AMERICAN POISON CENTERS Emergency Care Prevention Toxicosurveillance

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AMERICAN POISON CENTERS Emergency Care Prevention Toxicosurveillance

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1. AMERICAN POISON CENTERS Emergency Care Prevention Toxicosurveillance Edward P. Krenzelok, PharmD, FAACT, DABAT Director Pittsburgh Poison Center Professor of Pharmacy and Pediatrics University of Pittsburgh AAPCC Board of Directors

2. OBJECTIVES PROVIDE A HISTORICAL PERSPECTIVE DESCRIBE THE CONTEMPORARY CAPABILITIES OF POISON CENTERS Emergency Care Poison Prevention DISCUSS THE NATIONAL POISON DATA SYSTEM (NPDS) Data Collection Toxicosurveillance

3. THE EVOLUTION OF US POISON CENTERS 1940-50’s 800-1400 home poisoning fatalities/yr 33% = < 4 yr of age 1953 First Poison Center 1958 AAPCC 1970 Poison Prevention Packaging Act 1978 ~800 Poison Centers 1983 Toxic Exposure Surveillance System 2002 Nat’l Toll Free No. 1-800-222-1222 2007 61 Centers 24/7 Service

4. 2007 61 US Poison Centers

5. US POISON CENTERS Scope of Practice

6. US POISON CENTER ACCESS Common Telephone Number

7. US POISON CENTERS Emergency Care UNIFORM QUALITY STANDARDS AAPCC Certified Regional Centers 24/7 Service 2006 Statistics 4,033,279 Calls

8. US POISON CENTERS Types of Calls-2006 EXPOSURES Human-2,403,539 Animal-128,353 INFORMATION Drug ID-948,055 Drug Info-176,746 Prevention-44,489

9. WHO CALLS POISON CENTERS? PUBLIC PHYSICIANS NURSES PSAP’s PHARMACISTS PARAMEDICS VETERINARIANS URGI-CARE CTRS HEALTH DEPT’S OCCUP MED MD POLICE FIRE SERVICES PRISON OFFICIALS CORONERS ATTORNEYS INDUSTRY SCHOOLS GOV’T

10. WHO CALLS POISON CENTERS?

11. POISON CENTER STAFFING

12. RESOURCES Expert Staff Specialists in Poison Information Clinical Toxicologists Consultants Reference Texts Online Resources-Micromedex Literature Files Internet Resources Poison Center Treatment Guidelines

13. THE POISON CENTER PRODUCT

14. ACETAMINOPHEN EXPOSURE

15. POISON PREVENTION EDUCATION The Key To Success AAPCC CERTIFICATION STD Education is Mandatory Lay Public Medical Professionals POISON CENTER AWARENESS

16. NATIONAL POISON DATA SYSTEM NPDS FORMERLY = TESS DATA COLLECTION RETROSPECTIVE ANALYSIS REALTIME TOXICOSURVEILLANCE

17. Poison centers create a medical record as they respond to the poisoning emergency….

20. NPDS SURVEILLANCE Retrospective Analysis

21. NPDS SURVEILLANCE Realtime SPIs DOCUMENT LOCALLY AUTOUPLOAD 4-6 Min Lag Time Local Nat’l Surveillance Servers SURVEILLANCE TEAM Mine Data 24/7 Increased Activity Unusual Patterns Syndromic Surveillance Sentinel Events 100% COVERAGE-US, PR, Territories

22. TOXICOSURVEILLANCE Examples Look for early indicators of outbreaks Rapidly detect and report chemical or biological events. Continuously search for patterns suggesting covert chemical or biological events. Identify chemicals, products, environmental agents, and consumer products with potential public health significance.

23. ID SUBSTANCE ABUSE TRENDS February 7, 2001 M360 Hydrocodone 7.5 mg/APAP 750 mg Vicodin ES ‘Generic’ February-March, 2001 222 ID Requests PGH DRUG DIVERSION TASK FORCE Supplied Zipcodes Drug Diversion Source Identified

24. DISEASE SURVEILLANCE AND NONPRESCRIPTION MEDICATION SALES CAN PREDICT INCREASES IN POISON EXPOSURE CALLS

26. Chem/Bio Terrorism and Poison Centers Anthrax Calls 6/2000 through 6/2002

27. SALMONELLA TAINTED PEANUT BUTTER

28. AAPCC HAND SANITIZER DATA

29. RESEARCH MEDICAL RECORD REVIEW PROSPECTIVE DATABASE ANALYSIS EVIDENCE-BASED REVIEWS BASIC SCIENCE

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