centers, have become available recently through state cooperative agreements for emergency preparedness and response from CDC and HRSA.

Research investigations and surveillance activities are supported through many of the DHHS agencies as well as other agencies and departments outside of DHHS. The primary agencies are CDC, the National Institutes of Health, and the Environmental Protection Agency. In addition, regulatory, policy, and planning activities related to poisoning prevention and control occur in a number of federal agencies. Table 9-3 gives an overview of the types of poisonings addressed (e.g., alternative therapies, pesticides, occupational exposures, terrorism, drugs of abuse) by the various federal agencies.

SUMMARY AND CONCLUSIONS

Although a variety of agencies at the federal, state, and local levels have responsibility for one or more components of the Poison Prevention and Control System, there is currently no uniform, clear point of accountability at any level of government. There are uneven linkages and collaboration among the various agencies responsible for data collection and analysis, research and evaluation, policy and regulatory development, health education and other prevention activities, and clinical services and quality standards, as well as financing and payment for services across the agencies involved. Two federal agencies (CDC and HRSA) have funds earmarked for poison control centers, but these funds have not been directed to and are not sufficient to support the core activities for the proposed Poison Prevention and Control System. Furthermore, no federal agency has research funds specifically allocated for poisoning; this lack of support makes it difficult to develop a comprehensive picture of the epidemiology of poisonings or to understand the best way to deliver poison prevention and control services.

To achieve the ultimate goal of preventing poisonings, as well as to improve the outcomes for those who are poisoned, the Committee envisions the need for a clear, single point of accountability at each level of government. The responsible agencies would ensure the accomplishment of all of the core functions or essential services as they relate to poison prevention and control (Table 9-1). This does not mean that the responsible agencies would perform all of the functions within their agency. However, they would (1) take responsibility for the plan for accomplishing the activities needed to ensure the system is in place with a set of uniform standards across the country, and (2) convene and work with the other agencies, including the existing poison control center network, to implement the plan. Furthermore, the responsible agencies at the state and federal levels should work in partnership to develop a set of perfor-



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