Poison Control In The United States

Issues of Concern

History of Poison Centers[2][3]

The first organized poison center was established in 1953 in Chicago by doctors Edward Press, M.D. and Louis Gdalman, R.Ph. in response to national recognition on the impact of childhood poisonings in the United States. Doctor Press, a pediatrician, and Doctor Gdalman, a pharmacist, collected information on standard forms and providing medical advice to healthcare professions through a telephone hotline. 

Within two years the program was replicated in several other locations, and it became clear that these small poison centers were not sharing collected information or management experiences.  In 1957 the Surgeon General created the National Clearinghouse for Poison Control Centers which allowed for standardized data collection and compilation as well as dissemination of a set of standardized 5"x8” index cards containing poison management to the various centers. This, alongside the 1957 publication Clinical Toxicology of Commercial Products, which provided information on over 25000 products and treatments on over 50 compounds provided the first organized resource for management of poison emergencies. In 1958 at the annual meeting of the American Academy of Pediatrics the American Association of Poison Control Centers (AAPCC) was founded. 

The 1960s and 1970s saw a rapid expansion of poison centers throughout the country through the composition, staffing, guidelines and recommendations, and services provided varied greatly from one center to another.  Some centers only managed calls from healthcare professions, other from the lay public, and still others from both.  The calls were answered by various individuals ranging from clerks to physicians, pharmacists, veterinarians, to anyone with a remote interest or expertise in poison emergencies. 

By 1978 the United States had 661 poison centers, and due to the aforementioned lack of consistency from center to center, several organizations including the AAPCC called for fewer and better staffed and organized centers called “Regional Centers.”  These large centers provided more consistent staffing, training, public and professional education, data collection, and recommendations for poison emergencies.  The Toxic Exposure Surveillance System (TESS) came into being in 1985 which allowed poison centers to share uniformly collected data for toxicosurveillance.

The year 2001 saw the introduction of a toll-free number (1-800-222-1222) that routed phone calls to local, regional poison centers based on the caller’s zip code.  This toll-free number made poison center services universally accessible to every American.

Finally, in 2006 the National Poison Database System (NPDS) replaced TESS, which provided a more robust data collection, transmission, and analysis for all poison centers and their partners. [4] NPDS is the current database in use today by all 55 poison centers and continues to serve an important role in poison center and public health operations.

Poison Center Organization 

• Leadership
  • Poison centers are led by a Managing Director and Medical Director.

• Poison Specialists & Staff
  • Poison center staff who answer the 1-800-222-1222 hotline are specially trained in toxicology, which allows them to rapidly assess, triage, manage, and monitor individuals exposed to poisons.  Some staff also serve as educators and focus their time on developing and implementing educational and outreach programs.  There are three categories of staff who answer poison calls.
    • Specialists in Poison Information (SPIs) are trained registered nurses, pharmacists, physicians, or physician assistants.
    • Certified Specialists in Poison Information (CSPIs) are experienced SPIs that have logged a minimum of 2000 hours and handled 2000 human exposures as an SPI and pass a national certification examination.
    • Poison Information Providers (PIPs) are allied healthcare professionals who manage low-acuity and information calls under the direct supervision of a CSPI. 

• Medical Backup & Consultation
  • Medical backup and consultation are provided by both medical and clinical toxicologists and can be requested by any healthcare provider calling a poison center.
    • Medical Toxicologists are physicians who are board-certified or board-eligible in medical toxicology.  Medical toxicologists must complete a 2-year fellowship program following primary board certification.  Medical toxicologists can also serve as the medical director, managing director, or both.
    • Clinical Toxicologists are pharmacists or registered nurses who are diplomates of American Board of Applied Toxicology (DABAT) following residency or advanced training in toxicology.  Clinical toxicologists can also serve as managing directors. 

Core Functions of a Poison Center 

There are five core functions common to all poison centers.[5]

• Core Function #1: Accessible and affordable healthcare delivery
  • As mentioned above, 55 poison centers use the single toll-free 1-800-222-1222 phone number to provide 24/7/365 access to poison center services for every American.  Poison centers offer services in over 150 languages and provide TDD/TTY for hearing impaired callers.
  • The service is free to the public, and most centers do not charge a fee for a physician or hospital consultations.  Poison centers also serve to triage calls from the public and provide safe management recommendations and monitoring which allow individuals to be monitored at home without unnecessarily using hospital resources and healthcare dollars.

• Core Function #2: Healthcare cost savings
  • Poison centers also help minimize unnecessary healthcare costs through appropriate triage and management recommendations.  Blizzard et al. in 2008 surveyed individuals calling a poison center on what they would have done had poison center services been unavailable.[6]  He found that 24% of callers would have gone to an emergency department or their doctor and 55% would have called their doctor, the hospital, a pharmacist, or 911.  Simply looking at patients who would have unnecessarily sought medical care, the average benefit-to-cost ratio of calling the poison center was 7.67 (95% CI 6.83, 8.50).   Closures of poison centers in Louisiana and Michigan in the late 1980s led to a 40% increase in ED visits for poisoning provided further evidence of the cost-savings potential of poison centers.[7] 
  • Poison center co-management has also been shown to decrease the length of stay and healthcare costs associated with hospitalization.[8][9][10]

• Core Function #3: Toxico-surveillance
  • Poison centers auto-upload data on poison exposures to NPDS on average every 9.5 minutes which allows for real-time detection of surveillance anomalies and events of public health significance.  NPDS data is monitored with anomaly detection software by both AAPCC and the Centers for Disease Control (CDC).  NPDS data also gets shared with key regulatory agencies such as the Food and Drug Administration (FDA), Drug Enforcement Agency (DEA), Consumer Product Safety Commission (CPSC), and the Environmental Protection Agency (EPA).

• Core Function #4: Public and professional education
  • Poison centers provide a critical function in educating the public on both poisoning prevention as what services poison centers provide and how to use the service.  They provide educational sessions to school-aged children, aging adults, and to community groups.
  • Poison centers also provide professional education to medical students, medical residents, and fellows in toxicology fellowship training programs.  It also educates pharmacy students and pharmacy residents training in toxicology.  Finally, poison centers frequently provide continuing medical education programs, symposiums, webinars, etc. to help keep healthcare providers up to date on poison-related topics.

• Core Function #5: Drug and product safety research
  • All poison centers upload data to NPDS which serves as a rich repository of data that can be used to monitor the safety and clinical effects of new medications, chemicals, and emerging drugs of abuse.  Poison center data are used to identify needs for defects in packaging and medication formulations and monitor recalls and public health interventions.

Clinical Significance

Value of Poison Centers

Poison centers have evolved to serve a unique and key role in both direct patient care and public health.  They serve as an easily accessible and cost-effective resource for healthcare professionals and the public alike and provide access to the most up to date and evidence-based information on exposures to poison.  Finally, the ongoing robust data gathering has significant potential to assist in the understanding of the evolving public health crisis of drug abuse and drug-related deaths that exists in the United States.  Clinicians are encouraged to continue to use poison center services and report all poison exposures.

The nation-wide local poison center number is 1-800-222-1222.