Poison Control Centers and TESS

Role of Regional Poison Control Center 24-hour resource for poison information, prevention, education and clinical toxicology consultation Types of calls include: pediatric ingestions, overdoses, abuse, adverse reactions, therapeutic misadventures, environmental, occupational, natural products, plants, envenomations, etc.

US Poison Centers Available US Poison Centers Universal access through Specialized services Language translation Hearing Impaired Available to public and health professionals

New Telephone Number Nationwide toll-free number routes caller to one of 65 poison centers based on area code and exchange Coverage: 50 States, DC and Puerto Rico

Poison Center Staff Specialists in Poison Information: pharmacists and nurses with additional training in clinical toxicology Clinical Toxicologists Medical Toxicologists Educators

Regional Poison Control Centers Numerous resources on-site Interface with regional treatment facilities  pre -hospital providers  clinical laboratories  health care facilities Outreach education

Regional Poison Control Centers Disaster preparedness and response Epidemiologic surveillance

Calls to US Poison Centers million poison exposures 860,000 information calls 111,000 animal exposures

Exposure Management Public Call History of exposure Assessment of toxicity Triage – home, ED Home treatment recommendations Healthcare provider recommendations Prevention education Follow-up

Exposure Management HCF Call History of exposure Assessment of toxicity Differential diagnosis Clinical toxicology consultation Specific treatment recommendations Follow-up

Poisoning History Patient Status Substance Amount Time Since Exposure Reason Past Medical History First Aid Provided Age/gender/weight

Follow-up call Public To ensure that recommendations were understood Situation resolving Documentation of outcome HCF Review and update recommendations as patient status changes Documentation of outcome

TESS Toxic Exposure Surveillance System is the database of the American Association of Poison Control Centers Compiled by the AAPCC in cooperation with majority of US Poison Centers 64 poison centers reported in 2001 Requirement for certified regional poison centers

Toxic Exposure Surveillance System Single largest database on poison exposures in US 1983 to present Hospitalized and home management for poison exposures > 31 million poison exposures reported to date Strong consistent temporal relationship

History of TESS Deficiencies of US National Clearinghouse for PCCs PCC Driven FDA fellowship to organize, pilot and implement a functional system, develop software, instructions, generic classification scheme, uniform reporting forms Pilot tested in 1983 National implementation in 1984

TESS Data Collection Computerized data collection program at each poison center Data collected at time of telephone call Autoupload of data to AAPCC in real time Medical records retained on-site

Use of TESS Data TESS Annual Report September issue of Am J Emerg Med Identification of new product risks Post-marketing surveillance Public health surveillance Regulatory actions Education program development Research

TESS Data Collection Case Information Call type Caller Site Exposure Site Reason Relationship of caller to patient (optional) Location information (zipcode/exchange)

Caller/Exposure Site Own Residence Other Residence Health Care Facility School Restaurant Public area Workplace Other Unknown

Reason for Exposure Unintentional General Environmental Occupational Therapeutic error Unintentional misuse Food poisoning Bite/sting Unknown Intentional Suicide Misuse Abuse Unknown Other Malicious Contamination Adverse Reaction

TESS Data Collection Patient Data Age Gender Pregnant

TESS Data Collection Exposure Information Time since exposure (optional) Substance Clinical Effects Route of Exposure Therapy provided Management Site Medical Outcome

Substance Information Coded to brand and formulation if known Coded by generic or category if unknown Number of substances Quantity Certainty Dosage form

Clinical Effects Cardiovascular Dermatologic Gastrointestinal Heme/hepatic Neurologic Ocular Respiratory Renal/genitourinary Respiratory Miscellaneous Specific definitions – some require objective findings Coded as related, unrelated or unknown if related

Therapy Provided No therapy Observation only Refused Unknown Decontamination Other therapies

Management Site Onsite – non health care facility Already in/enroute to HCF Referred to HCF Other (nursing home, detox, jail) Unknown

Management Site - HCF Treated and released from ED Admitted to critical care Admitted to non-critical care Admitted for psychiatric care Lost to follow-up Refused referral (referred only)

Medical Outcome No effect Minor effect Moderate effect Major effect Death Unknown, non-toxic Unknown, minimally toxic Unknown, potentially toxic Unrelated Duration of symptoms

TESS Data Collection Scenarios Pesticide exposures Therapeutic errors

Information not available from TESS Narrative description Patient identifiers: name, address, birthdate Socioeconomic data

Use of TESS Data Specific Examples Iron formulations Acetonitrile Pesticides Arsenic containing rodenticides Mouthwash Rx  OTC switch (ibuprofen, H2 antagonists, nicotine patch)

Quality Control Data Collection Manual and Workbook Center specific chart audits Electronic data checks and edits Data quality factors Fatality verifications

What TESS Can Not Do Poison Exposure vs Poisoning Absence of clinical effects Prompt treatment or guidance by PCC Limited toxicity of substance Limited amounts/concentrations of substance Exposure suspected but did not occur Telephone reporting Passive reporting Increased reports ≠increased hazard Calculate incidence of poisoning

Exposure Site Site of Caller (%) Site of Exposure (%) Residence HCF Workplace School

Route % All% Fatal Ingestion Dermal Inhalation Ocular5.40.1

TESS 2001 Management Site

TESS 2001 Management Site Health Care Facility

TESS 2001 Most common substances by Age < 6 years Cosmetics Cleaners Analgesics Foreign bodies Topicals Plants Cold preps Adults Analgesics Sedative/hypnotics Cleaners Antidepressants Bites/stings Alcohols Food poisoning

Substances Related to Deaths Analgesics (pain killers) Antidepressants Sedatives/hypnotics/ antipsychotics Stimulants and street drugs Cardiovascular drugs Alcohols Anticonvulsants Muscle Relaxants Gases and Fumes Chemicals

Impact of Space Shuttle

Information calls to PCCs

Carbon monoxide

Summary Comprehensive poisoning surveillance database Includes cases managed in and outside HCF Voluntary Telephone reports Consistent temporal nature Identification of public health hazards

Questions 