tional medicine settings, and through contractual agreements with the pharmaceutical and other chemical companies. Ultimately, the vast majority of centers closed, leaving the current 63 to cover the U.S. population. Furthermore, the poison control centers were not involved with or incorporated into the development of the emergency medical services for children system. The 1999 Institute of Medicine (IOM) report, Reducing the Burden of Injury: Advancing Prevention and Treatment, barely mentions poison control; nor does this issue feature prominently in Healthy People 2000 or 2010 (http://www.healthypeople.gov).

Onto this background of a small, innovative field struggling to survive, four important developments emerged in the past 10 years:

  • First, the American Association of Poison Control Centers (AAPCC), although founded in 1958, emerged as the developer of a critical poison exposure data collection system, the certifier of poison control centers and their key personnel, and the principal advocate for federal legislation and funding.

  • Second, two federal agencies of the U.S. Department of Health and Human Services—the Health Resources and Services Administration/ Maternal and Child Health Bureau (HRSA/MCHB) and the Centers for Disease Control and Prevention (CDC)—entered the poison control center picture. For the first time, federal legislation (Poison Control Center Enhancement and Awareness Act of 2000 [Pub. L. No. 106–174]) authorized substantial funding for a variety of poison control services, including education, medical toxicology, enhanced data collection, and a national toll-free number. These federal agencies began examining the functioning of the poison control network and the place of poison control centers in public health.

  • Third, advances in telecommunication made it possible to answer telephone calls from anywhere in the country and to triage calls to appropriate centers. A national “800” telephone number created a single point of contact for consumers. In addition, a real-time, electronic submission of poison exposure data enabled the rapid assessment of toxic exposures handled by poison control centers across the United States.

  • Fourth, the national program of homeland security and the imperative of preparing the public health system to address the risks of biological and chemical terrorism provided new opportunities for poison prevention and surveillance. The availability of the Toxic Exposure Surveillance System (TESS) data propelled the poison control centers into a potentially crucial position in all-hazards/public health preparedness. The anthrax attack demonstrated how a concerned public looked to poison control centers for information and advice (see Appendix 5-A for description).

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