History
After World War II there was a proliferation of new drugs and chemicals in the marketplace, and consequently suicide and childhood poisonings from these agents drastically increased. Around this time up to half of all accidents in children were poisonings with a substantial number of fatalities. [3] These factors led to the medical community developing a response to both unintentional and intentional poisonings. In Europe in the late 1940s special toxicology wards were set up; initial wards were started in Copenhagen and Budapest, and the Netherlands began a poison information service. [4]
In the United States during the 1930s, Louis Gdalman, a pharmacist knowledgeable in the chemistry of harmful substances, set up a poison information service at St. Luke's Hospital (Chicago, Illinois). [5] He became known around Chicago and the country as the person to contact in a poisoning case and would take calls at home around the clock. In the late 1940s, Gdalman began to organize the poison information onto note cards and created a standardized form to collect new information on new toxic substances. By 1953 he had collected an extensive library of information on thousands of poisons and he established the first Poison Control Center along with Edward Press. [6] [7] By 1957 there were 17 poison control centers in the U.S., with the Chicago center serving as a model; these centers dealt mainly with physician enquiries by giving ingredient and toxicity information about products, along with treatment recommendations. Over time the poison control centers started taking calls from the general public. The majority of poison centers were not part of a patient treatment facility; they strictly provided information.
In 1958 the American Association of Poison Control Centers (AAPCC) was founded to promote cooperation between poison centers in different cities and to standardize the operation of these centers. An additional part of the AAPCC's activities was poison prevention and education programs for both physicians and the general public. In 1968 the American Academy of Clinical Toxicologists (AACT) was established by a group of medical doctors. The AACT's main objective was to apply principles of toxicology to patient treatment and improve the standard of care on a national basis. In the 1960s and 1970s a rapid proliferation of poison centers emerged and by 1978 there were 661 centers in the USA. This trend reversed during the 1980s and 1990s with a number of centers closing or merging. In 2000 there were 51 certified centers in the USA. [8] As of 2006 there are 55 centers operating in the US. [9]
A 2019 study conducted for the AAPCC showed that every dollar invested in the poison center system saves $13.39 in health care costs and productivity. [10]
While poison control centers have traditionally provided expert consultations by telephone, on 30 December 2014 an online option was launched by a group of U.S. poison centers to meet the growing demand for accurate web-based health information. [11] Based on age, weight, amount, route, symptom status and substance implicated, it provides case-specific guidance for poison exposures. The webPOISONCONTROL application uses ingredient-based algorithms to generate a recommendation including whether an emergency department visit or call to poison control is required. If it's safe to stay home, then home treatment recommendations, specific symptoms to expect, and symptoms of greater concern that would require a call to poison control or a visit to an emergency department are outlined.
Europe
A similar movement evolved in Europe but unlike the American movement the majority were centralized toxicology treatment centers with integrated poison information centers. The French developed an inpatient unit for the treatment of poisoned patients in the late 1950s. In England the National Poison Information Service was developed at Guy's Hospital under Dr Roy Goulding. [4] At around the same time Dr Henry Mathew started a poison treatment center in Edinburgh. [12] In 1964 the European Association for Poison Control Centers was formed at Tours, France. [4] Australasian centers were also established in the 1960s. The New Zealand center started in Dunedin in December 1964, while in Australia, the New South Wales Poisons Information Center was established in 1966. [14] [15]
Article 45 of the CLP Regulation places the duty upon Member States to appoint "bodies responsible for receiving information relating to emergency health response". These appointed bodies are often known as Poison Centres.
In the EEA, since 2020–2025, hazardous product manufacturers are required to send the formulation of their products to the European Chemicals Agency (ECHA) and to print a Unique formula identifier (UFI) code on their products. This code lets poison centers know the exact formulation of a product, while the formulation is only shared to the ECHA and attached poison control centers.
Countries
Belgium (and Luxembourg)
The Belgian Antipoison Centre (Centre Antipoisons in French, Antigifcentrum in Dutch) is tasked with receiving and answering urgent calls for medical advice regarding cases of poisoning 24/7 and throughout the year. Its hotline can be reached on the telephone number 070 245 245 in Belgium and is available to both medical professionals and the general public. To be able to answer the calls qualitatively, the Antipoison Centre manages a database with formulas of dangerous mixtures provided by the industry, and a database of relevant scientific literature in the field of toxicology. The Antipoison Centre is also responsible for keeping a stock of certain rare or expensive antidotes, and managing a network of hospital pharmacies that also have certain antidotes in stock. Lastly, the Antipoison Centre has a mission of toxicovigilance, meaning it warns relevant authorities (such as the FPS Public Health, Food Chain Safety and Environment or the FAMHP) about new and emerging risks of chemicals and pharmaceuticals involved in cases of poisoning. Since 2015, the Grand Duchy of Luxembourg has an agreement with Belgium to have the Antipoison Centre also function as the poison control center for Luxembourg. Medical professionals and members of the public from Luxembourg can reach the Antipoison Centre on the telephone number 8002 5500. [20]
Egypt
The Poison Control Centre of Ain Shams University (PCC-ASU) was established in 1981. It is one of the earliest poisoning treatment facilities to be established in the Middle East. It has its own inpatient department, ICU and Analytical Toxicology unit. [21] It serves between 20 and 25 thousand cases a year.
Germany
German states designate poison control centers. There are currently 7 different centers, some of them serving several states. [22] Calling the centers is free of charge for members of the public. Some centers charge a fee for calls by hospitals or other medical professionals.
- Baden-Württemberg: Poison Information Center of the Medical Center - University of Freiburg: (0761) 19 240
- Bavaria: Poison Control Center - University Hospital rechts der Isar (Munich): (089) 19 240
- Berlin, Brandenburg: Charité Poison Control Center (Berlin): (030) 19 240
- Bremen, Hamburg, Lower Saxony, Schleswig-Holstein: Poison Information Center Nord (Göttingen): (0551) 19 240
- Hesse, Rhineland-Palatinate, Saarland: Poison Information Center of the University Medical Center Mainz: (06131) 19 240
- Mecklenburg-Vorpommern, Saxony, Saxony-Anhalt, Thuringia: Joint Poison Information Center Erfurt: (0361) 730 730
- North Rhine-Westphalia: Poison Information Center Bonn: (0228) 19 240
India
- A Poison Control Centre with poison information service and analytical lab service has been established in Amrita Institute of Medical Sciences, Cochin, Kerala. center . This Poison Control Centre at Amrita Institute of Medical Sciences plays a pivotal role in the prompt diagnosis, treatment, and prevention of poisonings, offering essential support to both healthcare professionals and the general public.
- In April 2018, a Poison Information Center was established in Kolkata, in the Department of Forensic Medicine and Toxicology at R. G. Kar Medical College. The Center usually caters to patients as well as the doctors from the entire state of West Bengal, in addition to other parts of India. The toll free number is 1800-345-0033. [23]
- National Poisons Information Centre in the Department of Pharmacology at All India Institute of Medical Sciences, New Delhi. The toll free number is 1800-116-117.
- Poison Information Center at All India Institute of Medical Sciences, Bhopal. The toll free number is 1800-2333-1122.
- Poisons Information Centre at Christian Medical College Vellore. The toll free number is 1800-425-1213.
Netherlands
The National Poisons Information Centre (NVIC) of the University Medical Center Utrecht provides a 24/7 hotline service (030-2748888), staffed by poison information specialists (SPIs). It is open to medical professionals only and is not available to the general public.
Since 2011 the NVIC also provides a web-based exposure analysis and poison information system. [25] As with the webPOISONCONTROL system, this is a free-of-charge, fully confidential web application that enables medical professionals to quickly and efficiently assess the potential risks of (mixed) exposures, as well as their clinical signs and symptoms, and possible therapeutic interventions. As with the other online options worldwide, it remains advisable to consult the NVIC if the exposure is to a larger number of substances.
The NVIC can, on request, also provide specific training to emergency medical personnel (GMTs), emergency departments, physicians and their assistants, and other interested parties with regards to exposure prevention and management.
The NVIC was part of the National Institute for Public Health and the Environment until 2011. It was then transferred to the University Medical Center Utrecht.
Palestinian Territories
The Palestinian Poison Control and Drug Information Centre was established in 2006, by Ansam Sawalha. [26]
Saudi Arabia
The poison control department in King Fahad Medical City provides its service for healthcare professionals 24/7 throughout the year.
United Kingdom
The National Poisons Information Service (NPIS) provides toxicological information to health professionals to ensure patients receive appropriate treatment. [28] NPIS do not take calls from the general public, [29] who are instead advised to contact the non-emergency 111 number for specific information on poisons, or 999 in an emergency. [30]
United States
The American Association of Poison Control Centers manages a 24-hour hotline (1-800-222-1222), which is continuously staffed by pharmacists, physicians, nurses, and poison information specialists who have received dedicated training in the field of toxicology. Calls to the number are automatically routed to the poison control center that covers the territory from which the call is placed. It has a TTY/TDD number for the hearing impaired. Poison educators across the country also offer poison prevention training and education sessions to community institutions, along with educational materials. [31]
A poison is any chemical substance that is harmful or lethal to living organisms. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with a broad sense.
A pesticide poisoning occurs when pesticides, chemicals intended to control a pest, affect non-target organisms such as humans, wildlife, plants, or bees. There are three types of pesticide poisoning. The first of the three is a single and short-term very high level of exposure which can be experienced by individuals who commit suicide, as well as pesticide formulators. The second type of poisoning is long-term high-level exposure, which can occur in pesticide formulators and manufacturers. The third type of poisoning is a long-term low-level exposure, which individuals are exposed to from sources such as pesticide residues in food as well as contact with pesticide residues in the air, water, soil, sediment, food materials, plants and animals.
The United States National Library of Medicine (NLM), operated by the United States federal government, is the world's largest medical library.
Syrup of ipecac, or simply ipecac, is a drug that was once widely used as an expectorant and a rapid-acting emetic. It is obtained from the dried rhizome and roots of the ipecacuanha plant, from which it derives its name. It is no longer regularly used in medicine.
Carbon monoxide poisoning typically occurs from breathing in carbon monoxide (CO) at excessive levels. Symptoms are often described as "flu-like" and commonly include headache, dizziness, weakness, vomiting, chest pain, and confusion. Large exposures can result in loss of consciousness, arrhythmias, seizures, or death. The classically described "cherry red skin" rarely occurs. Long-term complications may include chronic fatigue, trouble with memory, and movement problems.
The Massachusetts Department of Public Health is a governmental agency of the Commonwealth of Massachusetts with various responsibilities related to public health within that state. It is headquartered in Boston and headed by Commissioner Monica Bharel.
The International Medical Commission on Bhopal (IMCB) was established in 1993 to organise medical responses to the 1984 Bhopal disaster (India).
Ethylene glycol poisoning is poisoning caused by drinking ethylene glycol. Early symptoms include intoxication, vomiting and abdominal pain. Later symptoms may include a decreased level of consciousness, headache, and seizures. Long term outcomes may include kidney failure and brain damage. Toxicity and death may occur after drinking even in a small amount as ethylene glycol is more toxic than other diols.
America's Poison Centers is a national nonprofit organization founded in 1958 that represents the nation's 55 poison centers. America's Poison Centers supports Poison Centers in their public health mission to prevent poisonings, provide education, conduct scientific research and treat individuals exposed to poisoning from medications, environmental events, plants, animals, and household products or toxins. America's Poison Centers also supports the efforts of poison centers and interested individuals to reduce morbidity and mortality from unintentional poisonings. America's Poison Centers sets standards for Poison Center operations and certifies specialists in poison information who are available 24/7 to respond to public, health-care provider and emergency medical service personnel requests for assistance. In addition, America's Poison Centers maintains the National Poison Data System (NPDS), the only near real-time poison information and surveillance database in the United States.
Tricyclic antidepressant overdose is poisoning caused by excessive medication of the tricyclic antidepressant (TCA) type. Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. If symptoms have not occurred within six hours of exposure they are unlikely to occur.
Medical toxicology is a subspecialty of medicine focusing on toxicology and providing the diagnosis, management, and prevention of poisoning and other adverse effects due to medications, occupational and environmental toxicants, and biological agents. Medical toxicologists are involved in the assessment and treatment of a wide variety of problems, including acute or chronic poisoning, adverse drug reactions (ADRs), drug overdoses, envenomations, substance abuse, industrial accidents, and other chemical exposures.
Aluminium phosphide poisoning is poisoning that occurs as a result of excessive exposure to aluminium phosphide (AlP), which is readily available as a fumigant for stored cereal grains and sold under various brand names such as QuickPhos, Salphos and Celphos. Aluminium phosphide is highly toxic, especially when consumed from a freshly opened container. Acute aluminium phosphide poisoning (AAlPP) is a large though under-reported problem throughout the world, particularly in the Indian subcontinent.
The National Poisons Information Service is an information service commissioned by Public Health England on behalf of the UK health departments. Poisoning accounts for 1% of NHS admissions. Pesticides used in agriculture are extremely toxic, but 87% of around 120,000 annual poisoning cases in the UK take place in the home.
Carol Remmer Angle is an American pediatrician, nephrologist, and toxicologist. Angle is known as one of the nation's leading researchers on lead poisoning. She is professor emeritus at the University of Nebraska Medical Center (UNMC) in Omaha, Nebraska. Angle joined UNMC in 1954 and was one of the first women to serve as chair of an academic medical department (pediatrics). She also served as chief of pediatric nephrology, director of the pediatric intensive care unit, and director of medical toxicology. In 1957, Angle along with Dr. Matilda McIntire, founded one of the country's first poison control centers. Angle is a founding member and a prior president of the American Association of Poison Control Centers. For forty years, Angle served as an expert for NIEHS, National Institutes of Health and U.S. Environmental Protection Agency panels investigating heavy metal toxicity. Angle continues as a toxicology consultant, reviewer and editor.
Chlorine gas poisoning is an illness resulting from the effects of exposure to chlorine beyond the threshold limit value.
Steven A. Seifert (1950–2022) was an American medical toxicologist. He was a professor of emergency medicine at the University of New Mexico, as well as the medical director of the New Mexico Poison and Drug Information Center. Since 2017, he was the editor-in-chief of Clinical Toxicology. He was also a jazz tenor saxophonist.
Barry H. Rumack is an American medical toxicologist and pediatrician. His primary clinical and research interest has been in clinical toxicology with a special interest in acetaminophen poisoning. Since 2014 he is emeritus professor of emergency medicine and pediatrics at the University of Colorado School of Medicine.
Frank LoVecchio is an American emergency medicine physician, medical toxicologist, academic and researcher. He is the medical director of Clinical Research at College of Health Solutions, the Director of Good Samaritan Regional Poison Center, the Research Director of Maricopa Medical Center Emergency Medicine Program, and clinical professor at Arizona College of Osteopathic Medicine. He also serves as an attending physician at Valleywise Health, Phoenix Children's Hospital, and in the Department of Medical Toxicology at Banner University Medical Center.
The American Board of Applied Toxicology (ABAT) was established in 1985 as a standing committee by the American Academy of Clinical Toxicology. The board functions to recognize and credential clinical toxicologists who have demonstrated competence in the management of toxicity related to poisoning, overdose, chemical exposure, envenomation, or environmental exposures. Candidates for board certification are health professionals with minimum perquisite experience in poisoning and overdose management as well as satisfactory experience in other core areas such as toxicology research, public health, and outreach. The ABAT establishes minimum competency for clinical toxicologists via administering examinations and maintaining certification renewal of diplomates. Successfully passing the ABAT board certification exam provides the taker a designation of Diplomate of the American Board of Applied Toxicology (DABAT). A DABAT designation privileges the clinical toxicologist to provide medical back up and consultation on poisoning, drug overdoses, or toxicity, often via poison centers. The DABAT designation also has legal implication in allowing credentialed toxicologists to manage a poison center in the United States. Credentialed DABAT members must recertify every 5 years via an application demonstrating continued competence and activity in clinical toxicology.
The Poison Control Centre (PCC) at Amrita Institute of Medical Sciences (AIMS) in Cochin, India, is a specialized toxicology facility dedicated to managing poison-related emergencies, toxic exposures, and chemical hazards. This center plays a pivotal role in the prompt diagnosis, treatment, and prevention of poisonings, offering essential support to both healthcare professionals and the general public..
