquito population. As concerns regarding possible public health effects among individuals who may have been exposed to these pesticides continued, the New York State Pesticide Poisoning Registry (NYSPPR) evaluated all calls regarding pesticide exposures received by poison control centers during the period of active spraying.
Centers work with local emergency planning boards and emergency services to assist and advise during toxic spills, fires and hazardous incidents. They also participate in disaster drills conducted by host institutions.
Since the events of September 11, 2001, the Network has continued to train health care professionals, governmental, and uniformed agencies regarding biological and chemical agents. In addition, the Network has also focused on the development and distribution of public education within the communities served. Network members were also involved in:
the development of decontamination rooms and hospital medical response systems in their local areas;
- serving as advisors to local and State health Bioterrorism Task Forces;
- assisting in the Metropolitan Medical Response System; and
- participating in the enhanced health Alert Network.
- providing Bioterrorism programs to various Health Department agencies, school groups and community organizations.
Since poison centers are considered sentinel units, the members of the Network assist local health departments in bioterrorism surveillance, including daily reports. Training, including mock drills in coordination with other governmental and uniformed agencies, has been ongoing.
Centers conduct quality assurance activities on a daily basis. Direct assessment occurs with peer review of active cases and supervisory review of active, random and high-risk cases. Feedback is provided and instruction given at staff meetings to address recurring problems and unusual poisonings, as well as review of protocols and guidelines. In addition, centers conduct periodic satisfaction surveys, hospital services and antidote availability. Fatalities are reviewed and discussed and abstracts written for submission to the national database. Staff receive periodic evaluation and skills assessment for competency.
Public Education and Awareness
The Network strives to offer a variety of outreach programs throughout the state in an effort to instruct the public in poison prevention and to create an awareness of the services of poison centers.
Various education programs have been designed and developed for the general public targeting specific age groups and are provided in different areas of the state. Examples of the types of programs provided are identified in Appendix Four.
An example of how the Public Educators utilize poison center data and bring an educational service to the community is described below:
A review of the ten most common calls to the poison center revealed that carbon monoxide (CO) exposures were a significant cause of morbidity and mortality in the community. When combined with other sources, this study helped facilitate the enactment of a law requiring CO detectors within the city limits. The Community Educators developed a community outreach program on CO. However, it was realized that low-income (home owning) families might not have the ability to purchase CO detectors. Using Geographical Information System (GIS) software, the educators determined areas of low call volume where most homes were one to two family units. A program was then created where attendees were educated on both CO and CO detectors. In addition, free CO detectors were distributed and follow up calls one month later charted the progress.
A statistical summary of public education outreach efforts is presented below:
|Public Service Announcements||4||2||3|
|TV and Radio Interviews||56||21||5|
Inhalant Awareness Programs
Reintroduces the concept of poison prevention and focuses specifically on poisons in their environment including inhalants. Topics include recognition of inhalants, short and long term effects, sudden sniffers death and how to help a friend who is using inhalants.
This program educates parents and other adults about common household products being abused by children. This program teaches the who, what, why and when of inhalant use, including signs and symptoms, short and long term effects, sudden sniffers death, and what to do if you find your child using an inhalant.
Collaboration with Community Groups
Poison control centers collaborate with the following community groups:
- American Association of Retired Persons
- American Red Cross
- Boy & Girl Scouts
- Child care councils
- Community action organizations
- Community health coalitions
- Cornell Cooperative Extensions
- Day care centers
- Department of Transportation
- Elementary, middle and high schools
- Emergency medical services
- Fire departments
- Grocery Stores
- Head Start
- Health departments
- Human service organizations
- Junior League
- Literacy organizations
- Migrant health centers
- National Safe Kids
- Office of the Aging
- Parenting programs
- Public libraries
- Religious organizations
- School nurses
- Senior centers
- Social service agencies
- Volunteers/auxiliaries at hospitals
- Women, Infant and Children (WIC)
- Children under five
- Foster care
- Migrant workers
- Day care/preschool workers
- Developmentally challenged
- Hearing Impaired
- Pregnant teens
- Adult learners
- Diverse populations and cultures
Poison Prevention Week
National poison prevention week is recognized during the third full week in March. Centers conduct special activities throughout the month.
2002 Through 2004 Highlights
Activated Charcoal Educational Campaign
Poster, Essay and Coloring Contests
Special News Releases, Public Service Announcements and Proclamations programs
Chain and Neighborhood Pharmacy literature distribution and advertisement programs
Inhalant Educational Program
Presentations and information tables at multiple WIC sites
Presentations and information tables for New York City libraries
In order to stay abreast of changes in the field of toxicology, all staff at the poison centers participate in toxicology symposia, in-service training, electronic continuing education, conferences and meetings. In turn, staff of the poison center teach pharmacy and nursing students, ambulance personnel (EMT), physicians and physician assistants.
Appendix Five includes a description of these programs.
|Health Professional Training||2002||2003||2004|
|Case Reviews/ Grand Rounds/ Journal Club||611||607||621|
|Electronic Continuing Education||6||5||5|
Research And Publications
The Network conducts research, studies, case reviews, quality assurance and presents and/or publishes its findings.
Appendix Six includes examples of research conducted and articles published, and abstracts presented at annual meetings for 2002 thorough 2004.
|Research and Publications||2002||2003||2004|