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•  A medical subspecialty focused on the diagnosis, management and prevention of adverse health effects from medications, occupational & environmental toxins, and biological agents

SOLVENTS!

PESTICIDES!

HEAVY METALS!

WORKER SAFETY & FITNESS FOR DUTY!

ENVENOMATIONS!

DRUG OVERDOSE!

BACK PAIN!

REPETITIVE STRAIN INJURIES! Occupational

Medicine!

Medical Toxicology!

Acute and Critical Care Medicine

TERRORISM (Bio/Chem/Rad)!

Infectious Disease!

ACUTE ORGAN FAILURE SYNDROMES!

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•  Officially recognized as a subspecialty by the American Board of Medical Specialties

•  Of ~800,000 physicians in the USA, less than 700 ever board certified in medical toxicology

•  ~600 physician members of ACMT, all of whom are board certified in medical toxicology

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•  Unintentional and Intentional Drug Overdose –  therapeutic drugs; drugs of abuse; over-

the-counter medicines; vitamins •  Envenomations

–  snake bites, spider bites, scorpion stings •  Ingestion of Food-Borne Toxins

–  Botulism, marine toxins (e.g. paralytic shellfish toxin, ciguatoxin)

•  Ingestion of Toxic Plants / Mushrooms

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•  Drug abuse management –  in-patient care for acute withdrawal from addictive

drugs and outpatient Medical Review Officer services for industry and organization

•  Hazardous Exposure to Chemical Products –  Pesticides, heavy metals (e.g. lead, arsenic,

mercury), household products (e.g. cleaning agents), toxic gases (e.g. carbon monoxide, hydrogen sulfide, hydrogen cyanide), toxic alcohols (e.g. methanol, ethylene glycol), and other industrial and environmental agents

•  Independent Medical Examinations –  assessing injury or disability resulting from toxic

exposures

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•  Emergency departments, ICU's, other in-patient units •  Outpatient clinics, offices, job sites •  Poison Control Centers •  Medical Schools, universities, and clinical training sites •  Industries and corporations (e.g. chemical,

pharmaceutical) •  Governmental agencies (ATSDR, CDC, FDA, DHS) •  Clinical and forensic laboratories

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•  ACMT is a professional, nonprofit association of physicians with recognized expertise in medical toxicology.

•  The ACMT is dedicated to advancing the science and practice of medical toxicology.

•  About 600 board certified or board eligible physicians

www.acmt.net

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•  30 fellowship programs across the US •  2 years in length, average 2 fellows/year •  Generally affiliated with Poison Centers

and academic medical centers •  Serve as educational sites for many

emergency medicine residents in the US –  Other rotating trainees include: Pediatrics,

critical care, medical students, pharmacy students, Pediatric emergency medicine fellows

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Alaska

Hawaii

Puerto Rico

Guam

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Lewis Nelson, MD Fellowship Director Medical Toxicology NYU Medical School Regional Director for Region 2

Fellowships New York, NY

Medical Toxicology University of Regional Director for Region 1

Fellowships Boston, MA Hartford, CT

Worcester, MA

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Tom Martin, MD University of Washington Seattle, WA Regional Director for Region 10

Fellowships

Jennifer Lowry, MD

Fellowship Director Medical Toxicology NYU Medical School Regional Director for Region 2

Fellowships New York, NY Long Island, NY

Charles McKay, MD, Fellowship Director Medical Toxicology University of Connecticut Regional Director for Region 1 and Network Director

Fellowships Boston, MA Hartford, CT

Worcester, MA

Mark Mycyk, MD Northwestern University School of Medicine, Chicago Regional Director for Region 5

Fellowships Chicago, IL Detroit, MI

Indianapolis, IN Cincinnati, OH

Regional Director for Region 5

Fellowships Chicago, IL Detroit, MI

Indianapolis, IN Cincinnati, OH

University of Colorado Denver, CO

Region 8 Fellowships

Andrew Monte MD

Regional Director for Denver, CO

Anthony Pizon, MD University of Pittsburgh Regional Director for Region 3

Fellowships Philadelphia, PA

Hershey, PA Charlottesville, VA

University of California San Francisco, CA

Fellowships San Francisco, CA

San Diego, CA Sacramento, CA

Phoenix, AZ

Timur Durrani MD Regional Director for Region 9

Fellowships San Francisco, CA

San Diego, CA Sacramento, CA

Phoenix, AZ

Carolinas Medical Center Charlotte, NC

Fellowships Atlanta, GA

Nashville, TN Charlotte, NC

Michael Beulher, MD Regional Director for Region 4

Fellowships Atlanta, GA

Nashville, TN Charlotte, NC

Kapil Sharma MD University of Texas Southwestern Dallas, TX Regional Director for Region 6

Fellowships Dallas, TX

Tom Martin, MD University of Washington Seattle, WA Regional Director for

Fellowships Portland, OR

Children’s Mercy Hospitals and Clinics, Kansas City Regional Director for Region 7

Paul Wax, MD Executive Director ACMT

Michael Kosnett, MD ACMT Coordinator for ACMT/ATSDR Cooperative Agreement

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•  Poisoning is an interaction between a host, the environment, and a toxin or toxicant

•  An exposure pathway must be completed in order to have toxicity

•  Exposure to a given compound generally results in predictable, often fairly specific host responses (toxidromes)

•  Dose determines effect – Large scale exposures require large doses – Mere detection of a compound does not identify

it as the culprit

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•  It is often difficult to distinguish between toxicity and host physiological responses – Causation vs. Association

•  General vs. Specific Causation •  The proper care of large numbers of

poisoned patients correctly balances the potential role (including benefit and risk) of – Decontamination – Supportive care – Diagnostic studies – Antidote therapy

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•  More than 80 courses presented in last 10 years throughout the country

•  More than 9000 participants •  Contributions by more than

100 medical toxicologists

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•  Intro/Background •  Neurotoxins •  Toxic Gases •  Cyanide & Fumigants •  Delivery of Agents by

Food/Water/Drug Supply •  Delayed Toxic

Syndromes •  Radiation •  Psychological Aspects

•  Agricultural Chemicals •  Break-out Sessions

–  PAPRs –  High-Fidelity Simulations –  Radiological survey

instruments –  Tabletop exercise

•  Environmental Monitoring •  Post-Event Biomonitoring •  OSHA First Receiver

Guidance •  Regulatory Aspects and

Local Implementation

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