To best achieve the goals and function as a system, federal, state, and local agencies ideally would perform in a unified fashion so that all of the essential services related to poison prevention and control are performed or assured for every community across the nation. Sharing and linking of relevant data addressing poisoning exposures, therapeutic interventions, and outcomes among providers, institutions, and poison control centers will be essential to advance these goals. The remainder of this chapter will review what capacity and activities currently exist within federal, state, and local agencies related to the system functions needed to meet the Healthy People 2010 goals for poisoning.

POISON CONTROL SERVICES IN THE CURRENT PUBLIC HEALTH INFRASTRUCTURE

Turnock has described public health infrastructure as the “nerve center of public health” (Centers for Disease Control and Prevention, 1998). Healthy People 2010 includes objectives for the nation regarding public health infrastructure in several areas: data and information systems, skilled workforce, effective public health organizations, resources, and prevention research. Because of the importance of public health’s role in national security and preparedness for all hazards, there is increased interest and attention on building an effective and sustainable public health infrastructure (Centers for Disease Control and Prevention, 2001c).

At present, the accountability for the establishment and maintenance of a population-based Poison Prevention and Control System is diffuse at all levels of governmental public health. Although there are a variety of interested programs and components of public health agencies involved in various aspects of poison prevention and control, some of which interact with the poison control centers, there is insufficient clarity in the roles of each entity in the maintenance of a system across any level of geography. For example, at a local and/or state public health level, it is not unusual for the following programs within a health department to have an interface with the poison control centers and larger Poison Prevention and Control System: emergency medical services, the injury prevention and control program, maternal and child health program, occupational health program, substance abuse program, health statistics, epidemiology, environmental health, emergency preparedness, and others. In addition, there are activities related to poisonings in agencies outside of the usual public health authority; these include the Environmental Protection Agency, the medical examiner’s office, the mental health agency, and the Board of Pharmacy.

Each of these programs at the local and/or state level(s) has an associated link(s) to a federal agency that mirrors the state. The complexity



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