4. Overview of the IPC
History of Poison Centers in Illinois
Mission
Emergency Call Center Services
Public Education
Professional Education
Public Health – Reporting, Surveillance
Research
5. Poison Center History
1953
First poison control center in the
nation: Rush University
Early 1960’s
Over 100 poison information centers
in Illinois
American Association of Poison
Control Centers (AAPCC) formed
6. Poison Center History
1980s
Poison centers around the state
gradually closed
1990
Three centers left in Illinois
None certified by AAPCC
By 1996
Two centers had closed
Rush center announced plans to close
7.
8. Illinois Poison Center
October 1997
50% of funding from State of Illinois
50% of funding raised privately and/or
from hospitals
Core functions
Call center for healthcare professionals and
general public
Professional education
9. Illinois Poison Center and MCHC
Program of Metropolitan Chicago Healthcare
Council (MCHC)
10. Poison Center History
1997
Rush poison center transitioned to
Metropolitan Chicago Healthcare Council
Organized as a not-for-profit 501(3c) under
MCHC/Chicago Hospital Council
Name changed to Illinois Poison Center
(IPC)
11. Illinois Poison Center
1998: Certified by AAPCC in 1998
Only AAPCC-certified regional poison
center in Illinois
Operational requirements
24/7/365 call center
Professional education requirements
Staff requirements
Certified specialist in poison information (CSPI)
Medical toxicologist
Medical director
On-call staff support
Education and outreach requirements
12. Mission
The Illinois Poison Center is dedicated to
reducing the incidence and injury of
poisoning in our communities through
immediate expert telephone
recommendations, innovative public and
health care professional education and
focused research.
Our vision is an Illinois that no longer
suffers from the harm of poisoning
13. Emergency Call Center
Available 24 hours a day, 365 days
a year via toll-free number
1.800.222.1222
14. Call Center Services
Over 107,000 calls in 2006
Almost 87,400 exposures
Over 15,000 calls from health care
providers (17% of calls); most from hospital
based personnel
We are consultants to healthcare professionals
on toxicology and poisoning
15. AAPCC Clinical Staff
Requirements
Specialists in Poison Information
Nurses, Pharmacist, Physician Assistants and
Physicians
Poison Information Providers
IPC prefers Pharm. Tech, Paramedics, BA/BS in a life
science and health care experience
Medical Directors
Board certified in EM, Pediatrics or Preventative
Medicine
Board Certified in Medical Toxicology
16. Illinois Poison Center
Current Clinical Staffing:
16 Pharmacists and
nurses (13 FT/3 PT)
7 Poison information
providers (6 FT/1 PT)
3 Medical directors (1
FT/ 2 PT)
17. Types of Calls
The IPC provides treatment advice and
information for overdoses, medication
errors, occupational accidents, hazardous
material incidents, venomous bites and
more
51% of exposures involve children under
the age of 6 years of age
18. Emergency Call Center
36% Increase in Service since 2000
0
20000
40000
60000
80000
100000
120000
2000 2002 2004 2006
Tot al Calls
20. Emergency Call Center Services
IPC Staff that answer HCF calls have all
been passed a national exam in toxicology
and are considered Certified Specialists in
Poison Information
Stability, additional training, monthly
educational lectures add to depth of
experience of staff
21. IPC CSPI exam scores
IPC scores average = 91% (101/110)
National average = 75% (82/110)
22. Value of Call Center Services
Health Resources and Services
Administration (HRSA) estimates that for
every $1 dollar spent on poison control
services $7 dollars in health care costs are
saved
IPC budget ~4,000,000 so about $28,000,000
saved
Caveat: based on 1980’s and early
1990’s data.
23. Value of Call Center Services
90% of calls from general public are
managed at home with simple first aid
instructions
70% of callers would seek healthcare if
poison center services are not available
Estimated ED cost of $1,000
Potential savings: $45,000,000
24. Value of Call Center Services
When poison center services not available,
admissions increase by 16%
10,843 admissions in 2005 per hospital
discharge data
Extrapolation of an additional 1700
admissions
Average cost of admission from poisoning is
$10,843
Potential savings: over $18,000,000
25. Value of Call Center Services
Length of Stay (LOS)
New Jersey Study (2007) showed:
Admitted patients where poison center was
consulted had mean LOS of 3.9 days
Admitted patients where poison center was
NOT consulted had mean LOS of 6.9 days
Hospital stay for poisoning $1,500 per day
average per IDPH data
Potential savings: $56,000,000
26. Value of Call Center Services
Poison Centers save society money
through:
Preventing unnecessary healthcare
visits
Decreasing admissions to hospitals
Decreasing the LOS at hospitals
Estimated potential savings for Illinois is
~$119,000,000 ($30 saved for every $1
spent)
27. Public Education
Goal #1 is to provide poison
prevention to families and
communities to create healthier and
safer communities
28. Public Education
Goal #2 is to raise awareness of the IPC
services so as to maximize the value of
the call center services in decreasing
medical costs.
29. Public Education
Service Region Size is a
significant barrier
State of Illinois
12.7 million people
55,000 square miles
30. Theory of Change
Problem
Low utilization of poison center services
Accidental poisoning a threat to community
Historically little poison prevention education led by
Illinois Poison Centers
Strategies
Media, Regional Education Centers, Volunteer
Educators, Professional/community
organizations
Assumptions
Little history of poison prevention education led
by poison centers, “space” could be filled with
31.
32. Theory of Change Planning Tool
Project A + Project B + Project C = Outcome D
• A+B+C are based on someone else’s research,
collective experience, historical principles,
preponderance of evidence
• A, B and C are the most compelling strategies to
achieve and outcome D (success of the program)
33. IPC theory of change strategy
A + B + C + E = D
Media Hospital
Satellite
Network
Volunteer
Educators
Individuals,
Community and
Professional
organizations
1) Increased
awareness
2)Decreased
unintentional poisoning
Newspaper
TV
Radio
Web
12 hospital
educators in
various
regions in
the state
“Online
educators”
Faith-based
Ethnic
Professional
Government
34. Measure and quantify the
processes
It is assumed that processes will make a
difference over time
Time may be months, years, generations
The only thing one can control is the
process and hope the assumptions are
correct
35. Media Processes – press
releases, interviews, “mentions”
(print)
0
50
100
150
200
250
300
350
400
2001 2003 2005
Releases
I nterview s
Mentions
36. Media – web utilization (page
views)
0
50000
100000
150000
200000
250000
300000
2004 2005 2006
Public
Professional
Educator
Total
37. Media
Broad ranging – 100’s of thousands if not
millions of people read an article in print,
web or hear about the poison center on
radio or TV
Passive
Difficult to measure at an individual basis
Constant updating to ‘new threats’
38. Hospital Satellite System
Regional Hospital based education centers
throughout the state
Train the trainer approach encouraged
Educators are regional experts for their
volunteer educators and “online” educators
Quarterly meetings – teleconference
One annual face-to-face all day meeting
Beginning to encourage the interaction with more
community groups
43. Community, professional and
government organizations
Children’s librarians
School Nurse associations
EMS
DCFS
WIC
Casa Central
HispanoCare
Over 20 additional community organizations
throughout the state
44. Types of events
EMS group that has poison prevention
booth at local fairs, parade, community
celebrations.
Pharmacy schools and students
School Nurses who provide poison
prevention during NPPW
Librarians who have a poison prevention
‘story time theme’
49. Poison Data for Illinois
0
2000
4000
6000
8000
10000
12000
14000
16000
2001 2002 2003 2004 2005 2006
I n/ enroute to HCF
Treated and
Released
50. % Treated and Released of
In/Enroute to HCF
15% decrease in non-emergent poisoning that
presents primarily to ED.
41
42
43
44
45
46
47
48
49
50
2001 2004
%
t r eat ed
and
r eleased
51. Causality
Control group: National data?
Change in number of severe poisonings
(acuity)?
Population/Demographic change?
Change in training of staff?
Still intriguing Data
52. Latino Outreach Results with
Sinai Community Institute
Total calls increased
18%
Calls from hospital
decreased 3%
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2002 2004 2006
Tot al
Calls
Calls
from
HCF
53. Latino Outreach Results with
Sinai Community Institute
Treated and Released
decreased 17% from
2002/2003 baseline
Total calls increased
18%, T and R
decreased 17%
Poison prevention vs.
calling IPC?
0
200
400
600
800
1000
1200
1400
1600
2002 2004 2006
Calls
from HCF
Treat ed
and
Released
54. Latino Outreach Results with
Sinai Community Institute
23% reduction in
pediatric HCF
visits
28% reduction in
Pediatric T and R
0
50
100
150
200
250
300
350
2002 2004 2006
Peds calls
from HCF
Treat ed
and
Released--
Pediat ric
55. Latino Outreach Results with
Sinai Community Institute
Essentially
unchanged from
baseline of
2002/2003
0
100
200
300
400
500
600
700
2002 2004 2006
Medical
Admissions
all ages
56. Latino Outreach Results with
Sinai Community Institute
36% reduction in
pediatric admissions
from poisoning
State numbers for
control unchanged
Decrease in ED visits
and Admissions =
>$219,000 saved from
baseline
0
5
10
15
20
25
30
35
40
45
50
2002 2004 2006
Pediatric
admissions
57. Theory of Change
What works the best?
Not sure if media, satellites or community
organizations is most cost effective
Community Organizations may be better
partners in hard to reach populations
Easier to raise foundation money if working with
community organizations
58. Professional Education
Expertise of Poison Center Staff in field of Poisoning
an Toxicology
Undergraduate and Graduate Education
Medical students
Pharmacy students
Medical and Pharmacy Residents
Continuing Education for practicing professionals
Advanced HAZMAT Life Support (AHLS)
Bioterrorism Training and Curriculum Development Program
(BTCDP)
Individual Lectures for institutions
59. Undergraduate Education
Medical and Pharmacy Students can come to
IPC for 2 weeks to 6 weeks at a time
12 per year at IPC
26 per year with Toxikon (affiliated educational
organization)
Individual lectures at Pharmacy and Medical
Schools
About 12 per year at 3 different schools of
pharmacy and 3 school of medicine
60. Post Graduate Education
80 to 100 medical residents, pharmacy
residents and fellows rotate through
Toxikon and the IPC every year
Most emergency medicine residencies in
Chicago send their residents for education
with the IPC and Toxikon
61. Continuing Education
Advanced HAZMAT Life Support (AHLS)
577 providers Trained since 2002
Bioterrorism Training and Curriculum
Development Program (BTCDP)
624 people educated since 2004
Individual Lectures (~ 10 to 30 per year) to
institutions that request presentations to
staff
62. Surveillance
Software-driven Surveillance of National
Poison Database System (NPDS)
Individual Reporting: High index of
suspicion, clinical awareness
Driven by experience
63. Software surveillance
All exposure calls are logged into an
electronic program with two functions
One function is the medical record:
Recorded history, physical, assessment
and plan
The second is database
All products are coded, route of exposure,
location of exposure, clinical effects noted
64. Software Surveillance
The coded fields from every poison center
in the U.S, are uploaded every 20 minutes
to New Jersey (essentially real-time)
The data is then analyzed with software
developed in conjunction with the CDC
(BIOSENSE)
65. Software Surveillance
National Surveillance
three standard deviations from moving 14 day
average for past three years creates a notification
Total Call Volume (by center)
Human Exposure Volume (by center)
Clinical Effects
Procedure
Alert at national office
National office investigates data
If signal is worrisome, local poison center contacted for
‘follow back”
66. Individual Reporting
Public Health Reporting by individuals
Astute clinician realizes something is out of
the ordinary and reports it to other agencies
Recognition can occur in various points of
patient care
67. Examples of Food Borne Illness
Reporting
March 2004
Call to Illinois Poison Center
from HCF re: 2 individual with
severe muscle breakdown
Recent ingestion of Buffalo
Fish
Dx: Haff Disease
68. Examples of Food Borne Illness
Reporting
Fall, 2006
Call from HCF regarding patient
with numbness, tingling and
reversal of hot and cold
Patient recalls eating grouper at
restaurant that night
Dx: Ciguatera Poisoning
69. Examples of Food Borne Illness
Reporting
May, 2007
Call from HCF re: patient
who had weakness, near
paralysis after ingestion of
“puffer fish”
Dx: Tetrodotoxin poisoning
FDA recall
70. Winter 2005 - 2006
Bootmate sealant
Exposures reported to PCC led to
respiratory symptoms ranging from cough
to pneumonitis to pulmonary edema
Initially noted by Detroit Poison Center
Investigation showed over 179 exposures
with mild to severe clinical effects in
midwest and eastern U.S.
Product recalled
72. Research
Answer questions that have not yet been
answered
Change the knowledge base of medicine
Change the knowledge base of the public
Change the practice of medicine
74. Crack Cocaine Body stuffers
Crack Cocaine Body Stuffers
50 KUB
No Foreign Body seen on x-ray
In the Chicago area, x-rays are of no value
in the diagnostic work up of a crack cocaine
body stuffer
Packaging in Chicago may be different than the
packaging in other parts of the country
75. Research examples
Rodenticides – long acting superwarfarins
750 cases, no bleeding
48 cases with f/u INR, 2 abnormal, both lab
error
No cases of true coagulopathy
76. Heroin Body Stuffers
Resurrection Program
65 heroin body stuffers
6 (9%) symptomatic, all within 1 hour of
ingestion
3 (4.6%) needed naloxone
77. 2007 ICEP Resident Research2007 ICEP Resident Research
Award WinnerAward Winner
Retrospective case series
All carbamazepine exposures reported to
our regional poison center between
January 1, 2001 and December 31, 2005
were investigated.
Inclusion criteria were all acute poisonings
with concentrations greater than 12
mcg/mL at any given time.
78. 0
50
100
1 4 7 10 13 16 19 22 25 28 31 34 37 40
Initial (mgc/mL) Highest (mcg/mL)
InitiallyInitially supratherapeuticsupratherapeutic concentrationconcentration
and continued to rise > 12 mcg/mLand continued to rise > 12 mcg/mL
82. Research – why?
Change the practice of medicine
Improve outcomes
Improve public health
83. Research – Why?
RRC requirement
Career choices
Academic vs. Community Practice
Medical Toxicology Fellowship
Change the useful knowledge base, change the
practice of medicine
Cool Trips: North American Congress of Clinical
Toxicology
2008 Toronto
2009 San Antonio
2010 Denver
84. Potential Examples
Triage criteria: Do they change
practice? Value?
Epidemiology of poisoning
New trends
Emerging trends in drug abuse
Coricidin
Alternate routes of exposure
85. Research
Medical Admissions all Poisoned Patients
0
1000
2000
3000
4000
5000
6000
7000
8000
2002 2003 2004 2005 2006 2007
Year
numberofadmissions
2002
2003
2004
2005
2006
2007