Pharmacists, nurses at Utah Poison Control respond to 145 calls a day
SALT LAKE CITY — The teenagers were hallucinating and their vital signs were all over the place, rapid heart beats battling delusions for the attention of emergency department staff. They'd been brought to University Hospital by a friend who was cold-sober but didn't know what they'd taken. All he could do was describe the plant he'd seen them eat.
Dr. Peter Taillac, working the University Hospital emergency department that night, did what he's done hundreds and hundreds of times over the years: He called the Utah Poison Control Center. Within minutes, after describing the plant and what the kids were doing, he had an answer. They'd ingested jimson weed, which can sometimes be very dangerous, even deadly.
Federal funding for America's network of poison control centers was in question as Congress was considering the fiscal year 2011 funding continuing resolution earlier this month. The first version of HR1 called for a 93 percent reduction in federal funding, according to the American Association of Poison Control Centers, which said federal money accounts for an average of about 20 percent of overall center budgets. In Utah, it's about 10 percent.
In the end, the centers took a 25 percent cut to federal funding. Added to some cuts at the state level, which varies from place to place, some centers will have 40 percent less in their budgets, lamented Dr. Richard Dart, president of the association, in a news release.
The Utah Poison Control Center, which can document $7 in health care cost savings for every dollar spent on it, was coincidentally sending out its annual report as the cuts were being discussed nationally.
Utah's center, housed at the University of Utah, answered close to 53,000 calls in 2010, from the intentional drug overdose to the worried mom of the pancake-makeup-eating toddler. Center staffers helped senior citizen couples who accidentally took each other's medication because their pill sorters are identical. They reassured parents whose toddlers ate something that might make them queasy but wouldn't pose long-term ill effect, said Marty Malheiro, the center's coordinator for outreach education. They likely saved some lives. And they helped scores of doctors like Taillac in emergency departments across the state.
Add those to the "worried well calls — and we're happy to get those, too," Malheiro said, and the volume just in Utah is close to 145 calls a day, fielded by highly trained pharmacists and nurses who have taken an additional intensive course in toxicology.
Besides that, the center staffers call those they help back to see what the outcomes are on cases, said Dr. Charles Pruitt, who specializes in pediatric emergency medicine at Primary Children's Medical Center and also is an associate professor of pediatrics at the U., as well as the childrens hospital's medical adviser for child advocacy.
It would be hard to over-estimate the value not only in helping people figure out when they don't need to go the emergency department, but what's happened and what type of care they do need, he said. Sometimes, the center calls the emergency room to say a patient's coming in "and here's what we know so far," he said.
"I think the Poison Control Center is a very comprehensive center and they are charged with nothing less than preventing deaths from poisonings. … They are an invaluable resource to a busy emergency department. Sometimes it's difficult to do background research that's necessary in a timely fashion to manage an acute poisoning," Pruitt said.
One of the situations virtually every emergency department confronts at some point is the child who drank something that an adult had poured into a different container — like a small amount of antifreeze "saved" in a soda bottle. Pruitt said it's tremendously helpful to be able to discuss options, including dosing based on amounts and a child's actual weight and age, with people who know instantly how to get to the right database and figure things out. "They help me make an assessment about how aggressive to be in managing a potential poisoning," he said.
Taillac, who besides working emergency room shifts is the medical director of the Bureau of Emergency Medical Services and Preparedness, also teaches at the university and serves on the center's board of directors. When he teaches emergency room residents about toxicology, he tells them to make calling the center part of their routine, even if they think they know what to do. No one person can stay current on everything and the center's staff has excellent, authoritative resources to access information very quickly, he said. "I learn something (from the center) with virtually every case."
The Utah center's annual report shows that about 87 percent of the last year's calls to poison control were for "exposure" to potentially toxic substances, nearly two-third of the calls for kids 6 and under. Though the order changes a little between adults and children and from year to year, analgesics, household cleaning substances and cosmetics and personal care items are always the top three reasons for calls, Malheiro said.
"Cosmetics and personal care are always highest with kids and that definitely is a supervision issue," she said, adding that adults think about keeping medicine out of reach, but they "don't think about the mouthwash next to the toothbrush that could kill a toddler." Alcohol's the issue there and for small children, it's "really dangerous."
Fortunately, most children's exposures to substances will just make them sick, perhaps enough to throw up.
"Most cleaning products are not so caustic now," she said, "and we take a measured approach. We typically will not send you to a health-care facility if we think it's a relatively safe product. If we think it's something like an antifreeze, which is potentially deadly, we're going to send you."
The center has lots of valuable information online, including identifying poisonous plants and resources at uuhsc.utah.edu/poison/. From anywhere in the country you can call 1-800-222-1222 and be connected to a center near you.
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