OutlineOutline
HistoryHistory Introduction Introduction Comparison between PCC and DICComparison between PCC and DIC Telephone Protocol for handling Telephone Protocol for handling
Poison CallsPoison Calls
HistoryHistory
1953 1953 The establishment of the First The establishment of the First PCCPCC
19581958 Formation of American Association Formation of American Association of of Poison Control Poison Control Center (AAPCC)Center (AAPCC)
1960 600 poison center in the USA1960 600 poison center in the USA
20072007 Annual Report of the American Annual Report of the American Association of Poison Control Centers’ Association of Poison Control Centers’ National Poison Data System (NPDS): National Poison Data System (NPDS): 25th Annual Report25th Annual Report
Over 4.2 million calls were captured by NPDS Over 4.2 million calls were captured by NPDS in 2007in 2007
2,482,041 human exposure calls, 2,482,041 human exposure calls,
1,602,489 information requests, 1,602,489 information requests,
131,744 nonhuman exposure calls. 131,744 nonhuman exposure calls.
Substances involved most frequently in were Substances involved most frequently in were analgesics (12.5% of all exposures). analgesics (12.5% of all exposures).
20072007 Annual Report of the American Annual Report of the American Association of Poison Control Centers’ Association of Poison Control Centers’ National Poison Data System (NPDS): National Poison Data System (NPDS): 25th Annual Report25th Annual Report
The most common exposures in children less The most common exposures in children less than age 6 were cosmetics/personal care than age 6 were cosmetics/personal care products (10.7% of pediatric exposures). products (10.7% of pediatric exposures).
Drug identification requests comprised 66.8% Drug identification requests comprised 66.8% of all information calls.of all information calls.
NPDS documented 1,597 human fatalities.NPDS documented 1,597 human fatalities.
Poison Control CentersPoison Control Centers
PCC were established for two PCC were established for two reasonsreasons::
To provide rapid access to information To provide rapid access to information valuable in assessing and treating valuable in assessing and treating poisoningspoisonings..
To assist with poisoning preventionTo assist with poisoning prevention
FunctionsFunctions
Assess and treatment recommendations Assess and treatment recommendations during poisoning via 24-hour emergency during poisoning via 24-hour emergency telephone servicestelephone services
Provide public and professional educational Provide public and professional educational programsprograms
To collect data on poisoningsTo collect data on poisonings
To perform researchTo perform research
Assist the public and health care providers Assist the public and health care providers during hazardous material spillsduring hazardous material spills
StaffingStaffing Medical director ( physician with interest and Medical director ( physician with interest and
expertise in medical toxicology) duties includeexpertise in medical toxicology) duties include Protocol review and approvalProtocol review and approval Audit of poison center recommendationsAudit of poison center recommendations Availability for consultation on difficult casesAvailability for consultation on difficult cases
Administrative directorAdministrative director 5-6 full time specialists5-6 full time specialists
PharmacistsPharmacists NursesNurses
PhysiciansPhysicians
One year experienceOne year experience answered at least 2000 callsanswered at least 2000 calls ExamExam
Public education CoordinatorPublic education Coordinator
Poison Center Poison Center CertificationCertification
AAPCC provides a program That certifies regional AAPCC provides a program That certifies regional poison centers:poison centers:
Designation by appropriate public health officialsDesignation by appropriate public health officials
Demonstration that the center is used appropriately Demonstration that the center is used appropriately
throughout the regionthroughout the region
adequate staffing by specialist adequate staffing by specialist
Demonstration of the role of the physicianDemonstration of the role of the physician
Poison Center Poison Center CertificationCertification
Medical director in the operation of the centerMedical director in the operation of the center
Adequate training and experience of an Adequate training and experience of an administrative director administrative director
Demonstration of adequate programs in Demonstration of adequate programs in professional and public educationprofessional and public education
Participation in the AAPCC data collectionParticipation in the AAPCC data collection
Comparison Between Comparison Between DIC and PCCDIC and PCC Both have a common goal Both have a common goal ““provide comprehensive, accurate, and timely provide comprehensive, accurate, and timely
information to their clients”information to their clients” Both used the informationBoth used the information “ “to enhance the medical care of patients”to enhance the medical care of patients” Both have similar Both have similar ““information retrieval process and physical information retrieval process and physical
layouts”layouts”
Despite these similarities, there are a number Despite these similarities, there are a number of important differences between the two of important differences between the two servicesservices
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Comparison Between Comparison Between DIC and PCC DIC and PCC (Cont’d)(Cont’d)
ClienteleClientele : : Public vsPublic vs. . health care professionalshealth care professionals
Eighty eight percent of PCC calls came Eighty eight percent of PCC calls came from publicfrom public
Nine to 10 perecnt of DIC calls came Nine to 10 perecnt of DIC calls came from publicfrom public
Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation
Comparison Between Comparison Between DIC and PCC DIC and PCC (Cont’d)(Cont’d)
Call VolumeCall Volume : : Exteremily large from public versus Exteremily large from public versus
health care professionalshealth care professionals.. Average is 103 calls per day Average is 103 calls per day ((human human
exposure onlyexposure only)) Range is 33 to 213 calls per dayRange is 33 to 213 calls per day
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Comparison Comparison Between DIC and Between DIC and PCC PCC (Cont’d)(Cont’d) Administrative differencesAdministrative differences Hours of Operation/CostHours of Operation/Cost :: PCC operates 24 hrs a day year-round PCC operates 24 hrs a day year-round
vs. 9 AM to 5 PMvs. 9 AM to 5 PM
PCC requires large staffs compare to DICPCC requires large staffs compare to DIC
PCC is more expensive to operate than DIC PCC is more expensive to operate than DIC
Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation
Comparison Between Comparison Between DIC and PCC DIC and PCC (Cont’d)(Cont’d) Administrative differencesAdministrative differences
Staffing :Staffing : PCC relies not only on pharmacist but PCC relies not only on pharmacist but
also on other health care professionals also on other health care professionals (nurses, physicians, technicians)(nurses, physicians, technicians)
Nurses worked 52% of the total phone Nurses worked 52% of the total phone hours in 1993hours in 1993
Pharmacists and physicans worked Pharmacists and physicans worked 36% and 3% of the total hours, 36% and 3% of the total hours, respectivelyrespectively
Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation
Comparison Between DIC Comparison Between DIC and PCC and PCC (Cont’d)(Cont’d) Procedural differencesProcedural differences
Response TimeResponse Time ::
All PCC calls require an immediate responseAll PCC calls require an immediate response
Time is related to the efficacy of the therapeutic Time is related to the efficacy of the therapeutic
interventionsinterventions
The average response time is 5 minThe average response time is 5 min. . in PCC vsin PCC vs. .
1515 - - 30 min DIC 30 min DIC
Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation
Comparison Between DIC Comparison Between DIC and PCC and PCC (Cont’d)(Cont’d) Procedural differencesProcedural differences
Call complexityCall complexity : : PCC calls are less complex than DIC callsPCC calls are less complex than DIC calls
Most poisoning patients rarely have complex Most poisoning patients rarely have complex
medical historymedical history
Poisoning agents rePoisoning agents re--occur constantly from occur constantly from
yearyear--toto--yearyear
PCC is the first point of contact by public and PCC is the first point of contact by public and
health professsionalshealth professsionals
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Comparison Between DIC Comparison Between DIC and PCC and PCC (Cont’d)(Cont’d) Procedural differenceProcedural difference
ReferencesReferences:: PCC assess and make treatment PCC assess and make treatment
recommendation for any potential poison recommendation for any potential poison (medication, chemical, household, biological, (medication, chemical, household, biological, natural toxin). But DIC handle medication- and natural toxin). But DIC handle medication- and pharmacy-related inquirespharmacy-related inquires
PCC will often have a broader base reference PCC will often have a broader base reference collection than DICcollection than DIC
Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation
ReferencesReferences:: PCC assess and make treatment PCC assess and make treatment
recommendation for any potential poison recommendation for any potential poison (medication, chemical, household, biological, (medication, chemical, household, biological, natural toxin). But DIC handle medication- and natural toxin). But DIC handle medication- and pharmacy-related inquirespharmacy-related inquires
PCC will often have a broader base reference PCC will often have a broader base reference collection than DICcollection than DIC
Comparison Between DIC and Comparison Between DIC and PCC PCC (Cont’d)(Cont’d) Procedural differenceProcedural difference
DocumentaionDocumentaion:: Documentation helps in developing a Documentation helps in developing a
data system data system General Epidemiological Data (date & time General Epidemiological Data (date & time
of call, reason of exposure)of call, reason of exposure) Caller characteristics (site of call)Caller characteristics (site of call) Patient characteristics (age, gender, Patient characteristics (age, gender,
pregnancy status)pregnancy status)
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Comparison Between DIC and Comparison Between DIC and PCC PCC (Cont’d)(Cont’d) Procedural differenceProcedural difference
DocumentaionDocumentaion::(Cont’d)(Cont’d)
Exposure characteristics (substance, route Exposure characteristics (substance, route and site of exposure)and site of exposure)
Clinical course (Clinical manifestation, Clinical course (Clinical manifestation, medical outcomes)medical outcomes)
Medical management Medical management characteristics(Therapeutic intervention)characteristics(Therapeutic intervention)
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Considerations of Considerations of PCCPCC
Facility considerationsFacility considerations : : LocationLocation ( (near ER, medical library, hospital near ER, medical library, hospital
pharmacy)pharmacy) Work space and environmentWork space and environment
EquipmentEquipment : : Telephone system Telephone system ((direct with enough linesdirect with enough lines)) PC computer system andPC computer system and//or local area network or local area network ((LANLAN)) Modem and facsimile machineModem and facsimile machine Internet accessInternet access Other Other ((such as file cabinets, refrigerators, such as file cabinets, refrigerators,
microwavemicrowave) ) Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center
(PCC).Power Point Presentation (PCC).Power Point Presentation
Considerations of Considerations of PCC PCC (Cont’d)(Cont’d)
ResourcesResources : : Two factors should be available in Two factors should be available in
PCCPCC The experience and training of the The experience and training of the
specialistspecialist The quality of the information The quality of the information
available to the specialist.available to the specialist.
Yousif Abdu Asiri, Yousif Abdu Asiri, The Difference Between Drug Information Center (DIC) and Poison Control Center The Difference Between Drug Information Center (DIC) and Poison Control Center (PCC).Power Point Presentation (PCC).Power Point Presentation
Considerations of Considerations of PCC PCC (Cont’d)(Cont’d) ResourcesResources : :
Micromedex’s Poisindex (a database of more Micromedex’s Poisindex (a database of more than 800,000 household products, chemicals, than 800,000 household products, chemicals, and medications)and medications)
Clinical Toxicology of Commercial ProductsClinical Toxicology of Commercial Products General clinical toxicology textsGeneral clinical toxicology texts Specialized toxicology textsSpecialized toxicology texts Internal protocol for handling certain poisonsInternal protocol for handling certain poisons Primary literature (case report)Primary literature (case report) On-call medical support and expertsOn-call medical support and experts in the areain the area
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Considerations of Considerations of PCC PCC (Cont’d)(Cont’d) Policy and ProceduresPolicy and Procedures : :
Different than DIC in almost all Different than DIC in almost all aspectsaspects
Handling intentional exposureHandling intentional exposure Long term public education programLong term public education program Release of PCC tape recordingRelease of PCC tape recording Telephone system repairTelephone system repair
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Telephone Protocol For Telephone Protocol For Handling Poison CallsHandling Poison Calls
I .Initial assessment I .Initial assessment SubstanceSubstance Symptoms Symptoms What has been doneWhat has been done
II. HistoryII. History Basic informationBasic information SubstanceSubstance AmountAmount SymptomsSymptoms
III. AssessmentIII. Assessment Toxicity of the substanceToxicity of the substance Circumstances of exposureCircumstances of exposure Competency of the callerCompetency of the caller
Telephone Protocol For Telephone Protocol For Handling Poison CallsHandling Poison Calls
IV. Treatment plan (one of the following)IV. Treatment plan (one of the following) No treatmentNo treatment First aid and observe at homeFirst aid and observe at home Syrup of ipecac and observe at homeSyrup of ipecac and observe at home Refer t o MD, ER,etcRefer t o MD, ER,etc
V. Follow upV. Follow up Made at 0.5 hr,2-4hrs,12hrsor 24hrsMade at 0.5 hr,2-4hrs,12hrsor 24hrs
Has the victim remained asymptomaticHas the victim remained asymptomatic Were instructions followedWere instructions followed Was treatment effectiveWas treatment effective Poison prevention teachingPoison prevention teaching ReferralReferral