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The Role of Clinical Toxicologists and Poison Control Centers in Public Health

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Background

Poison control centers and clinical toxicologists serve many roles within public health; however, the degree to which these entities collaborate is unknown.

Purpose

The objective of this survey was to identify successful collaborations of public health agencies with clinical toxicologists and poison control centers. Four areas including outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources were assessed.

Methods

An online survey was sent to the directors of poison control centers, state epidemiologists, and the most senior public health official in each state and selected major metropolitan areas. This survey focused on three areas: service, structure within the local or state public health system, and remuneration. Questions regarding remuneration and poison control center location within the public health structure were asked to assess if these were critical factors of successful collaborations. Senior state and local public health officials were excluded because of a low response rate. The survey was completed in October 2007.

Results

A total of 111 respondents, 61 poison control centers and 50 state epidemiologists, were eligible for the survey. Sixty-nine (62%) of the 111 respondents, completed and returned the survey. Thirty-three (54%) of the 61 poison control centers responded, and 36 of the 50 state epidemiologists (72%) responded. The most frequent collaborations were terrorism preparedness and epidemic illness reporting. Additional collaborations also exist. Important collaborations exist outside of remuneration or poison control centers being a formal part of the public health structure.

Conclusions

Poison control centers have expanded their efforts to include outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources. Collaboration in these areas and others should be expanded.

Introduction

State and local public health officials often encounter a wide variety of public health issues for which consultation with a subspecialist may be beneficial. Subspecialists, including toxicologists, have the knowledge to assist public health officials substantially. Clinical toxicologists are physicians or pharmacists who have undergone advanced subspecialty training in toxicology and typically participate in patient care either in hospital settings or in combination with a poison control center. Clinical toxicologists may additionally choose work in private practice or pharmaceutical settings; however, commonly public health agencies actively collaborate with clinical toxicologists who are affiliated with poison control centers. The extent of these collaborations on a national level is unknown. The purpose of this survey is to identify successful collaborations of clinical toxicologists and poison control centers with public health agencies.

As of May 2009, there are 61 poison control centers across the U.S. All poison control centers are accredited by the American Association of Poison Control Centers (AAPC), whose goal is to reduce the morbidity and mortality from poisonings through public and professional education. Poison control centers are staffed 24 hours a day by poison information specialists who respond to a variety of telephone calls from hospitals, physicians, and the public. The attributes of around-the-clock staffing, on-call physician access, and frequent communication with regional hospitals allows for the development of mutually beneficial collaborations with public health agencies outside of traditional poison prevention and education.

Previous collaborations of clinical toxicologists with poison control centers have demonstrated successful results. Examples include the quantification of ciguatera fish poisoning in Florida and a multidisciplinary investigation of a potential terrorist attack with ricin in a South Carolina postal facility.1, 2 In addition to these examples, poison control center data have also been used for syndromic surveillance for the outbreak of foodborne illness in Arizona. Interestingly, one of the findings of this study demonstrated that poison control center calls did not duplicate calls to public health agencies identifying the benefits of a collaborative effort.3

Both poison control centers and public health agencies are increasingly challenged by immense work demands in the face of stringent budget constraints. However, collaborations of these entities can improve public health and optimize available funding. With this in mind, a survey was conducted of poison control center directors, state epidemiologists, and senior state and local public health officers to evaluate existing successful collaborations. The goal of the present survey was to identify successful and mutually beneficial collaborations of clinical toxicologists and poison control centers with public health agencies. The aim was to identify specific collaborations in four major categories: acute outbreak identification, syndromic surveillance, terrorism preparedness and planning, and daily public health responsibilities amenable to poison control center resources.

Section snippets

Methods

An online survey was conducted using a commercial, web-based survey tool. The survey was conducted between July and October 2007. The data were analyzed in 2008. Survey results were collected and a descriptive analysis was performed. The survey population consisted of two major respondent groups: toxicologists who work primarily in poison control centers and public health officials. The AAPC provided contact information for each medical director of the 61 accredited poison control centers; one

Results

A total of 111 respondents, 61 poison control centers and 50 state epidemiologists, were eligible for the survey. Sixty-nine (62%) of the 111 respondents, completed and returned the survey. Thirty three (54%) of the 61 poison control centers responded, and 36 of the 50 state epidemiologists (72%) responded. A total of 44 states were represented with at least one respondent. In eight of the 44 states, only poison control center officials responded and in 11 of the 44 states only the state

Discussion

The results of this survey demonstrate that collaboration exists in each of the four service categories of outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources. In addition, the survey identified that poison control center inclusion into the formal public structure is highly variable among states. The vast majority of poison control center directors responded that they did not receive

Conclusion

Public health officials are faced with events and questions that frequently require subspecialty knowledge in the field of toxicology. Although all poison control centers participate in classic public health education activities such as education and prevention, some have expanded their efforts to include outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources. Continued efforts to develop and

Acknowledgments

No financial disclosures were reported by the authors of this paper.

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