Inside Pediatrics Spring 2015

Inside Good Health Regional Poison Control Center Reduces Emergency Room Visits, Saves Lives

A single telephone and a passionate young doctor became the first pipeline of information that has saved untold lives and curtailed unnecessary, expensive emergency room visits. The Regional Poison Control Center (RPCC) at Children’s of Alabama had its beginnings 60 years ago when pediatricians from around the state began regularly calling the hospital seeking help for patients who were presenting with symptoms of toxic ingestions from medications and household products. At a time before product labeling and child-resistant packaging were mandated, doctors were limited in the knowledge that was available to help them identify and treat suspected poisonings. “Manufacturers collectively felt little responsibility for adequately warning of poison hazards,” said Don Palmer, M.D., a pediatrics resident at the time. “Contact information for the manufacturer was more often than not missing on the label, and warnings the calling — and soon became the “go-to guy” for providing diagnostic and treatment guidance. By 1958, he had founded the Regional Poison Control Center at Children’s, one of the first 14 established in the United States. Eight years later, Paul Palmisano, M.D., became the center’s first medical director, installing a “poison phone” in the pharmacy so that it could be answered around-the-clock. The program rapidly expanded during his tenure. In its first year, the new poison center fielded about 100 calls. “During those early years, staff members would use an old index card system to help guide them through the triage and treatment recommendations,” Children’s Child Safety Institute divisional director Bill King, Dr.PH, R.Ph, said. By 1979, the cards had been replaced by microfiche and the first toll-free hotline in Alabama for poison information established. At the same time, the center began tracking the calls received, noting were woefully inadequate or wrong.” Palmer answered the calls   and

a more comprehensive picture of the increasingly important and complex role of poison control centers. Today, technology permits instantaneous posting and analysis of data derived from received calls. That data is surveilled by the Centers for Disease Control and Prevention to recognize and evaluate emerging trends and public health risks. The data is also used to kick-start prevention efforts and even spark legislative efforts. In Alabama, for example, spikes in the number of calls related to synthetic cathinone derivatives, or “bath salts,” led to new legislation that reclassified the substance as a Schedule 1 controlled substance and banned its possession, manufacture and distribution. Similarly, a sharp rise in the number of carbon monoxide exposures following Hurricane Katrina being improperly used across Alabama by families who were without electricity for days after the storm. Such close monitoring of data is useful for a wide array of public health hazards and would be crucial in the occurrence of a bioterrorism event. Community outreach Beyond telephone triage and data reporting, the RPCC at Children’s provides a statewide educational program to heighten public and professional awareness of the center, to inform parents and caregivers of the best preventive actions, and to provide continuing education for health care professionals on the assessment, triage and management of poisoned patients. Advanced Hazmat Life Support courses help train first responders in the event alerted public health officials to the number of home generators

details that would eventually be used to monitor trends and enhance the triage process. Since 1999, the RPCC has used electronic medical records, which allow data to be uploaded to the National Poison Data System in real time. Training and certification In 2014, the RPCC fielded 50,941 calls related to poison information and toxic ingestions in children, adults and animals. About 53 percent were pediatric cases. Each is answered by one of 22 staffers, all specially trained registered nurses and pharmacists. To become a certified poison center specialist, each licensed health care professional must complete six to 12 weeks of intense training in toxicology, log 2,000 hours of work in the poison center and answer 2,000 calls before sitting for the national certification exam. Certification must be renewed every seven years. “At least 50 percent of a poison center’s staff must be certified in order for the center to gain accreditation. We have 90 percent,” explained managing director Ann Slattery, Dr.PH, RN, R.Ph, CSPI, DABAT. In addition to King and Slattery, board- certified emergency medicine pediatrician Michele Nichols, M.D., and Erica Liebelt, M.D., who is also board-certified in pediatric emergency medicine and medical toxicology, serve as co-medical directors. Advanced level consultation beyond the initial contact with center staff is available around-the-clock from this team. Funding is provided primarily by Children’s along with limited state and federal dollars, and a significant annual contribution from Blue Cross Blue Shield of Alabama through The Caring Foundation. Impact on public health The numbers help tell the story of the growth of the RPCC, but the far-reaching impact of those calls and the center’s commitment to educational outreach gives

The RPCC is the only poison control center in Alabama and was one of the first 14 established in the U.S.

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