cians, nurses, paramedics, and emergency medical technicians often call poison control centers when they have questions about treatment or prevention. If hands-on medical treatment is necessary, the centers call an ambulance, stay on the line until the ambulance arrives, and give treatment advice to the emergency care providers, as appropriate. Emergency medical services agencies typically are regulated by state departments of health. It is important for poison control centers to communicate with the EMS system regarding protocols for management of relevant exposures to avoid the potential for conflicting information and to contribute to developing systems that assure accessible and timely treatment for victims of poisonings.

Finally, poison control centers should develop cooperative arrangements with community and institutional pharmacists. These individuals are in a position to recognize and report symptoms of exposure to biological or chemical agents because they are often the first health care providers contacted by patients, particularly when persons seek advice on over-the-counter treatments for flu-like illnesses. They are well positioned to detect emerging or unusual patterns of disease and surges in sales of medications that might suggest an attack (Edge et al., 2002; MacKenzie et al., 1995). Should emergencies arise, whether in an urban or rural area, there is usually a pharmacy within 5 miles of nearly any household to serve as a point of access (The National Conference on Pharmaceutical Organizations, 2002).

Federal Agencies Involved with Poison Prevention and Control

There is no single point of accountability for poison prevention and control activities within the federal public health system. There are currently eight departments of the Cabinet (U.S. Department of Health and Human Services [DHHS], U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Homeland Security, U.S. Department of Labor, U.S. Department of Justice, U.S. Department of Transportation, and U.S. Environmental Protection Agency), as well as the U.S. Consumer Product Safety Commission and the U.S. Office of National Drug Control Policy, involved with poison prevention and control activities.

The primary leadership for the public health system at the federal level resides in the DHHS. The three major agencies within DHHS are the CDC, HRSA, and Substance Abuse and Mental Health Services Administration (SAMHSA). Currently, federal money dedicated specifically for poison control activities is administered through the Maternal and Child Health Bureau in HRSA and the Center for Injury Prevention in CDC. Other parts of DHHS involved in poison prevention and control include



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