Rocky Mountain Poison Center Automotive Chemicals Product Stewardship

1. Rocky Mountain Poison CenterAutomotive Chemicals Product Stewardship Alvin C. Bronstein MD, FACEP Medical Director Rocky Mountain Poison Center Associate Professor University of Colorado Health Sciences Center Denver Health and Hospitals Denver, CO Dennis R. Lemon MBA Corporate Account Manager Rocky Mountain Poison Center Denver, CO Automotive Specialty Products Alliance – Spring Meeting 12 June 2014 Rocky Mountain Poison Center

2. Pre-History 1940-50’s 800 -1400 home poisoning fatalities a year 33% < 4 years of age First US poison center 1953 Rocky Mountain Poison Center (RMPC) founded 1956 Toxicology Fellowship – 1974 Drug Consultation Center – 1977 Research and Consulting – 1995 Denver Health Advice Line established – 1997 Appointment Center, Workers Compensation Center, Spanish Line – 1999 Public Health Preparedness Information Center – 2004 RMPC History

3. RMPC • Serves combined population of 10.3 M • 35 SPIS / 25 PIPs • 18 medical toxicologists on staff • 200,000 calls per year Rocky Mountain—Regional Center: Part of 55 PCs All 50 States, Puerto Rico, US Virgin Islands, 3 Pacific Jurisdictions

4. RMPC Data Collection • Open 24/7 • National Phone Support for Supported States • Dedicated Corporate Phone Lines • Staff • Specialists in Poison Information (SPIs) • RNs • Pharmacists • PharmDs • Poison Information Providers (PIPs) • Medical and clinical toxicologists • RMCP collects standardized data set • Who calls the poison center (PC)? • Consumers • Health care professionals • Health departments • Public Safety Agencies

5. RMPC Call Data Examples Two types of calls Information Exposure Standardized data fields Demographics Exposure Route Product Name Clinical Effects Therapies Management Medical Outcome

6. Defined Medical Outcomes

7. Case Activity Across America — 2000-2013

8. Automotive Product Percentage of National Calls — 2000-2013

9. Top 10 US Automotive Products Exposure Categories — Humans: 2013 Total Calls = 13261

10. Top 10 US Automotive Products Exposures Categories — Animals: 2013 Total Calls = 545

11. 2013 US Outcomes – All Products

12. Medical Outcome Human Exposures: Automotive Products - 2013

13. Medical Outcome US Animal Exposures: Automotive Products - 2013

14. Case Data from National Source • Redacted Contact Information • Product Details Limited to Generic Codes • Limited Case Details • Case Notes Removed • Only Aggregate Reports Available • Costly Reports

15. Sample Case

16. Sample Case

17. Case Data from RMPC as Service Provider —Product Stewardship • Complete Contact Information – Caller and Patient(s) • Product Details – Product Type and Size • Full Case Details – Progression of Case • Complete Case Notes – The Story to Outcome • Detailed Reports – Periodic Reporting – Sentinel Events / Legal Threats – Quick Notification • Very Cost Effective Value • You Know What is Happening with Your Products and Brands

18. Things to Look for in a Service Provider • Years of Experience and Staff for 24/7 Coverage • Expertise to handle Tough Circumstances – Medical Management • Keep Major Outcomes from becoming Deaths • Keep Moderate Outcomes from becoming Major • Keep Minor Outcomes from becoming Moderate • Help Consumers manage incident without ER involvement • Ability to Follow Cases to Medical Outcomes • Complete Case Reporting Capabilities • Situational Awareness for Sentinel Event Monitoring • Standard Periodic Reporting • Case Escalation / Notification Processes in Place

19. RMPDC Example — Win/Win/Win Arrangement with Chemtrec • Chosen by Chemtrec to Support Call Activity • Chemtrec Reps have HAZMAT/Spill-Response/Incident Command Experience • Yet, Uncomfortable with the Growing Medical Case concerns and relying on reading MSDS First Aid Only • RMPC was already servicing Chemtrec for HCP Calls • Healthcare Professionals • On-site EMT Paramedics • Critical Event Medical Problems • Chemtrec Staff still encountering calls from General Public—Consumers • RMPC now manages all medical calls for Chemtrec – Chemtrec found the Value to be Positiveand a Win/Win/Win • Win for Consumers, who receive sound medical advice tailored for their circumstance • Win for Chemtrec, since their expert staff can focus on what they do best • Win for RMPC, as we continue to do what we do best

20. Rocky Mountain Poison Center – Summary • Automotive Chemical Products are Used Everywhere • There are Medically-Related Incidents in Process • Some of the Incidents have very serious outcomes • Without a Central Location for Case Data Management • Difficult to know about incidents • Very costly to obtain details • You’ll unlikely ever know the true story • But, by Collaborating with Service Provider • Reporting • Surveillance • Consultation • 24/7 national infrastructure • Emergency information and surveillance • Situational awareness • Help mitigate disruptive challenges to business and product brands • It’s a Solution of Reasonable Value

21. Rocky Mountain Poison Center – Questions? Dr. Al Bronstein Al.Bronstein@rmpdc.org 303-739-1215 Dennis Lemon Dennis.Lemon@rmpdc.org 303-739-1178