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2005 Annual Report - Nebraska Regional Poison Center
8401 West Dodge Road, Suite 115 Omaha, NE 68114 1-800-222-1222 (Nebraska & Wyoming) (402) 955-5555 (Omaha) 2005 Annual Report Nebraska Regional Poison Center is sponsored by: The Nebraska Medical Center, Creighton University Medical Center, and University of Nebraska Medical Center Table of Contents 2005 Staff………………………….……………………………………….. 2 24-Hour Emergency Telephone Service..….…………………………… 3 Toxicologist Consultations….…………………………………………….. 3 Public Education……………………………………………………….….. 4 Media Interviews…….………………………………………….…………. 5 Professional Education…………………………………………………… 9 Research……….…………………………………………………………..11 Professional Staff Development…………………………………………12 Poisoning Data Collection……………………………………………......12 Hazardous Materials Incidents/Terrorism……………………………….12 Medical Cost Savings……………………………………………………. 13 Call Volume By Month…………………………………………………… 14 Calls By Day of the Week……………………………………………….. 15 Call Type…………………………………………………………………... 16 Call Site By Call Type……………………………………………………. 17 Exposure Site………………..……………………………………………. 17 Reason…………………………………………………………………….. 18 Acute/Chronic…………………………………………………...….…….. 19 Route of Exposure………………………………………………....…….. 19 Decontamination and Therapeutic Intervention………………………. 19 Management Site By Referral Pattern…………….…………………… 20 Medical Outcome…………………………………………………………. 20 Poisoning Fatalities………………………………………………………. 21 Top Ten Substances: Non-Drug………………………………….…….. 22 Top Ten Substances: Drug……………………………………………… 23 Exposures By Substance………………………………………….…….. 24 Age By Gender…………………………………………………………… 25 Calls By State…………………………………………………………….. 26 Calls By County – Top 10……………………………………………….. 26 Calls From Health Care Facilities – Top 25…………………………… 27 Patient Referrals to Health Care Facilities – Top 25…………………. 28 1 2005 Staff Medical Director Steven Seifert, MD, FACMT, FACEP Assistant Medical Director Jennifer Audi, MD Managing Director Kathy Jacobitz, RN, CSPI Staff Toxicologist David Tolo, MD Specialists in Poison Information Kathy Besancon, RN, BSN Karla Finnigan, RN, CSPI* Chris Fladby, RN, CSPI* Luis Gonzalez, RN, BSN Teresa Heeney, RN, BSN, CSPI* Marlys Horky, RN, CSPI* Julia Kimble, RN, BSN, CSPI* Jean Lubbert, RN, CSPI* Sandra Lurry, RN, CSPI* Kristyn McEachen, RN, BSN Joan McVoy, RN, CSPI* Marcia Rasmussen, RN, CSPI* Gail Shannon, RN, BA Karen Smith, RN, BSN, CSPI* Julie Tomoser, RN, CSPI* Connie Tschetter, RN, BSN, CSPI* *AAPCC Certified Specialist in Poison Information Nebraska Regional Poison Center 2 The Nebraska Regional Poison Center (NRPC) is certified as a regional poison center by the American Association of Poison Control Centers. It is designated by state health departments to serve Nebraska, Wyoming, American Samoa, and Federated States of Micronesia. NRPC and its programs are sponsored through collaborative community support from The Nebraska Medical Center, Creighton University Medical Center, and University of Nebraska Medical Center. This report highlights services provided throughout the region in 2005. 24-Hour Emergency Telephone Service Nebraska Regional Poison Center operates 24 hours a day, seven days per week, and is staffed by a nationally certified team of registered nurses and physicians. Its primary function is to assess and make treatment recommendations during poisonings. The emergency telephone service is available to both health care professionals and the public. The following is a 2005 summary: •Handled 36,604 incoming calls in 2005 •24,952 calls were regarding human poisonings •836 calls were regarding animal poisonings •10,691 calls were for poison or drug information •31,480 follow-up calls were made by NRPC staff •56% of the poisoning exposures involved children less than 6 years of age •85% of poisoning exposures were unintentional; 12% were intentional; 2% were the result of an adverse reaction to a drug or food; 1% were due to substance contamination, tampering or malicious intent •Common exposure substances include medications, cosmetics/personal care products, cleaning products, foreign bodies, and pesticides •73% of poisoning exposures were treated safely at home •15% of calls originated from health care professionals requesting treatment advice for poisoned patients Toxicologist Consultations A medical toxicologist is available by telephone 24 hours a day to provide consultations as needed. In 2005, toxicologists provided telephone consultations directly with health care professionals on 248 cases and consulted with Poison Center staff on another 433 cases. In addition, toxicologists treated 19 poisoned patients at The Nebraska Medical Center, Children’s Hospital, and Creighton University Medical Center. Public Education Nebraska Regional Poison Center’s public education activities are organized by the education coordinator, Joan McVoy, RN, CSPI. She works closely with schools, healthcare organizations, parenting groups, childcare providers and business groups 3 throughout the region. Each activity is designed to inform the public about the 24-hour emergency telephone service and to provide education on methods to prevent poisonings. The following is a summary of 2005 activities: Live Presentations by NRPC Staff Seventy-nine live presentations were conducted during 2005 by the education coordinator. A population of 5,710 people heard a variety of presentations. Educational Materials NRPC distributed 219,128 poison prevention brochures, telephone stickers, magnets, and other educational materials throughout its region. Pinky the Elephant, NRPC’s mascot costume, was used during 234 presentations. Video Tape Loan Library NRPC maintains a lending library of audio-visual programs available to groups in its service area. The following table represents usage for 2005: Program Primary (Preschool-2nd Grade) Intermediate (3rd Grade-Jr. High) Adult (Sr. High & Adults) Total Number 639 66 46 751 Audience 43,360 1,993 1,124 46,477 Pharmacy Students NRPC partnered with pharmacy students at the University of Nebraska Medical Center (UNMC), Creighton University, and University of Wyoming. This program helps NRPC reach more schools, and it also educates future pharmacists. • UNMC pharmacy students provided 6 presentations/health fairs to an audience of 634. • Creighton University pharmacy students provided 7 presentations to an audience of 238. • University of Wyoming pharmacy students provided 4 presentations to an audience of 64. Casper-Natrona (Wyoming) Health Department Tammy Haines gave 56 poison prevention presentations, serving a total of 3,744 people. Nebraska Injury Prevention Coalition NRPC is a member of the Injury Prevention Coalition, a statewide network of professionals dedicated to reducing the risk of serious injury to Nebraska residents. Safe Kids NRPC is actively involved in the Safe Kids Coalition. Web Site NRPC’s web site (www.nebraskapoison.com) is continuously updated with educational materials. National Poison Prevention Week Congress intended this event as a means for local communities to raise awareness of the dangers of accidental poisoning. In 2005, NRPC participated in the following activities: • Proclamations from the Governors of Nebraska and Wyoming and the Omaha City Council • Mailed information about public education programs to elementary schools throughout Nebraska and Wyoming • Presentations and displays at various sites throughout the service area 4 • • • Public service announcements, radio, newspaper, and television interviews Poster contest for Grand Island and Omaha schools with the Tri-Cities Safe Kids, St. Francis Medical Center, and the Omaha Safety and Health Council A Grand Island poster won the national contest and will be the National Poison Prevention Week Poster in 2006! Media Interviews Nebraska Regional Poison Center regularly sends public service announcements on poison topics to the media. This generates radio and television interviews and newspaper and magazine articles. The following table lists the 2005 media interviews and articles generated from the public service announcements. Date Media Type Agency Topic 1/1/05 Newsletter Carbon Monoxide 1/4/05 Newspaper 1/19/05 Newspaper 1/21/05 Television 1/24/05 Magazine 1/25/05 Newspaper 2/14/05 Newspaper 3/14/05 Television 3/21/05 Television 3/24/05 Radio 3/24/05 Newspaper 3/25/05 Newspaper 3/25/05 Newspaper 3/29/05 Newspaper 3/31/05 Newspaper 4/24/05 Newspaper 5/2/05 Television 5/10/05 Newspaper New Horizons ENOA Omaha, NE Guernsey Gazette Guernsey, WY Burt County Plaindealer Tekamah, NE KETV Channel 7 News Omaha, NE Weekly Reader Omaha, NE Pilot Tribune Blair, NE Lincoln Star Journal Lincoln, NE WOWT Channel 6 News Omaha, NE KM3 News Omaha, NE KWYO Radio Sheridan, WY Sun Schuyler, NE Grand Island Independent Grand Island, NE Wyoming Tribune Eagle Cheyenne, WY Omaha World Herald Omaha, NE Criterion Dodge, NE Omaha World Herald Omaha, NE KHAS TV Hastings, NE Journal Falls City, NE Carbon Monoxide Health Fair With Pinky Methamphetamine Methamphetamine Carbon Monoxide Spider Bite Poison Prevention Lawn Care Safety Gasoline Poison Prevention Poison Prevention Poison Prevention Dextromethorphan Poison Prevention Mercury Tilmicosin Poison Prevention Date Media Type Agency Topic 5/11/05 Newsletter Spring Outdoor Hazards 5/19/05 Newspaper Kids Safety Chronicle National Safety Council Omaha, NE Omaha World Herald 5 Acetaminophen 5/27/05 Newspaper 6/7/05 Newspaper 6/13/05 Newsletter 6/27/05 Television 7/7/05 Newspaper 7/8/05 Television 7/11/05 Radio 7/15/05 Television 7/19/05 Newspaper 7/20/05 Television 7/25/05 Television 7/26/05 Newspaper 7/26/05 Newspaper 7/27/05 Newspaper 7/27/05 Newspaper 7/28/05 Newspaper 8/11/05 Newspaper 8/16/05 Television 8/31/05 Newspaper 9/1/05 9/2/05 Newspaper Newspaper 9/6/05 Newspaper 9/8/05 Newspaper 9/18/05 Television 9/21/05 Television Omaha, NE Omaha World Herald Omaha, NE Lincoln Journal Star Lincoln, NE The Label Lincoln, NE WOWT Channel 6 News Omaha, NE Omaha World Herald Omaha, NE WOWT Channel 6 News Omaha, NE KRVN Lexington, NE KETV 7 News Omaha, NE Omaha World Herald Omaha, NE KPTM Fox 42 News Omaha, NE KETV 7 News Omaha, NE Star Mail Madison, NE Falls City Journal Falls City, NE Journal Register Hebron, NE Grand Island Independent Grand Island, NE Grand Island Independent Grand Island, NE Plattsmouth Weekly Plattsmouth, NE KETV 7 News Omaha, NE Times Herald Alliance, NE Omaha World Herald Falls City Journal Falls City, NE Northern Wyoming Daily News Worland, WY Pierce Leader Pierce, NE KTWO Television Casper, WY KCWY Casper, WY Tilmicosin Tilmicosin Poison Center Annual Report Insect Repellents Chlorine Gas Chlorine Gas Chlorine Gas Methamphetamine Poison Prevention Chlorine Gas Insect Repellents Chlorine Gas Chlorine Gas Toxic Algae Chlorine Gas Poison Prevention Chlorine Gas Inhalant Use Hot Peppers Hot Peppers Hot Peppers Poison Prevention Hot Peppers Poison Prevention Poison Prevention Date Media Type Agency Topic 10/10/05 Television Halloween Safety 10/10/05 Television WOWT Channel 6 News Omaha, NE WOWT Channel 6 News 6 Beestings Omaha, NE KFAB Omaha, NE Falls City Journal Falls City, NE KFAB Omaha, NE KGBI Omaha, NE KQSW Rock Springs, WY Beatrice Daily Sun Beatrice, NE Omaha World Herald Omaha, NE Norfolk Daily News Norfolk, NE Lincoln Star Journal Lincoln, NE KPTM Fox 42 News Omaha, NE WOWT Channel 6 News Omaha, NE Yankton Daily Press Yankton, SD KPTM Fox 42 News Omaha, NE KTWO Radio Casper, WY Radio Station Gillette, WY Red Cloud Chief Red Cloud, NE KPTM Fox 42 News Omaha, NE WOWT Channel 6 News Omaha, NE Northern Wyoming Daily News Worland, WY KQSW Rock Springs, WY Crete News Crete, NE Thomas County Herald Thedford, NE Journal Crofton, NE Tribune Niobrara, NE Southwest Nebraska News Indianola, NE 10/13/05 Radio 10/14/05 Newspaper 10/15/05 Radio 10/17/05 Radio 10/18/05 Radio 10/22/05 Newspaper 10/22/05 Newspaper 10/24/05 Newspaper 10/24/05 Newspaper 10/24/05 Television 10/24/05 Television 10/24/05 Newspaper 10/24/05 Television 10/26/05 Radio 10/28/05 Radio 11/2/05 Newspaper 11/8/05 Television 11/8/05 Television 11/8/05 Newspaper 11/9/05 Radio 11/10/05 Newspaper 11/17/05 Newspaper 11/17/05 Newspaper 11/17/05 Newspaper 11/17/05 Newspaper Date Media Type Agency Topic 11/17/05 Newspaper Enterprise Stapleton, NE Turkey Safety 7 Beestings Beestings Halloween Safety Halloween Safety Halloween Safety Snakebite Symposium Snakebite Symposium Snakebite Symposium Snakebite Symposium Snakebite Symposium Snakebite Symposium Snakebite Symposium Halloween Safety Halloween Safety Halloween Safety Hot Peppers Arsenic in Yards Arsenic in Yards Turkey Safety Turkey Safety Turkey Safety Turkey Safety Turkey Safety Turkey Safety Turkey Safety 11/17/05 Newspaper Pierce County Leader Pierce, NE Journal Plattsmouth, NE The Index Mitchell, NE Omaha World Herald Omaha, NE Creighton News Creighton, NE Journal Palmer, NE KFAB Omaha, NE KPTM Fox 42 News Omaha, NE KZWY Sheridan, WY KROE Radio Sheridan, WY KYTI Sheridan, WY KQSW Rock Springs, WY Weekly Valentine, NE Herald Springview, NE Times Milford, NE Weekly Creighton, NE Harlan County Journal Alma, NE Messenger Wolbach, NE News Chronicle Wisner, NE Index Mitchell, NE Thomas County Herald Thedford, NE Thursday Weekly Schuyler, NE Journal Palmer, NE Kids Safety Chronicle National Safety Council Mirror Sun Lyons, NE Enterprise Stapleton, NE 11/17/05 Newspaper 11/18/05 Newspaper 11/21/05 Newspaper 11/23/05 Newspaper 11/24/05 Newspaper 11/26/05 Radio 11/26/05 Television 11/28/05 Radio 11/28/05 Radio 11/28/05 Radio 11/29/05 Radio 11/30/05 Newspaper 11/30/05 Newspaper 11/30/05 Newspaper 11/30/05 Newspaper 12/1/05 Newspaper 12/1/05 Newspaper 12/1/05 Newspaper 12/1/05 Newspaper 12/1/05 Newspaper 12/1/05 Newspaper 12/1/05 Newspaper 12/1/05 Newsletter 12/1/05 Newspaper 12/1/05 Newspaper Date Media Type Agency Topic 12/1/05 Newspaper Pierce County Leader Carbon Monoxide 8 Turkey Safety Turkey Safety Turkey Safety Turkey Safety Turkey Safety Turkey Safety Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Poison Prevention Carbon Monoxide Carbon Monoxide 12/5/05 Radio 12/7/05 Newspaper 12/8/05 Newspaper 12/13/05 Radio 12/14/05 Radio 12/14/05 Newspaper 12/15/05 Newspaper 12/15/05 Radio Pierce, NE KRVN Lexington, NE News Blade Bridgeport, NE News Times York, NE KQSW Rock Springs, WY KFAB Omaha, NE Republican Osmond, NE Monitor Bloomfield, NE KGMT Fairbury, NE Carbon Monoxide Carbon Monoxide Carbon Monoxide Holiday Hazards Holiday Hazards Carbon Monoxide Holiday Hazards Holiday Hazards Professional Education Nebraska Regional Poison Center contributes regularly to health care professionals’ knowledge in the area of clinical toxicology. Dr. Steven Seifert, NRPC's medical director, writes periodic clinical toxicology updates for emergency department physicians, physician assistants, and nurses. These are faxed to all Nebraska and Wyoming hospital emergency departments. NRPC is a clerkship site for UNMC and Creighton pharmacy students. Eleven students completed month-long rotations in 2005. In July, NRPC also became a rotation site for UNMC Emergency Medicine residents. Five residents completed month-long rotations in 2005. NRPC staff gave the following professional education presentations to health care professionals and students: Date Topic Presenter Location 1/0512/05 Approach to the Poisoned Patient Steven A. Seifert, MD Nebraska Regional Poison Center 1/0512/05 7/0512/05 1/05, 4/05, 7/05,10/05 1/05, 7/05 Monthly Toxicology Lectures Monthly Toxicology Lectures Toxicology Lectures Steven A. Seifert, MD Steven A. Seifert, MD Toxicology Lectures Steven A. Seifert, MD Steven A. Seifert, MD 3/05 Rattlesnake Bite Recurrence Pharmaceutical Disaster Planning Anticholinesterases UNMC Omaha, NE UNMC Omaha, NE Emergency Medicine Conferences, UNMC UNMC Omaha, NE Loma Linda, CA Steven A. Seifert, MD Date Topic Presenter 1/05 2/21/05 Steven A. Seifert, MD Kathy Jacobitz, RN OMMRS Committee Mtg Omaha, NE Creighton University Medical Center Location 9 Attendees # Physician Residents; Pharmacy Students UNMC & Creighton Pediatric Residents UNMC Emergency Medicine Residents Physicians; Residents Internal Medicine Residents Various Health Care Professionals Various Health Care Professionals Pathology Residents & Staff 46 Attendees 35 6 20 25 175 80 25 # 4/05 Pharmacotherapy I Steven A. Seifert, MD 5/05 Steven A. Seifert, MD 6/05 Poison Ctr Medical Error Reduction Chemical & Biologic Contamination of Food and Water Toxicology Review 8/05 Toxicology Update Steven A. Seifert, MD 8/05 Pesticides in Museum Artifacts Unmasking Comm. Risks to Youth Envenomation Management Toxicology 888 Steven A. Seifert, MD 5/05 9/05 9/05 9/05 9/7 & 9/8/05 10/05 10/05 10/05 General Management of Poisonings Snake Envenomations Naja Envenomation Steven A. Seifert, MD Steven A. Seifert, MD Steven A. Seifert, MD Steven A. Seifert, MD Steven A. Seifert, MD Kathy Jacobitz, RN Steven A. Seifert, MD Steven A. Seifert, MD 11/05 Characterization of Non-Native Envenomations Quality of Literature on Non-Native Envenomations Rattlesnake Envenomation Case Report Toxicology Update Steven A. Seifert, MD 11/05 Toxicology Update Steven A. Seifert, MD 11/05 Toxicology Update Steven A. Seifert, MD 11/05 Toxicology Update Steven A. Seifert, MD 11/05 Toxicology Update Steven A. Seifert, MD 11/05 Toxicology Update Steven A. Seifert, MD 11/17/05 OMMRS Overview Kathy Jacobitz, RN 12/05 Methamphetamine Steven A. Seifert, MD 12/05 Pesticides & Plants Steven A. Seifert, MD 10/05 10/05 Steven A. Seifert, MD Steven A. Seifert, MD Jennifer Audi, MD 10 UNMC Omaha, NE Pediatric Research Forum CDC Emergency Preparedness Conf. Atlantic, IA UNMC Omaha, NE Wyoming Med Center Casper, WY Ojibwe Tribe Conference Madison, WI Nebraska Nurses Association Conference Henry Doorly Zoo, Omaha, NE UNMC Omaha, NE Paramedic Course Omaha Fire Department UNMC Omaha, NE Snakebite Symposium UNMC Snakebite Symposium UNMC Omaha, NE Snakebite Symposium UNMC Omaha, NE Snakebite Symposium UNMC Omaha, NE The Nebraska Medical Center Creighton University Medical Center Omaha, NE Alegent Bergan Mercy Omaha, NE Alegent Immanuel Medical Center Omaha, NE Alegent Midlands Papillion, NE Methodist Hospital Omaha, NE Disaster Response Conf., Omaha, NE Creighton University Conference Region VII PEHSU Conference Health Care Students Physicians 35 50 Various Health Care Professionals 100 Pediatric Medicine Residents Physicians, Nurses 25 50 Various 75 Nurses 24 Paramedic Trainees 50 Toxicology Students 20 EMTs, Paramedics 35 Second-year medical students Various Health Care Professionals Various Health Care Professionals 110 130 130 Various Health Care Professionals 130 Various Health Care Professionals 130 ED Medical and Nursing Staff ED Medical and Nursing Staff 25 ED Medical and Nursing Staff ED Medical and Nursing Staff 20 ED Medical and Nursing Staff ED Medical and Nursing Staff Various Health Care Professionals Various Health Care Professionals Various Health Care Professionals 15 25 20 15 20 125 150 Research Published Scientific Journal Articles, Peer Reviewed: Seifert SA, Schwartz MD, Thomas JD. Aripiprazole (Abilify™) overdose in a child. Clinical Toxicology 2005;43(3):193-195. Lund B, Seifert SA, Mayersohn M. Efficacy of sustained low-efficiency dialysis in the treatment of salicylate toxicity. Nephrol Dial Transplant. 2005 Jul;20(7):1483-4. Epub 2005 Mar 29. Published Scientific Abstracts, Peer Reviewed: Seifert SA, Odegaard N, Smith DR, Smith DL. Pesticide contamination of repatriated objects under the Native American Graves Protection and Repatriation Act: A multidisciplinary approach. Clinical Toxicology, 2005; 43(6):753-4. Lubbert J, McVoy J, Seifert SA, Jacobitz K. Accuracy and completeness of initial substance identification. Is what you hear, what they got? Clinical Toxicology, 2005; 43(6):764. Lubbert J, Jacobitz K, Suhr D, Weber AT, Seifert SA. Home observation of tendedyard mushroom ingestions in Nebraska, Wyoming, and Western Iowa. Clinical Toxicology, 2005; 43(6):762. Seifert SA, Jacobitz K. TESS-based characterization of human tilmicosin exposures and the dose-response relationship in parenteral exposures. Clinical Toxicology, 2005; 43(6):735-6. Seifert SA, Boyer, LV, Bronstein AC, Jacobitz K, McNally J, Meza JL. Reduction of Medical Error by Introduction of a New Protocol in a Poison Center. Clinical Toxicology, 2005; 43(6):767-8. Seifert SA, Boyer LV, Bronstein AC, Jacobitz K, McNally J, Meza J. Medical Error Detection, Characterization and Reduction. Clinical Toxicology, 2005; 43(6):686. Book Chapters: Boyer LV, Seifert SA, Odegaard N. Understanding the Hazards: Toxicity and safety. In Old Poisons, New Problems: A museum resource for managing contaminated cultural materials. Odegaard N, Sadongei, and Associates, Eds. AltaMira Press, Walnut Creek, 2005. Professional Staff Development 11 Clinical presentations are regularly provided to NRPC staff by the medical directors, specialists in poison information, residents, students, and guest speakers. Date 2/24/05 2/24/05 3/24/05 3/24/05 4/26/05 4/26/05 5/19/05 5/19/05 6/16/05 6/16/05 8/11/05 8/11/05 9/6/05 9/6/05 10/4/05 11/29/05 11/29/05 Topic Ciguatera, Scrombroid, and Paralytic Shellfish Poisoning Pesticides Drugs of Abuse and Digoxin Immune Fab Trileptal Toxicity Uncommon Rodenticides and Heavy Metals Ziconotide Toxicity Radiation Emergencies Lunesta Toxicity Toxicity of Fireworks Non-Native Snake Envenomations Poisoning Fatalities Case Review Nicotine Toxicity Bactrim Toxicity Electrophysiologic Antiarrhythmic Medications Highlights of the 2005 North American Congress of Clinical Toxicology Inhalant Abuse Carbon Monoxide Poisoning Presenter Sandy Lurry, RN Larry Schulze, PhD Steve Seifert, MD Connie Tschetter, RN Steven Seifert, MD Chris Fladby, RN Steven Seifert, M.D. Marcia Rasmussen, RN Karen Smith, RN Steve Seifert, MD Steve Seifert, MD Jean Lubbert, RN Marlys Horky, RN R. Srinivasan, MD Jean Lubbert, RN Kathy Jacobitz, RN Steve Seifert, MD Joan McVoy, RN Ben Fagot, MD Poisoning Data Collection NRPC maintains an electronic database that captures poisoning case information, which is then uploaded to the American Association of Poison Control Centers’ Toxic Exposure Surveillance System on a real-time basis. This data is used both nationally and locally for surveillance, to target poison prevention efforts, and to improve poisoning treatment. Hazardous Material Incidents/Terrorism Nebraska Regional Poison Center assists first responders, hospitals, and the public during hazardous material incidents such as chemical spills. NRPC participates in a hazardous materials notification system for area hospitals. NRPC’s role in planning and response for nuclear, biological and chemical (NBC) terrorism includes: ♦ Provides immediate NBC treatment information to health care professionals and the public on a 24-hour basis ♦ Provides educational presentations to health care professionals on recognition and management of NBC agents ♦ Assists state and local health departments with surveillance ♦ Assists with monitoring the Nebraska Health Alert Network 12 ♦ Tracks pharmaceutical capabilities in the region and assists in the transfer of antidotes between hospitals ♦ Is actively involved with community NBC preparedness planning: ¾ Omaha Metropolitan Medical Response System (OMMRS) Steering Committee (Kathy Jacobitz) ¾ OMMRS Pharmacy Subcommittee (Kathy Jacobitz, co-chairperson) ¾ OMMRS Emergency Operations Center Subcommittee (Kathy Jacobitz) ¾ Nebraska Bioterrorism Education Consortium (Kathy Jacobitz and Steve Seifert) ¾ Nebraska CHEMPAK Advisory Task Force (Kathy Jacobitz) Estimate of Medical Cost Savings From Nebraska Regional Poison Center’s Services Nebraska Regional Poison Center (NRPC) curbs medical costs associated with treatment of poisoning by reducing inappropriate use of emergency departments and by preventing poisoning case progression through early intervention. In addition, NRPC reduces costs by preventing poisonings from occurring. The following shows how NRPC reduced the cost of poisonings in 2005. If NRPC was not in operation, theoretically, all callers in 2005 would need to visit an emergency department: Average charge for emergency department evaluation of poisonings = $1,245 Human poison exposures in 2005 = 24,944 Total cost of emergency department visits = $31,055,280 Because NRPC was in operation, certain exposures could be managed safely at home. In 2005, 18,130 poisoning exposures were managed by NRPC without the need for a visit to a health care facility. The cost savings from NRPC’s prevention of unnecessary emergency room visits is: 18,130 x $1,245 = $22,571,850 In 2005, NRPC reduced the cost of poisonings by 73%, resulting in savings of over 22.5 million dollars. This estimate does not incorporate savings resulting from poison prevention efforts, increased efficiency in medical management of poisonings, and reductions in ambulance and inpatient care utilization. 13 2005 Call Volume By Month 3,300 3,200 3,100 3,000 Number of Calls 2,900 2,800 2,700 2,600 2,500 Series1 Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. 3,158 2,792 3,072 3,103 3,147 3,174 3,178 3,202 2,993 3,053 2,885 2,847 Month 14 2005 Calls By Day Of The Week 5,800 5,600 5,400 5,200 Number of Calls 5,000 4,800 4,600 4,400 4,200 Series1 Sunday Monday Tuesday Wed. Thursday Friday Sat. 4,721 5,615 5,410 5,427 5,218 5,275 4,938 Day of Week 15 2005 Call Type Call Type Number Exposures Human Animal Subtotal % of Total 24,952 836 25,788 68.16 2.28 70.45 123 2 125 0.34 0.01 0.34 Information Drug information Drug identification information Environmental information Medical information Occupational information Poison information Prevention/Safety/Education Teratogenicity information Substance Abuse Administrative Caller Referred Other information Subtotal 1,138 6,546 378 331 17 727 1,224 35 146 106 25 18 10,691 3.11 17.88 1.03 0.90 0.05 1.99 3.34 0.10 0.40 0.29 0.07 0.05 29.21 Total 36,604 100.00 Confirmed Nonexposure Human Animal Subtotal 16 2005 Call Site by Call Type Human Exposures Animal Exposures Confirmed Non-Exp Information Total No No Col % No Col % No Col % No Col% Own residence Other residence Workplace Health care facility School Restaurant / food service Public area Other Unknown 18,136 876 527 3,136 152 11 120 1,935 59 72.68 3.51 2.11 12.57 0.61 0.04 0.48 7.75 0.24 679 26 4 4 0 0 3 118 2 81.22 3.11 0.48 0.48 0.00 0.00 0.36 14.11 0.24 93 5 3 9 0 0 0 15 0 74.40 4.00 2.40 7.20 0.00 0.00 0.00 12.00 0.00 7,219 215 639 508 342 4 40 1,600 124 67.52 2.01 5.98 4.75 3.20 0.04 0.37 14.97 1.16 26,127 1,122 1,173 3,657 494 15 163 3,668 185 Total 24,952 68.17 836 2.28 125 0.34 10,691 29.21 36,604 2005 Human Poisoning Exposures Exposure Site Number Col % Own residence Other residence Workplace Health care facility School Restaurant / food service Public area Other Unknown 20,894 1,116 953 81 418 113 362 459 556 83.74 4.47 3.82 0.32 1.68 0.45 1.45 1.84 2.23 Total 24,952 100.00 17 2005 Call Site by Call Type 17 2005 Human Exposures By Substance Other Non-Drug Substances 18.3% Plants 2.4% Gases 2.8% Medications 50.1% Alcohols 3.1% Pesticides 3.6% Foreign Bodies 4.2% Cleaning Products 7.4% Personal Care Products 8.1% 24 2005 Human Poisoning Exposures Reason Reason Number Col % 15,055 1,156 837 2,746 706 352 426 14 21,292 60.34 4.63 3.35 11.01 2.83 1.41 1.71 0.06 85.33 1,770 575 401 131 2,877 7.09 2.30 1.61 0.53 11.53 41 132 12 185 0.16 0.53 0.05 0.74 Adverse reaction Drug Food Other Total: Adverse reaction 325 56 102 483 1.30 0.22 0.41 1.94 Unknown Unknown reason Total: Unknown 115 115 0.46 0.46 24,952 100.00 Unintentional General Environmental Occupational Therapeutic error Misuse Bite / sting Food poisoning Unknown Total: Unintentional Intentional Suspected suicide Misuse Abuse Unknown Total: Intentional Other Contamination / tampering Malicious Withdrawal Total: Other Total 18 2005 Human Poisoning Exposures Reason 18 2005 Human Poisoning Exposures Management Site by Referral Pattern Patient Already in HCF Number Row % Col % Treated/evaluated and released Admitted to critical care unit Admitted to noncritical care unit Admitted to psychiatric facility Patient lost to follow-up/left AMA Refused referral Unspecified level of care 1,697 466 565 256 151 0 0 55.80 84.12 79.69 71.11 21.88 0.00 0.00 54.13 14.86 18.02 8.17 4.82 0.00 0.00 Total 3,135 49.50 100.00 Patient Referred by Poison Center Number Row % Col % 1,344 44.20 88 15.88 144 20.31 104 28.89 539 78.12 979 100.00 0 0.00 3,198 50.50 Total Number Col % 42.03 2.75 4.50 3.25 16.85 30.61 0.00 3,041 554 709 360 690 979 0 48.02 8.75 11.20 5.68 10.90 15.46 0.00 100.00 6,333 100.00 2005 Human Poisoning Exposures Medical Outcome Number Col % No effect Minor effect Moderate effect Major effect Death Death, indirect report No follow-up, nontoxic No follow-up, minimal toxicity No follow-up, potentially toxic Unrelated effect Subtotal for exposures Confirmed nonexposure 2,969 4,909 1,294 132 6 1 2,519 11,172 984 966 24,952 0 11.90 19.67 5.19 0.53 0.02 0.00 10.10 44.77 3.94 3.87 100.00 0.00 Total 24,952 100.00 20 2005 Human Poisoning Exposures Management Site by Referral Pattern 20 2005 Human Poisoning Exposures Acute/Chronic Number Col % Acute 21,461 86.01 Acute-on-chronic 2,448 9.81 Chronic 746 2.99 Unknown 297 1.19 24,952 100.00 Total 2005 Human Poisoning Exposures Route of Exposure Route Ingestion Inhalation/nasal Aspiration Ocular Dermal Bite/sting Parenteral Rectal Otic Vaginal Other Unknown Total Number Col % 19,964 2,128 14 1,677 2,438 353 201 14 27 8 16 48 26,888 74.25 7.91 0.05 6.24 9.07 1.31 0.75 0.05 0.10 0.03 0.06 0.18 100.00 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Human Poisoning Exposures Acute/Chronic 19 2005 Poisoning Fatalities Reason Age Gender Substances Unknown 69 years Female Avandamet Intentional Abuse 24 years Male Codeine, Hydrocodone, Propoxyphene, Acetaminophen Intentional Suspected Suicide 46 years Female Methadone, Diazepam Intentional Suspected Suicide 34 years Female Tylenol PM Unintentional Therapeutic Error 13 years Female Acetaminophen Unintentional Therapeutic Error 45 years Female Propafenone 21 2005 Top Ten Substances: Non-Drug Human Exposures Substance Number Cosmetics & Personal Care Products Nail Care Products Dental Care Products Creams, Lotions, & Make-up Deodorant Hair Care Products Perfume, Cologne, & Aftershave Mouthwash 2340 293 291 290 216 184 174 180 8.1% Household Cleaning Products Bleaches Miscellaneous Cleaners Wall/Tile/Floor Cleaners Laundry Products Automatic Dishwasher Detergents Glass Cleaners 2145 449 298 278 255 203 136 7.4% Foreign Bodies Desiccants Toys Glow Products 1223 401 182 123 4.2% Pesticides Insecticides Rodenticides Repellents Herbicides Fungicides 1054 434 258 172 172 16 3.6% Alcohols Ethanol Isopropanol 897 741 134 3.1% Gases 887 372 190 87 3.1% Food Products/Poisoning 750 2.6% Hydrocarbons Gasoline Freon & Other Propellants 743 286 123 2.5% Plants 692 143 162 115 74 2.4% 494 74 47 44 1.7% Carbon Monoxide Chlorine/Chloramine Gas Hydrogen Sulfide Non-toxic Oxylate Containing Dermatitis Producing Gastrointestinal Irritant Chemicals Acids Alkali Ammonia 22 % Of Total 2005 Top Ten Substances: Drug Human Exposures Substance Number Analgesics Acetaminophen (Alone & Combined With Other Drugs) Ibuprofen Opioids Aspirin (Alone & Combined With Other Drugs) 2996 1503 834 224 185 10.3% Cold & Cough Preparations Dextromethorphan (Alone & Combined With Other Drugs) Antihistamine/Decongestant (Combined With Other Drugs) 1462 793 653 5.0% Sedative/Hypnotics/Antipsychotics Benzodiazepines Atypical Antipsychotics 1227 548 407 4.2% Topical Preparations Diaper Care/Rash Products Camphor Steroids Methyl Salicylate 1144 534 123 106 100 3.9% Antidepressants SSRIs (Selective Serotonin Reuptake Inhibitors) Cyclic 844 442 94 2.9% Vitamins Multiple Vitamins B Vitamins Vitamin C Vitamin E 779 626 76 24 23 2.7% Antimicrobials Antibiotics Antifungals Anthelmintics 759 591 103 22 2.6% Antihistamines Diphenhydramine 718 271 2.5% Cardiovascular Drugs Beta Blockers Antihyperlipidemics ACE Inhibitors Calcium Antagonists Clonidine 598 158 98 94 64 44 2.1% Gastrointestinal Preparations Antacids Laxatives Other Antidiarrheals 506 242 161 104 19 1.7% 23 % Of Total 2005 Age By Gender 2500 2000 1500 Number of Exposures 1000 500 0 <1 1 2 3 4 5 6-12y 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90 Male 814 2370 2402 1086 498 297 883 824 796 529 396 268 120 94 44 5 Female 767 2187 2079 393 224 685 878 926 648 546 391 181 155 104 17 841 Age 25 2005 Calls By State State Animal Exposures 490 Information Only Calls 7,131 Total Percent Nebraska Human Exposures 18,121 25,742 70.33% Wyoming 5,426 221 1,654 7,301 19.9% Unknown 415 93 1,465 1,973 3.8% Iowa 755 24 428 1,207 3.3% Other States (combined) 28 2 42 72 0.4% Missouri 40 1 40 81 0.2% Kansas 57 2 8 67 0.2% Colorado 33 3 25 61 0.2% South Dakota 46 0 6 52 0.2% Total 24,952 836 10,816 36,604 100% 2005 Calls By County – Top 10 County State Douglas County Nebraska Lancaster County Nebraska Sarpy County Nebraska Laramie County Wyoming Natrona County Wyoming Hall County Nebraska Pottawattamie County Iowa Sweetwater County Wyoming Fremont County Wyoming Dodge County Nebraska Human Exposures 7,074 Animal Exposures 204 Information Only Calls 3,684 Total Percent 10,962 29.95% 2,589 85 1,112 3,786 10.3% 897 35 315 1,247 3.4% 811 39 282 1,132 3.1% 708 25 189 922 2.5% 475 8 212 695 1.9% 364 17 314 695 1.9% 469 17 131 617 1.7% 465 20 106 591 1.6% 357 6 165 528 1.4% 26 26 2005 Calls From Health Care Facilities – Top 25 (Patient was already in HCF when the Poison Center was contacted) Site of Caller The Nebraska Medical Center Omaha, NE Bryan-Lincoln General Hospital West Lincoln, NE Children’s Hospital Omaha, NE Good Samaritan Hospital Kearney, NE Regional West Medical Center Scottsbluff, NE Alegent Midlands Hospital Papillion, NE United Medical Center Cheyenne, WY Memorial Hospital of Dodge County Fremont, NE St. Elizabeth Community Health Center Lincoln, NE Creighton University Medical Center Omaha, NE St. Francis Medical Center Grand Island, NE Faith Regional West Hospital Norfolk, NE Wyoming Medical Center Casper, WY Mary Lanning Memorial Hospital Hastings, NE Memorial Hospital of Sweetwater County Rock Springs, WY Alegent Immanuel Hospital Omaha, NE Great Plains Regional Medical Center North Platte, NE Nebraska Methodist Hospital Omaha, NE Campbell County Memorial Hospital Gillette, WY Lander Valley Medical Center Lander, WY Columbus Community Hospital Columbus, NE Alegent Bergan Mercy Hospital Omaha, NE Alegent Lakeside Hospital Omaha, NE Ivinson Memorial Hospital Laramie, WY Beatrice Community Hospital Beatrice, NE Total Calls From Health Care Facilities 27 Number Percent of Total # 142 5.4% 127 4.8% 115 4.4% 101 3.8% 93 3.5% 84 3.2% 83 3.2% 75 2.8% 73 2.8% 69 2.6% 68 2.6% 67 2.5% 65 2.5% 61 2.3% 61 2.3% 59 2.2% 56 2.1% 53 2.0% 51 1.9% 45 1.7% 45 1.7% 43 1.6% 42 1.6% 41 1.6% 41 1.6% 2,625 100% 2005 Patient Referrals To Health Care Facilities – Top 25 (Patients were referred by the Poison Center or were transferred to the HCF) Site of Caller Children’s Hospital Omaha, NE Alegent Midlands Hospital Papillion, NE The Nebraska Medical Center Omaha, NE Bryan-Lincoln General Hospital West Lincoln, NE St. Elizabeth Community Health Center Lincoln, NE Wyoming Medical Center Casper, WY United Medical Center Cheyenne, WY Alegent Immanual Hospital Omaha, NE Bryan-Lincoln General Hospital East Lincoln, NE Alegent Lakeside Hospital Omaha, NE Alegent Bergan Mercy Hospital Omaha, NE St. Francis Medical Center Grand Island, NE Nebraska Methodist Hospital Omaha, NE Regional West Medical Center Scottsbluff, NE Memorial Hospital of Sweetwater County Rock Springs, WY Creighton University Medical Center Omaha, NE Great Plains Regional Medical Center North Platte, NE Mary Lanning Memorial Hospital Hastings, NE Memorial Hospital of Dodge County Fremont, NE Campbell County Hospital Gillette, WY Memorial Hospital Sheridan, WY Riverton Memorial Hospital Riverton, WY Ivinson Memoral Hospital Laramie, WY Good Samaritan Hospital Kearney, NE Faith Regional West Hospital Norfolk, NE Total Referrals to Health Care Facilities 28 Number Percent of Total # 102 6.6% 77 4.9% 72 4.6% 66 4.2% 62 3.9% 58 3.7% 51 3.3% 51 3.3% 50 3.2% 49 3.2% 44 2.8% 43 2.8% 36 2.3% 32 2.1% 31 2.0% 31 2.0% 27 1.7% 27 1.7% 26 1.7% 24 1.5% 23 1.5% 23 1.5% 23 1.5% 20 1.3% 17 1.1% 1,555 100%