1. Virginia Poison Control Network Blue Ridge Poison Center at UVA Virginia Poison Center at VCU National Capital Poison Center in DC

2. Virginia Poison Control Network Institute of Medicine 2004 Report: Forging a Poison Prevention and Control System poisoning is a larger and more important public health problem than has generally been recognized

3. Virginia Poison Control Network Falls19,08945% Poisoning6,87716% Motor Vehicle4,22010% Injury in Virginia: 2008 Top 3 causes of injury hospitalization

4. Virginia Poison Control Network Motor Vehicles82420.99% Firearms80820.52% Poisoning78219.90% Falls53913.72% Injury in Virginia: 2008 Top causes of injury death

5. Virginia Poison Control Network 92,346 total incoming calls –67,363 human poison exposures 53,174 in 1998 –24,983 other calls (e.g., drug information, occupational, abuse, teratogenicity, animals). 97,521 follow-up calls Virginia Poison Control Network (Virginia Calendar 2010 Data)

6. Virginia Poison Control Network General34,36751.02% Therapeutic error8,95213.29% Misuse Adverse reaction 4,810 1,971 7.14% 2.93% Environmental1,8162.70% Bite/sting1,2561.86% Food poisoning8701.29% Occupational8381.24% Unknown1200.18% Total Unintentional55,00081.7% Unintentional Poisonings: 81.7% (Virginia Calendar 2010 Data)

7. Virginia Poison Control Network Suspected suicidal6,84910.17% Intentional Misuse2,1943.26% Abuse (for psychotropic effect)1,4732.19% Unknown9751.45% Total Intentional11,491 17.06% Intentional Poisonings: 17.06% (Virginia Calendar 2010 Data)

8. Virginia Poison Control Network Poison centers handle more than simply calls about children…

9. Virginia Poison Control Network

11. Coordination of referrals to appropriate facility Statewide professional education Statewide public education Poison control surveillance Disaster preparedness planning And more than telephone services… Commonwealth of Virginia Contract

12. Virginia Poison Control Network Presented at 235 public prevention programs Provided 206 media interviews/features Trained 536 healthcare professionals Provided 519 professional educational programs Distributed 1.6 million prevention materials Activities (FY 2010 Data)

13. Virginia Poison Control Network Poison Center data is submitted to American Association of Poison Control Centers N NATIONAL P POISON D DATA S SYSTEM NPDS

14. Virginia Poison Control Network

15. Studies have shown that every dollar spent on poison center services saves more than $6-36 in health care expenditures. In 2010, ~85% of human exposure calls that originated outside of a healthcare facility were able to stay at the exposure site and not seek medical attention. Virginias poison centers safely managed ~48,000 patients at the site of exposure. Research demonstrates that 70% of patients who are managed at home by the poison center would have sought unnecessary care in emergency rooms if the poison center were not available. In Virginia, use of the poison center services therefore likely prevented 33,000 unnecessary ED visits. Poison Centers are Cost-Effective

16. Virginia Poison Control Network In FY 2004, state funding was cut by 15% In FY 2007, state funding was cut by 3% In FY 2009, state funding was cut by 3% In FY 2010, state funding was cut by 15% In FY 2011, state funding was cut by 62% Currently operating at 25% of the 1998 funding State is funding 11.8% of overall budget State Funding Cuts

17. Virginia Poison Control Network State Funding Current Cost $4,250,963 (FY 10)

18. Virginia Poison Control Network Currently the Commonwealth has a total of 92,346 calls. By the AAPCC certification rules, nurses may take no more than 5,000 calls per year (goal is 3,500). The average cost of a nurse (salary plus benefits) is $90,000. To outsource, nursing costs alone would be $1.8 million (~20 nurses) and there would be substantial other costs. Outsourcing to another state would eliminate at least 40 Virginia jobs associated with the 3 poison centers. The loss of dedicated clinical toxicology expertise in Virginia would be detrimental to universities, EMS and healthcare facilities statewide. No other state will pick up Virginia calls without funding. Why not outsource calls?

19. Virginia Poison Control Network The in-kind contributions from the 3 poison center host institutions is substantial. Currently, state funds and federal funds do not cover even the most basic components of the poison centers (e.g., nurses, public educators, facilities, materials). Each of the centers has worked diligently to bring in additional funds (research, teaching, clinical) to support expanding services associated with but not in the poison centers. In 1999, there were only 3 clinical toxicologists in Virginia (2 physicians and 1 PharmD). Currently, there are 10 (9 physicians and 1 PharmD), all supported by monies not from the poison center state funds. Why not consolidate centers?

20. Virginia Poison Control Network There is no one who will pick up the calls. Instead of calling, patients will have to seek medical attention, further stressing the EMS and EDs. No education to either public or professionals in Virginia as all clinical toxicologists will leave (domino effect). No associated unique Virginia research, disaster expertise, toxicology expertise for bio/chemterrorism, etc. Why not just close the centers?

21. Virginia Poison Control Network Where local civic leaders, citizens, and families are educated regarding threats and are empowered to mitigate their own risk, where they are practiced in responding to events, where they have social networks to fall back upon, and where they have familiarity with local public health and medical systems, there will be community resilience that will significantly attenuate the requirement for additional assistance. Homeland Security Presidential Directive 21 (HSPD-21): National Strategy for Public Health and Medical Preparedness Community Resilience