POISON CONTROL INFORMATION AND MANAGEMENT

POISON CONTROL
INFORMATION AND
MANAGEMENT.
Past, Present & Future
Singapore Pioneers in Poison
Information Management
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Late Prof. Chao Tzee Cheng.
Prof. Gopalakrishnakone.
Dr. Bosco Bloodworth.
Prof. Anantharaman.
Dr. R.Ponnampalam.
The study shows the need for enhanced
drug and poison information resources.
The local physician community also
expect guidance and expert advice from
a specialist.
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The DPIC was highly regarded for its
speed, competence and applicability,
facilitating better treatment and
unnecessary emergency visits. There
was overall satisfaction with the
service provided by DPIC.
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SGH PROCEEDINGS • VOL 18 • NO 1
• 2009
Are Poison Centres cost effective?
Direct public access to these services reduces the use of emergency health care
resources, thus lowering health care costs.
T E Kearney, et al. Health care cost effects of public use
of a regional poison control center. West J Med. 1995;162(6): 499–504.
The average additional cost per blocked call was $10.89 from a societal perspective,
or $33.14 from a health care purchaser perspective.
Phillips KA et al. The costs and outcomes of restricting public access to poison control centers.
Results from a natural experiment. Med Care1998 Mar;36(3):271-80
The regional poison control center was substantially more cost-effective than the
treatment of poison exposures without the services of a regional poison control
center for both morbidity and mortality.
Harrison DL et al. Cost-effectiveness of regional poison control centers
Arch Intern Med 1996 Dec 9-23;156(22):2601-8
PCC provides large dollar savings compared to dollars received in state support.
LoVecchio F et al. Poison control centers decrease emergency healthcare
utilization costs. J Med Toxicol 2008 Dec;4(4):221-4.
The maximum annual cost attributable to unnecessary outpatient service utilization in
Louisiana was estimated to be $1.4 million, an amount more than three times the
annual poison control center state appropriation.
King WD et al. Poison control centers: can their value be measured?
South Med J 1991 Jun;84(6):722-6.
a 1% higher poison control center human poison exposure call rate was associated with
a 0.19% lower hospitalization rate among people who visited emergency
departments because of poisoning. If the observed association is causative, then 43.3
calls would prevent 1 hospital admission, yielding 7321 dollars in net cost savings
and a return on investment of 5.9:1
Zaloshnja E et al. The potential impact of poison control centers
on rural hospitalization rates for poisoning. Pediatrics 2006 Nov;118(5):2094-100.
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poisoning and toxic exposure cases may be diverted safely from emergency medical
services dispatch to a regional poison center for management, reducing unnecessary
responses, with substantial cost savings.
Anderson BD et al. Diversion of 911 poisoning calls
to a poison center. Prehosp Emerg Care 1998 Jul-Sep;2(3):176-9.
Are Poison Centres cost effective?
Direct public access to these services reduces the use of emergency health care
resources, thus lowering health care costs.
T E Kearney, et al. Health care cost effects of public use
of a regional poison control center. West J Med. 1995;162(6): 499–504.
The average additional cost per blocked call was $10.89 from a societal perspective,
or $33.14 from a health care purchaser perspective.
Phillips KA et al. The costs and outcomes of restricting public access to poison control centers.
Results from a natural experiment. Med Care1998 Mar;36(3):271-80
The regional poison control center was substantially more cost-effective than the
treatment of poison exposures without the services of a regional poison control
center for both morbidity and mortality.
Harrison DL et al. Cost-effectiveness of regional poison control centers
Arch Intern Med 1996 Dec 9-23;156(22):2601-8
PCC provides large dollar savings compared to dollars received in state support.
LoVecchio F et al. Poison control centers decrease emergency healthcare
utilization costs. J Med Toxicol 2008 Dec;4(4):221-4.
The maximum annual cost attributable to unnecessary outpatient service utilization in
Louisiana was estimated to be $1.4 million, an amount more than three times the
annual poison control center state appropriation.
King WD et al. Poison control centers: can their value be measured?
South Med J 1991 Jun;84(6):722-6.
a 1% higher poison control center human poison exposure call rate was associated with
a 0.19% lower hospitalization rate among people who visited emergency
departments because of poisoning. If the observed association is causative, then 43.3
calls would prevent 1 hospital admission, yielding 7321 dollars in net cost savings
and a return on investment of 5.9:1
Zaloshnja E et al. The potential impact of poison control centers
on rural hospitalization rates for poisoning. Pediatrics 2006 Nov;118(5):2094-100.
poisoning and toxic exposure cases may be diverted safely from emergency medical
services dispatch to a regional poison center for management, reducing unnecessary
responses, with substantial cost savings.
Anderson BD et al. Diversion of 911 poisoning calls
to a poison center. Prehosp Emerg Care 1998 Jul-Sep;2(3):176-9.
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1953
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1950’s
1953
1950’s
1958 AAPCC
1964 EAPCC
1968 AACT
1953
1950’s
1958 AAPCC
1964 EAPCC
1968 AACT
1966
1964
1953
1950’s
1958 AAPCC
1964 EAPCC
1968 AACT
1990’s
1966
1964
As to the future, although the 'epidemic' of serious acute
poisoning of the 1960s and 70s appears to be past its
peak, there will always be unusual and serious problems
and the UK poisons information services must develop to
make the best use of computer-based technology.
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Alex Proudfoot. Clinical Toxicology - Past, Present and
Future. Hum Exp Toxicol 1988;7:481-487
As to the future, although the 'epidemic' of serious acute
poisoning of the 1960s and 70s appears to be past its
peak, there will always be unusual and serious problems
and the UK poisons information services must develop to
make the best use of computer-based technology.
16
Alex Proudfoot. Clinical Toxicology - Past, Present and
Future. Hum Exp Toxicol 1988;7:481-487
Jamu
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The symptoms had come on suddenly after he
and his girlfriend, had tried a new synthetic
heroin. Though the drug had caused an odd
burning sensation when injected and
hallucinations, they continued to use it for three
days; two days later both had frozen into living
statues.
Phenethylamines I
have known and
loved
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Tryptamines
I have known and
loved
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Back to the legal drug scene ..
Tobacco additive
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The poison
is in the
dose
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Poisoning from chemicals is a significant risk in all
countries.
Some countries already have well established facilities
for the prevention and control of poisoning, many wish
to establish or strengthen such facilities, and others
have not yet fully recognized the extent of the risk.
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Situation as at 1 July 2011
Only 46% of WHO Member
States had a poison centre
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Definition, Role of Poison Centre
Provision of toxicological information
Management of poisoning cases,
laboratory analytical services
toxicovigilance activities,
Research,
education and training
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In association with other responsible bodies, role
in developing contingency plans for chemical
disasters,
monitoring the adverse effects of drugs,
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
handling problems of substance abuse
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http://www.who.int/ipcs/publications/training_poisons/guid
elines_poison_control/en/index.html accessed 3 Jan 2012
Information service
Should be available 24/7
Staff
Location, facilities and equipment
Financial aspects
Education & Research
The main function of a poison
information centre is to provide
information and advice concerning
the
Diagnosis
prognosis,
treatment,
chemicals
and the risks they pose.
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Significant
Cross-reactivity
is present
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Staff
“Poison information specialist”
Medical personnel from
emergency
Intensive care
Treatment units
Administration
Teaching and training
Training of medical
Practitioners
Professional health workers
Mass media
Clinical services
Should be closely linked
to the information
service
Clinical toxicologists
A poison information centre (including training in
preparing documents, collecting information,
replying to enquiries recording case data, and
follow-up of cases.
A clinical toxicology unit, emergency department,
or intensive care unit where poisoned patients are
treated.
A toxicological laboratory, where a practical
understanding of sampling and analytical
methods and of the medical interpretation of the
results of analyses is provided.
Poison Information Specialists, Clinical
toxicologists
Nurture the
organisation
Nurtured by
the
organisation
Analytical toxicology and other
laboratory services
Basic
Comprehensive analysis
Toxicovigilance
It is the active process of
identifying and evaluating the
toxic risks existing in a
community and evaluating the
measures taken to reduce or
eliminate them.
Toxicovigilance and prevention
of poisoning
Toxicovigilance and prevention
programmes.
School of Public Health
Prevention
Alerting responsible authoritiespreventive measures
User of toxic chemicals to the risk
involved
Introducing codes of practice
Legislation to control the labelling
of toxic products
Special packing-substances and
modification or withdrawal of
products form the market.
Response to major emergencies
involving------- chemicals/biologicals
Information
Treatment
Contingency planning
Follow-up studies
Financial support
Collaboration between centres
DSO, DMERI, Civil Defence, MHA, A&E
Antidotes, antivenom and their
availability
DATA BASE on:
Scientific aspects
Technical aspects
Economic aspects
Registration and administrative
requirements
Considerations of time and geography
Specific problems of developing countries
Improving stocking, availability &
distribution
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Challenges ahead
An innovative structure.
Contribution form various
agencies is recognised.
Overcome territorial
boundaries.
Harness communication &
information technology.
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FUTURE DIRECTIONS :
1)Establishment of PIC’s .
2)Establishment of networks.
3)Regional collaborations.
4)International collaborations.
5)WHO,IPCS,CCOHS.
6)Training of personnel.
7)Toxicology research.
8)Public education
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