attempts, alcohol intoxications, medication errors, hazards evaluations—that arise from requests from emergency medical services and emergency department personnel, police and fire officials, and homeland security staff. A future system for poison prevention and control may need to be more appropriately designed and organized to respond to this variety of demands.

THE COMMITTEE’S APPROACH TO THE PROBLEM

Early in its deliberations, the Committee realized that in order to address its charge, it must step back from a focus on the poison control centers alone and reexamine the overall context for preventing and treating poisoning. Reviewing the history of poison prevention in the United States reminded us that, in the past, a broad array of societal strategies, including safe product packaging and consumer legislation, had been used to reduce the risks posed by potentially hazardous substances. Adopting such a broad analysis led us to view poison control centers as part of a public health system intended to improve the health of communities and populations.

The argument for a broad public health approach to poisoning begins with the recognition that the United States has set specific year 2010 objectives (Healthy People 2010) for reduction of nonfatal poisonings to no more than 292 per 100,000 population, from the baseline of 349 in 1997, and deaths caused by poisoning to 1.5 per 100,000, from 6.8 in 1997. These ambitious objectives cannot be achieved by the poison control center network alone. There is no evidence that these centers, despite their critical role in poison control management, have reduced the incidence of poisoning in the population. There is good evidence, however, that hazardous substance packaging and regulation have had a primary preventive impact on poisoning (Rodgers, 1996). Furthermore, the body of evidence from the broader field of injury control indicates that reducing the burden of injury in the population (Bonnie et al., 1999) requires an integrated strategy of active behavioral, passive regulatory and engineering, and medical management strategies. Drawing on this broad perspective leads us to propose in Chapter 2 the creation of a Poison Prevention and Control System.

Currently there is no comprehensive system of poison prevention and control. Although poison control centers operate on a common set of certification standards, they form at best a loosely organized network. Each center has grown up in its own culture, has created its own organization and procedures, and cultivates its own mixture of funding sources. The absence of a “system” has led, in part, to the uneven and unstable development of the field. The current poison control center network needs



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