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Forging a Poison Prevention and Control System
Index
A
Access to services, 131, 137, 139, 194, 202, 205, 271, 282, 292
see also Internet;
Public education/ outreach;
Telephone services;
Utilization of health care services
cost factors, 140, 141
emergency service personnel, 114, 126, 282
ethnic minorities, 43
historical perspectives, 84
mass poisonings, 114
nonpoisoning information needs, 117
pharmacists, 230
public education and, 202, 205, 208, 214
research on, 10, 18, 19, 118, 270, 274, 275, 316, 317
toxicologists, 87
Accountability
see also Quality control
government organizational assurance structure, 10, 12, 282, 284-286
poison control centers, 12, 13, 100, 107, 310, 311
Poison Prevention and Control System (proposed), 273, 282, 284-286, 308-309
Accreditation Council for Graduate Medical Education, 122
Adolescents, 3, 29, 223, 224
Advocacy, 10, 11, 25, 31, 39, 203, 204, 205, 218, 271, 274, 289
Age factors, 29
see also Children
adolescents, 3, 29, 223, 224
elderly persons, 3, 29, 43, 51-53, 55, 58, 59, 60, 64, 99
public education materials, 223
incidence data, 48, 51-60 (passim), 63, 64, 68, 69
public education, 209
Agency for Healthcare Research and Quality, 19, 180, 283, 294-295, 317
Agency for Toxic Substances and Disease Registry (ATSDR), 39, 90, 115, 126, 189, 195, 283, 292
Hazardous Substances Emergency Events Surveillance System, 181, 198
Alcohol use and abuse, 30, 99
costs of, 29
deaths due to poisoning, 3, 28, 68
definition of poisoning, 4, 45-46, 79
incidence data, 68, 74
Allergic responses, 4, 45, 46, 223, 294
American Academy of Clinical Toxicology, 83
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American Association of Poison Control Centers (AAPCC), 6, 17, 25, 32, 49, 115, 118-119, 123, 134, 309
see also Toxic Exposure Surveillance System
certification of centers, 2, 15-16, 26, 84, 127-129, 130, 160
cost-effectiveness/cost-benefit analysis, 137, 142-170
definition of poisoning, 34-35
ethnic diversity issues, 208
funding for centers, 312
historical perspectives, 83, 90, 91, 92, 97-98, 100
incidence data, 48, 90, 91-92, 98, 184-190
public education efforts, 209, 210-212, 219, 234
quality assurance, 127-128, 130
telephone services, 113
American Board of Applied Toxicology, 127
American Board of Medical Specialists, 84, 128, 130
American Board of Medical Toxicology, 83, 128
American College of Emergency Physicians, 83
American Medical Association, 80-81, 86, 230
American Nurses Association, 230
American Pharmacists Association, 80-81, 230
Animals, poisoning of, 110, 119, 144, 165, 186
Animals, venomous, see Insect/snake bites
Anthrax, 25, 46, 99, 114, 132, 133
Antidotes, 120
poison control centers, 112, 114, 116, 134, 205, 213, 281
stockpiles, 132, 134
Arizona, 214
Arsenic, 117, 134-135, 177
Aspirin, 99, 204
Association of Maternal and Child Health Programs, 33, 276
A Su Salud, 208, 215
B
Behavioral Risk Factor Examination Survey, 182, 199
Biological and chemical terrorism, 3, 5, 7-8
see also Mass poisonings
anthrax, 25, 46, 99, 114, 132, 133
Centers for Disease Control and Prevention (CDC), 85, 114-115
committee methodology, 2, 26, 33
committee recommendations, 9, 305, 309
Department of Homeland Security, 134, 282, 285, 288, 298
funding for response services, 14, 85
Haddon Matrix, 203
historical perspectives, 85, 99
poison control centers, 9-10, 25, 35, 37, 85, 99, 100, 107, 114-115, 116, 127, 132-133, 278-282
Poison Prevention and Control System (proposed), 12, 26, 35, 37, 38, 309
Block grants, 14, 15, 92-93, 147, 148, 311
Maternal and Child Health Block Grants, 11-12, 98, 276, 283, 285-286, 308
Bureau of Labor Statistics, 299-300
Census of Fatal Occupational Injuries, 181, 198
C
California, 7, 31, 36, 113, 143, 214, 215
Canada, 212
Case series studies, 119, 191
see also Medical examiners/coroners
Census of Fatal Occupational Injuries, 181, 198
Center for Biologics Evaluation and Research, 294
Centers for Disease Control and Prevention (CDC), 12
see also National Center for Health Statistics
Behavioral Risk Factor Examination Survey, 182, 199
biological and chemical terrorism, 85, 114-115
epidemiology, 18, 48, 176, 316-317
human costs of poisoning, 19
National Center for Environmental Health, 189, 289-290
National Center for Injury Prevention and Control, 18, 196, 291, 316-317
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National Health and Nutrition Examination Survey, 182, 199
National Institute for Occupational Safety and Health, 33-34, 198, 228, 285, 291-292
National Vital Statistics System, 50, 66-68, 179, 192-193
poison control centers and, 25, 35, 85, 97, 114-115, 122, 134
Poison Prevention and Control System (proposed), 12, 15, 39, 282, 287, 315-317 (passim)
public education, 207, 237-238
role in poison prevention, overview, 288-292
surveillance methodology, 176
Toxic Exposure Surveillance System (TESS), 6, 17, 18, 189, 315-316, 317
Centers for Medicare and Medicaid Services, 294
Certification of professionals, 15, 123, 127-128, 130
emergency medical personnel, 84
toxicologists, 15, 24(n.1), 38, 118-119, 122, 125
Chemical terrorism, see Biological and chemical terrorism
Children, 3, 4, 5, 27, 29
Association of Maternal and Child Health Programs, 33, 276
Head Start program, 211
historical perspectives, 53, 81, 84, 87, 96, 99
incidence data, 51-53, 55, 58, 59, 60, 64
death rates, 3, 50, 66-68, 74, 85, 86
lead poisoning, 120, 227, 228, 230, 276, 289, 290, 296
legislation to protect, 23, 96
packaging, child-resistant caps, 84-85, 99, 106, 204, 205, 210, 218, 287
poison control centers, 4, 5, 84, 87, 96, 99, 106
public education, 209, 210-212, 216, 219, 234-268 (passim), 276, 277, 317
The Clinical Toxicology of Commercial Products, 83, 87, 92, 95
Coding of data, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 187-188
see also E-codes;
International Classification of Diseases
morbidity and mortality statistics, 50, 66-68
Confidentiality, see Privacy and confidentiality
Consumer Product Safety Commission, 23, 35, 39, 48, 219, 229, 301
Core activities
see also Telephone services
poison control centers, 8-15 (passim), 31, 37-38, 106-131, 169, 173, 306-307, 308, 310
funding, 11-12, 14-15, 39, 307, 310
Poison Prevention and Control System (proposed), 270-275, 284, 306-307, 308
population-based, 10, 11
quality assessment/assurance, 270-272
telephone services discussed as, 14, 107-113, 116, 123, 125-127, 130, 307
toxiciology training, 15, 24(n.1), 38, 118-119, 122, 125
Coroners, see Medical examiners/coroners
Cost and cost-benefit factors
access to services, 140, 141
American Association of Poison Control Centers, determination of, 137, 142-170
interagency coordination, 157, 159
poison control centers, 9, 13-14, 92, 96, 136-171 (passim), 191, 310, 311
public education, 158, 163, 164, 166, 206
quality assurance, 158
staff, 136, 143-158 (passim), 161-163, 170-171, 310, 311
telephone services, 143, 144, 152-155, 160
Poison Prevention and Control System (proposed), 13, 18, 19, 311-313
poisoning, economic burden, 3, 19, 27, 29, 96, 137-142, 310, 317
methodology for determining morbidity, 27, 28, 34
safety products, low-cost distribution, 204-205
survey data, general, 180
Cultural factors
see also Race/ethnicity
languages, 43-44, 113, 164, 208, 210, 214-215
poison control centers, 11, 43-44, 113, 208-209
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D
Data needs, 18-19, 78-79, 176-200
see also Definitional issues;
Epidemiology;
National Center for Health Statistics;
Research methodology;
Surveillance
Agency for Toxic Substances and Disease Registry, 39
coding of data, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 187-188
committee charge/methodology, 2, 5, 26
committee recommendations, 18-19, 305, 314-317
cost-effectiveness studies, 142, 153-155, 170, 310
Drugdex, 92
historical perspectives, 90-92, 95, 98
Micromedex, 91, 92, 113
organizational factors, general, 44, 309-310
poison control centers, 10, 11, 12-13, 25, 37, 90-92, 95, 98-99, 106-108, 117-118
quality control, 129, 309-310
Poisindex, 91, 92, 113
Poison Prevention and Control System (proposed), 13, 16-17, 37, 39, 305
privacy issues, 17, 18, 112, 169, 192, 214-215, 315
Toxic Exposure Surveillance System, 6, 17-19 (passim), 178, 184-190, 199-200
Death rates, 18
see also Suicide and attempts
alcohol poisoning, 3, 28, 68
annual, from poisoning, 3, 28, 48
children, 3, 50, 66-68, 74, 85, 86
data coding, 50-51
incidence data, general, 64, 66, 69-72, 74, 88, 94, 181
medical examiners/coroners, 179, 193-194, 197, 199, 200, 273
mortality vital statistics, 50, 66-68, 74, 179, 181, 192-193
Definitional issues
see also Core activities
data coding, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 187-188
epidemiology, 2, 43
Haddon Matrix, 115, 201-204
poisoning, 2, 3, 4, 16-17, 27, 28, 34-35, 43, 45-48, 50-51, 73, 79, 306, 314-315
prevention, primary and secondary, 205
surveillance, 3, 4, 176-177
toxicology, 2, 3, 4, 24(n.1), 27, 45-46
Demographic factors, general, 43, 48
see also Age factors;
Cultural factors;
Geographic factors;
Race/ ethnicity
committee charge, 2, 26
gender factors, 48, 51, 52, 55-60 (passim), 63, 64, 68
incidence data, 48-68 (passim), 76
poison control centers, 7, 209
Department of Agriculture, 297-298
Department of Health and Human Services (DHHS), 19
see also Centers for Disease Control and Prevention;
Food and Drug Administration;
Health Resources and Services Administration;
National Center for Health Statistics
Agency for Healthcare Research and Quality, 19, 180, 283, 294-295, 317
Centers for Medicare and Medicaid Services, 294
definition and classification issues, 16-17, 314-315
legislation, national repository, 12, 309
Maternal and Child Health Bureau, 1, 2, 25, 26, 285
National Institute of Child Health and Human Development, 296
National Institute of Environmental Health Sciences, 296
National Institute on Drug Abuse, 295
National Institutes of Health, 120, 283, 295-296
Poison Prevention and Control System (proposed), 12, 282-283, 285-286, 308-309, 313
privacy issues, 17, 315
role in poison prevention, overview, 12, 282-283, 285-286, 288-292
Substance Abuse and Mental Health Services Administration (SAMHSA), 181, 182, 196, 229, 282, 287, 293
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Department of Homeland Security, 134, 282, 285, 288, 298
Department of Housing and Urban Development, 282, 288, 289, 296
Department of Justice, 282, 288, 300
Department of Labor, 198, 282, 288, 298
Bureau of Labor Statistics, 299-300
Census of Fatal Occupational Injuries, 181, 198
Mine Safety and Health Administration, 285, 299
Occupational Safety and Health Administration, 198, 285, 298-299
Diagnosis
see also Incidence and prevalence;
Symptoms
definitional issues, 3, 27, 46, 50-61 (passim)
definitional issues, classification codes, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 187-188
poison control centers, core activities, 10, 109
Dosage factors, 3
see also Drugs
data sources, 184-185
definitional issues, 4, 23, 43
Haddon Matrix, 202
legislation, 23
Drug Abuse Warning Network, 19, 181, 196-197, 200
Drug Enforcement Administration, 300
Drugdex, 92
Drugs
see also Alcohol use and abuse;
Packaging and labeling;
Substance abuse
definition of overdose, 27, 43, 45, 46, 51, 78-79
household, 2, 81, 84, 87
incidence of overdose, 50, 51, 61, 62, 64, 67
overdoses during hospitalization, 184
research on overdose, 18, 19, 184, 197-198, 317
suicides and attempts, 3, 5, 27, 29-30, 51, 61, 68, 71
telephone services, 110, 164
unintentional overdose, 3, 30
E
E-codes, 50-63 (passim), 70, 76, 78
Economic factors
see also Cost and cost-benefit factors;
Funding
poison control centers, 3, 6, 7, 136-171
geographic factors, 142, 143, 152-153, 162
prevention incentives, 204-205
Education, see Professional education;
Public education/outreach
Elderly persons, 3, 29, 43, 51-53, 55, 58, 59, 60, 64, 99
public education materials, 223
Emergency and Environmental Health Services, 289-290
Emergency medical services (EMS)
see also Biological and chemical terrorism
certification of specialists, 84
HAZMAT response, 112, 114, 126, 130, 133
historical perspectives, 83-84, 92, 96
incidence data, 53, 54, 59-61, 65-66, 72, 73, 74, 75, 78, 179, 180
National Electronic Injury Surveillance Survey (NEISS), 4, 17-18, 48, 49, 65-66
organizational factors, 6, 39, 309
poison control centers and, 2, 6, 24, 30, 38, 60, 107, 108, 112, 114, 116, 278-282
access by EMS personnel, 114, 126, 282
Poison Prevention and Control System (proposed), 38, 39
state emergency department data, 179
Emergency Medical Services Systems Act, 24, 84
Environment and Natural Resources Division (Department of Justice), 300
Environmental Protection Agency, 98, 219, 226, 227, 273, 282, 284, 285, 288, 289, 301
Epidemiology, 1, 24, 25, 27-30, 48-68, 176, 177
see also Death rates;
Incidence and prevalence;
Surveillance
annual poisoning cases, 3, 28
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Centers for Disease Control and Prevention (CDC), 18, 48, 176, 316-317
committee study methodology, 32
definitional issues, 2, 43
historical perspectives, 81
public education materials, 221
research recommendations, 18-19
Essential Services of Public Health, 10, 272
Ethnic groups, see Race/ethnicity
External cause of injury codes, see E-codes
F
Federal government, 6
see also Funding;
Legislation;
specific departments and agencies
agencies involved in poison prevention, overview, 282-284, 288-301
committee study methodology, 32-33
definitions and classification systems, 3, 4
poison control centers and, 1-2, 11-12, 35-36, 39, 92-93, 95-96
Poison Prevention and Control System (proposed), 12, 15, 35-36, 39
public education efforts, 219-231
Food and Drug Administration (FDA), 35, 39, 81, 82, 283, 293-294
MedWatch, 181, 197
National Clearinghouse for Poison Control Centers (NCHPCC), 83, 87, 91, 92, 95-96, 97, 184
poison control centers, 84, 87-90, 93, 94-97, 122
historical perspectives, 81, 82, 84, 86
Food and Safety Inspection Service, 297
Food poisoning, 297-298
definitional issues, 46, 51, 53
historical perspectives, 80-81
incidence data, 66, 191
sentinel events, 118
Funding
see also Research recommendations
American Association of Poison Control Centers (AAPCC), 312
biological and chemical terrorism response, 14, 85
block grants, 14, 15, 92-93, 147, 148, 311
core activities, 11-12, 14-15, 39, 307, 310
committee study charge/methodology, 2, 26, 32
federal agencies responsible, overview, 282
Maternal and Child Health Block Grants, 11-12, 98, 276, 283, 285-286, 308
Medicaid, 14, 147, 148, 214, 285, 288, 294, 311
Medicare, 93, 285, 288, 294
poison control centers, 3, 6, 24-25, 26, 32, 36, 83, 130, 147-152, 159-160, 165, 283-286
committee conclusions/ recommendations, 7, 9, 11-12, 13, 14-15, 307, 310, 311-313
core activities, 11-12, 14-15, 39, 307, 310
historical perspectives, 85, 90, 92-93, 95, 97-98, 100, 103-105
hospital funding of, 36, 93
private sector, 148-149
public education, 11, 93
quality assurance, 129, 130, 159
regionalization, 37
state government, 24, 36, 92-93, 98, 136-137, 147, 148, 284, 311, 313
Poison Prevention and Control System (proposed), 8, 12, 14-15, 36, 39, 283-287 (passim), 305, 307
regionalization, 37
technical assistance, 12
public education, general, 11, 93, 211, 286, 313
research, general, 18-19, 90, 316-317
Toxic Exposure Surveillance System, 17-18, 90
G
Gender factors, incidence data, 48, 51, 52, 55-60 (passim), 63, 64, 68
Geographic factors
see also Population-based factors
incidence data, regional, 52, 53, 55, 56, 58, 59, 64, 68, 71
national telephone service, 25, 52, 55, 92, 97, 103, 113, 210, 211
poison control centers case studies, 132-135
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economic factors, 142, 143, 152-153, 162
general, 93, 95
regionalization, 7-8, 10, 36-37, 88-89, 93, 94, 142, 143, 306, 312
telephone services, 127
H
Haddon Matrix, 115, 201-204
Hazardous Substances Emergency Events Surveillance System, 181, 198
Hazardous Substances Labeling Act, 96
HAZMAT response, 112, 114, 126, 130, 133
Health care professionals
see also Nurses;
Pharmacists;
Physicians;
Poison control center staffing;
Professional education
certification, 15, 123, 127-128, 130
emergency medical personnel, 84
toxicologists, 15, 24, 83, 122
medical examiners/coroners, 179, 193-194, 197, 199, 200, 273
poison control centers, relationships with outside, 107
poison information providers/ specialists, 123, 124-125, 127, 130
telephone services, 110-112
public education materials, 221-231 (passim)
toxicologists, 15, 24(n.1), 83, 87, 122
Health departments
local, 35, 114, 274-282, 289, 307
state, 35, 93, 133, 274-282, 289, 307
Health Insurance Portability and Accountability Act, 17, 112, 169, 191, 192, 315
Health Resources and Services Administration (HRSA)
biological and chemical terrorism, 85, 114-115
committee study charge, 1, 2, 26, 305
Maternal and Child Health Block Grants, 11-12, 98, 276, 283, 285-286, 308
poison control centers, 11-12, 15, 25, 35, 39, 97
Poison Prevention and Control System (proposed), 12, 13, 15, 39, 282, 285, 287, 309
role in poison control, overview, 292-293
Healthcare Cost and Utilization Program National Inpatient Sample, 180
Healthy People 2000, 5, 25, 276
Healthy People 2010, 9-10, 25, 30, 269, 273
Historical perspectives, 23-26, 30, 80-105
access to services, 84
American Association of Poison Control Centers (AAPCC), 83, 90, 91, 92, 97-98, 100
children, 53, 81, 84, 87, 96, 99
committee study charge/methodology, 1, 2
epidemiology, 81
data needs, 90-92, 95, 98
definition of poisoning, 3
emergency medical services, 83-84, 92, 96
food adulteration, 80-81
Food and Drug Administration (FDA), 81, 82, 84, 86
incidence of poisonings, 3, 30, 43-44, 48-75 (passim), 79, 270
legislation, 23, 24, 30, 31, 82
pharmacists, 80-81
poison control centers, 2, 5-6, 24-25, 30, 81-84, 86-96, 159
Food and Drug Administration (FDA), 81, 82, 84, 86
funding, 85, 90, 92-93, 95, 97-98, 100, 103-105
organizational factors, 84, 87-90, 93-100
state government role, 86, 87, 88-89, 91-93, 98
telephone services, 81, 83, 88, 92, 94, 97, 103
regulatory issues, 80-81, 84-85, 87, 94, 95, 96, 98
surveillance, 90
terrorism, 85, 99
toxic exposure surveillance system, 90, 91, 92
Home Safety Council, 206
Hospitals and hospitalization, 8, 14, 306
see also Emergency medical services
bioterrorism preparedness, 33
committee study charge/methodology, 26, 28, 33
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incidence data, 3, 28, 49, 53, 54, 58, 66, 72
National Hospital Ambulatory Care Survey, 4, 49, 51, 54, 57-63, 71, 72, 73-74, 75, 78, 180, 195
National Hospital Discharge Survey, 4, 49, 63-65, 72, 74, 78, 179, 195
state/local hospital discharge data systems, 194
overdoses during hospitalization, 184
poison control center funding, 36, 93
Household products, 2, 3, 81, 84, 87, 88, 206
see also Packaging and labeling
I
Illinois, 86, 87, 91
Incidence and prevalence, 3, 5, 6, 18, 27-30, 44, 48-79, 94, 95
see also Death rates
alcohol poisoning, 3, 28, 68, 74
American Association of Poison Control Centers (AAPCC), 48, 90, 91-92, 98, 184-190
children, 51-53, 55, 58, 59, 60, 64
death rates, 3, 50, 66-68, 74, 85, 86
data coding, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 187-188
data needs, 176-199 (passim)
definitional issues, 47-48
drug overdoses, 50, 51, 61, 62, 64, 67
emergency medical services, 53, 54, 59-61, 65-66, 72, 73, 74, 75, 78, 179, 180
National Electronic Injury Surveillance Survey (NEISS), 4, 17-18, 48, 49, 65-66
public education, evaluation of impacts, 218
food poisoning, 66, 191
historical perspectives, 3, 30, 43-44, 48-75 (passim), 79, 270
hospital data, 3, 28, 49, 53, 54, 58, 66, 72
National Hospital Ambulatory Care Survey, 4, 49, 51, 54, 57-63, 71, 72, 73-74, 75, 78, 180, 195
National Hospital Discharge Survey, 4, 49, 63-65, 72, 74, 78, 179, 195
state/local hospital discharge data systems, 194
International Classification of Diseases (ICD), use in incidence surveys, 50-51, 55, 57, 58, 59, 60, 62, 63, 76, 77, 192-193
physicians, data from, 53, 54, 55, 65, 72, 77, 78
poison control center call volume, 110, 143, 144, 164, 187, 309
racial/ethnic breakdowns, 48, 52-60 (passim), 63, 68, 70
referral data, 59, 60, 63-66 (passim), 72, 74
regional breakdowns, 52, 53, 55, 56, 58, 59, 64, 68, 71
research methodology, 53-79 (passim)
substance abuse, 62, 67
suicide attempts, 51, 61, 68, 71
symptoms, 46, 55, 56, 58, 59, 61
telephone services, data on, 52, 53, 55, 69, 70-71, 72, 73-74, 94, 178, 184-190
race/ethnicity data, 208-209
Toxic Exposure Surveillance System (TESS), 66, 68-74, 76
Injury prevention and control field
committee study methodology, 1, 26
definition of poisoning, 3, 45, 50
Haddon Matrix, 115, 201-204
medical directors, 12, 33
poison control center organization, 23, 122
Poison Prevention and Control System (proposed), 40
public education materials, 224
state public health departments, linkage, 277
Insect/snake bites, 61, 62, 65, 66, 74, 131, 191
Interagency coordination, 3, 26, 30-31, 35-36, 39, 100, 114-115, 132-135, 165-166, 172-173, 273, 276-278, 284, 289
committee recommendations, 6, 10-11, 12, 17, 18-19, 305, 307, 308-309
cost effectiveness, 157, 159
public education, 205-206, 211, 219-232
International Classification of Diseases (ICD), 3, 16-17, 27, 34, 47, 78-79, 314-315
incidence surveys, 50-51, 55, 57, 58, 59, 60, 62, 63, 76, 77, 192-193
surveys, various, 179-181, 195
vital statistics mortality data, 66-67
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Internet
American Association of Poison Control Centers (AAPC), public education site, 211-212, 216
educational materials published by non-poison center sources, 221-231
federal agency websites, 288-301 (passim)
National Poison Prevention Week, 219
poison control centers, 112, 113, 118, 120, 215-216, 234-268
surveillance surveys, various, 12, 183
technical assistance for site development, 12, 309
Toxic Exposure Surveillance System (TESS), 49-50, 183
L
Labeling, see Packaging and labeling
Languages, non-English, 43-44, 113, 127, 164, 208, 210, 214-215
Lead poisoning, 120, 227, 228, 230, 276, 289, 290, 296
Legislation
see also Advocacy;
Funding;
Regulatory issues
Emergency Medical Services Systems Act, 24, 84
Food and Drug Act, 81, 82
Hazardous Substances Labeling Act, 96
Health Insurance Portability and Accountability Act (HIPAA), 17, 112, 169, 191, 192, 315
historical perspectives, 23, 24, 30, 31, 82
Maternal and Child Health Block Grants, 11-12
national repository, committee recommendation, 12, 309
Poison Control Center Enhancement and Awareness Act, 6, 14-15, 25, 97-98, 101-105, 312
Poison Prevention and Control System (proposed), 39, 312, 313
Poison Prevention Packaging Act, 23, 94, 96, 204
Local government
health departments, 35, 114, 274-282, 289, 307
hospital discharge data systems, 194
poison control centers and, 1-2, 5, 9, 114, 148, 307, 312-313
Poison Prevention and Control System (proposed), 273-282
M
Managing directors, 31, 32, 33, 84, 123, 127, 133, 159, 224
Mass media, 95, 103, 107, 116, 207, 210, 286, 307
National Poison Prevention Week, 95, 103, 209, 219
Mass poisonings
see also Biological and chemical terrorism
access to poison services, 114
HAZMAT response, 112, 114, 126, 130, 133
legislation on, 103
poison control centers, 107, 112, 114, 127, 191
Poison Prevention and Control System (proposed), 37
Maternal and Child Health Block Grants, 11-12, 98, 276, 283, 285-286, 308
Maternal and Child Health Bureau, 1, 2, 25, 26, 285
Medicaid, 14, 147, 148, 214, 285, 288, 294, 311
Medicare, 93, 285, 288, 294
Medical directors
background of, 84
injury prevention directors, 12, 33
poison control centers, 84, 145
committee methodology, 31, 32, 33
Medical examiners/coroners, 179, 193-194, 197, 199, 200, 273
Medication poisoning, see Drugs
MEDMARX, 197-198
MedWatch, 181, 197
Men, see Gender factors
Methodology, see Epidemiology;
Quality control;
Research methodology;
Surveillance
Micromedex, 91, 92, 113
Mine Safety and Health Administration, 285, 299
Minnesota Poison Control System, 189-190
Minority groups, see Race/ethnicity
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Morbidity
alcohol poisoning, 36
committee study methodology, 27, 28, 34, 43
cost of poisoning, methodology, 27, 28, 34
definitional issues, 28
national reduction goals, 5
Mortality, see Death rates;
Suicide and attempts
Mortality Vital Statistics, 50
N
National Ambulatory Medical Care Survey (NAMCS), 4, 48-49, 51, 54, 55-57, 71, 73, 77, 78, 180, 195
National Bioterrorism Hospital Preparedness Programs, 33
National Center for Environmental Health, 189, 289-290
National Center for Health Statistics (NCHS), 4, 17, 18, 32, 39, 47-48, 290-291, 315, 317
see also National Ambulatory Medical Care Survey;
National Hospital Ambulatory Medical Care Survey;
National Hospital Discharge Survey;
National Vital Statistics System
National Center for Injury Prevention and Control, 18, 196, 291, 316-317
National Clearinghouse for Poison Control Centers (NCHPCC), 83, 87, 91, 92, 95-96, 97, 184
National Drug Intelligence Center, 300
National Electronic Injury Surveillance Survey (NEISS), 4, 17-18, 48, 49, 65-66, 72, 181, 196, 317
National Health and Nutrition Examination Survey, 182, 199
National Health Interview Survey (NHIS), 4, 17-18, 48, 51-55, 68-74, 76, 182, 192, 317
National Hospital Ambulatory Medical Care Survey (NHAMCS), 4, 49, 51, 54, 57-63, 71, 72, 73-74, 75, 78, 180, 195
National Hospital Discharge Survey (NHDS), 4, 49, 63-65, 72, 74, 78, 179, 195
National Household Survey on Drug Abuse, 182
National Institute for Occupational Safety and Health, 33-34, 198, 228, 285, 291-292
National Institute of Child Health and Human Development, 296
National Institute of Environmental Health Sciences, 296
National Institute on Drug Abuse, 295
National Institutes of Health, 120, 283, 295-296
National Poison Prevention Week, 95, 103, 209, 219
National Vital Statistics System, 50, 66-68, 179, 192-193
Northern New England Poison Center, 134-135
Nurses
American Nurses Association, 230
poison control centers
calls to, 112, 132
training, 6, 84
public education materials, 221, 222
O
Occupational Safety and Health Administration, 198, 285, 298-299
Office of National Drug Control Policy, 282, 285, 288, 301
Ohio, 215
Organizational factors
see also Accountability;
Cost and cost-benefit factors;
Funding;
Quality control
committee charge, 2, 26
committee methodology, 5, 31-33, 34-35
data needs, 44, 309-310
emergency medical services, 6, 39, 309
health departments
local, 35, 114, 274-282, 289, 307
state, 35, 93, 133, 274-282, 289, 307
interagency coordination, 3, 26, 30-31, 35-36, 39, 100, 114-115, 132-135, 165-166, 172-173, 273, 276-278, 284, 289
poison control centers, 1-3, 5-7, 8-10, 12-14, 23, 24-25, 26, 30-31, 32, 114, 155-175, 309-311
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see also Poison control centers staffing
affiliation (private/public), 13, 93, 100, 108, 118-119, 124, 125, 136, 157-158, 160-161, 173, 311
core activities, 8-15 (passim), 31, 37-38, 106-131, 169, 173, 306-307, 308, 310
historical perspectives, 84, 87-90, 93-100
injury prevention and control field, general, 23, 122
partnerships, 10, 11, 13, 277-278, 308
planning, 35-36, 93, 98-99, 115, 123, 133, 147, 171, 175, 177
Poison Prevention and Control System (proposed), 7-8, 35-40, 306
regionalization, 7-8, 10, 14, 36-37
systems approach, 35-36, 38, 305-306
telephone services, 107-109
Poison Prevention and Control System (proposed), 5, 7, 8, 12, 13, 35-36, 38-40, 268-301, 305-306, 308-309
Overdose, see Drugs
P
Packaging and labeling, 23, 30, 35, 80-81, 84-85, 94, 95, 96, 99, 196, 203, 210, 218
child-resistant caps, 84-85, 99, 106, 204, 205, 210, 218, 287
Haddon Matrix, 202-203, 204
imprint codes, 84, 89
Poison Prevention Packaging Act, 23, 94, 96, 204
Pharmacists
accessibility, 230
American Pharmacists Association, 80-81, 222
elderly persons, 99
historical perspectives, 80-81
poison control centers, 115, 212
training, 6, 9, 99
public education materials, 221
Physicians
American College of Emergency Physicians, 83
American Medical Association, 80-81, 86, 230
biochemical terrorism, poison control center consultations, 7-8, 37
incidence data, 53, 54, 55, 65, 72, 77, 78
poison control centers, 53, 112, 116, 212, 306
public education materials, 221
telephone consultations, 53, 112
toxicology training and certification of, 15, 24, 83, 122
Poisindex, 91, 92, 113
Poison Control Center Advisory Working Group study (1996), 136
Poison Control Center Enhancement and Awareness Act, 6, 14-15, 25, 97-98, 101-105, 312
Poison control centers staffing, 6, 7, 8, 9, 13, 14, 24, 37, 168, 172, 311
costs, 136, 143-158 (passim), 161-163, 170-171, 310, 311
managing directors, 31, 32, 33, 84, 123, 127, 133, 159, 224
medical directors, 31, 32, 33, 84, 145
pharmacists, 115, 212
training, 6, 9, 99
physicians, 53, 112, 116, 212, 306
professional education, 37, 123-126, 167, 307
public education, 205-206, 209, 212-213
recruitment and retention, 14, 159, 168, 169, 170, 171, 172, 310, 311
specialists in poison information/ poison information providers, 123, 124-125, 127, 130, 143-145, 153-155
training of staff, 37, 123-126, 167, 307
volunteers, 124, 161, 172, 208
Poison Prevention and Control System (proposed), 5, 7-8, 12, 269-301, 305-317
accountability issues, 273, 282, 284-286, 308-309
biological and chemical terrorism, 12, 26, 35, 37, 38, 309
Centers for Disease Control and Prevention (CDC), 12, 15, 39, 282, 287, 315-317 (passim)
concept of, 34-40, 305-306
core activities, 270-275, 284, 306-307, 308;
see also Telephone services
cost factors, 13, 18, 19, 311-313
data needs, 13, 16-17, 37, 39, 305
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Department of Health and Human Services (DHHS), 12, 282-283, 285-286, 308-309, 313
emergency medical services, 38, 39
federal government, general,, 12, 15, 35-36, 39;
see also specific departments and agencies
funding, 8, 12, 14-15, 36, 39, 283-287 (passim), 305, 307
regionalization, 37
technical assistance, 12
local government role, 273-282
mass poisonings, 37
organizational factors, 5, 7, 8, 12, 13, 35-36, 38-40, 268-301, 305-306, 308-309
population-base factors, 18, 287
professional education, 15, 37
public education, 12, 15, 37, 39, 274
quality control, 8, 13, 37, 270-272, 274-275, 284-285, 305, 308-309, 313-314
regionalization of centers, 7-8, 10, 36-37, 306, 312
state government role, 12, 273-282, 285-286, 309
surveillance, 14-15, 37, 305
Toxic Exposure Surveillance System (TESS), 35, 309
Poison Prevention Council, 219
Poison Prevention Packaging Act, 23, 94, 96, 204
Poison Prevention Week, see National Poison Prevention Week
Poisoning, 2, 3, 4, 16-17, 27, 28, 34-35, 43, 45-48, 50-51, 73, 79, 306, 314-315
Department of Health and Human Services, committee recommendations, 16-17, 314-315
diagnosis, 3, 27, 46, 50-61 (passim)
dosage, 4, 23, 43
overdose, 27, 43, 45, 46, 51, 78-79
Toxic Exposure Surveillance System (TESS), 34-35, 45-46, 79
Policy, see Advocacy;
Legislation;
Regulatory issues
Population-based factors
see also Demographic factors;
Geographic factors
committee study charge, 2, 26
poison control centers, 35, 164, 169-170, 171
core activities, 10, 11
population at risk, 29-30
regionalization, 7-8, 10, 36-37
Poison Prevention and Control System (proposed), 18, 287
PRECEDE/PROCEED model, 206-207
Prevalence, see Incidence and prevalence
Privacy and confidentiality, 17, 18, 112, 169, 192, 214-215, 315
Private sector
see also Toxic Exposure Surveillance System
Drugdex, 92
epidemiological data, 38, 90
Poisindex, 91, 92, 113
poison control centers and, 1-7, 13, 14, 17, 35, 117, 122, 160, 164
affiliation (private/public), 13, 93, 100, 108, 118-119, 124, 125, 136, 157-158, 160-161, 171, 173-174, 311
funding, 148-149
Professional education, 26
certification of professionals, 15, 123, 127-128, 130
cultural competence, 11, 43-44, 113, 208-209
educational materials, 221-231
poison control centers, 6, 9, 10, 11, 15, 24, 25, 81, 83, 87, 107, 115-116, 117, 118-119, 121-131 (passim), 133, 158, 162-163
staff of, 37, 123-126, 167, 307
telephone services, 110-112
Poison Prevention and Control System (proposed), 15, 37
privacy regulations, 17, 315
toxicologists, 15, 24(n.1), 38, 118-119, 122, 125
Program Evaluation Logic Model, 207-208, 214
Public education/outreach, 201-268
see also Advocacy;
Mass media;
Packaging and labeling;
Telephone services
access to services, enhancement, 202, 205, 208, 214
American Association of Poison Control Centers (AAPCC), 209, 210-212, 219, 234
Centers for Disease Control and Prevention (CDC), 207, 237-238
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children, 209, 210-212, 216, 219, 234-268 (passim), 276, 277, 317
federal government, general, 219-231
funding for, general, 11, 93, 211, 286, 313
Haddon Matrix, 115, 201-204
language factors, 43-44, 113, 164, 208, 210, 214-215
materials by organizations other than poison centers, 219-231
pharmacists, 221
poison control centers, 9, 10, 11, 37, 89, 93, 95, 107, 116-117, 120-121, 123-124, 204, 205-268, 307
best practices, 213-215
biological/chemical terrorism, 115
children, 209, 216, 217, 234-268 (passim)
cost and cost-effectiveness, 158, 163, 164, 166, 206
educational materials available from, 233-268
ethnic diversity and, 43-44, 113, 208, 210, 214-215
quality control, 206-209, 217-219
staff types and roles, 205-206, 209, 212-213
state government role, 213-215, 234-268
Poison Prevention and Control System (proposed), 12, 15, 37, 39, 274
quality control, 206-209, 217-219, 231-232
racial/ethnic factors, 43-44, 113, 208-209, 214, 215
theoretical models, 206-208
Q
Quality control
see also Accountability;
Core activities;
Cost and cost-benefit factors
American Association of Poison Control Centers (AAPCC), 127-128, 130
assessment as core public health function, 270-271
assurance as core public health function, 271-272
best practices, 11, 15, 37, 213-215, 232, 275, 287, 313
certification of professionals, 15, 123, 127-128, 130
emergency medical personnel, 84
toxicologists, 15, 24, 83, 122
committee study charge, 2, 26
data coding, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 188
data on, 12-13, 129, 309-310
data quality, 176, 187-188
national tool free telephone service, 211
poison control centers, 37, 95, 107, 127-130, 167, 171, 174, 206-208, 313-314
best practices, 11, 15, 37, 213-215
certification of, 2, 15-16, 26, 84, 127-129, 130, 160
committee recommendations, 8, 10, 11, 13, 15-16, 309, 310
cost factors, 158
public education, 206-209, 217-219
telephone services, 211, 217
Poison Prevention and Control System (proposed), 8, 13, 37, 270-272, 274-275, 284-285, 305, 308-309, 313-314
public education, 206-209, 217-219, 231-232
theoretical models
Haddon Matrix, 115, 201-204
program development and evaluation, 206-208, 214
R
Race/ethnicity, 43
see also Cultural factors
access to services, 43
incidence data, 48, 52-60 (passim), 63, 68, 70
language factors, 43-44, 113, 164, 210, 214-215
A Su Salud, 208, 215
public education and, 43-44, 113, 208-209, 214, 215
Reducing the Burden of Injury: Advancing Prevention and Treatment, 25
Referrals
incidence data, 59, 60, 63-66 (passim), 72, 74
poison control centers, 166-167
telephone services, 110, 112, 116, 131, 137, 157
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self-referrals to emergency departments, 138-139
Regional factors, see Geographic factors
Regulatory issues, 18
see also Legislation;
Packaging and labeling
advocacy, 10, 11, 25, 31, 39, 203, 204, 205, 218, 271, 274, 289
data coding, 315
data sources on regulation fulfillment, 186
historical perspectives, 80-81, 84-85, 87, 94, 95, 96, 98
privacy, 17, 18, 112, 169, 192, 214-215, 315
telephone services, 112
Reporting, 6
definition of poisoning, 46
National Clearinghouse for Poison Control Centers (NCHPCC), 97
poison control centers, 117-118, 310
sentinel events, 117-118, 188-190
Research methodology
see also Data needs;
Definitional issues;
Epidemiology;
Quality control;
Surveillance;
Theoretical models
committee charge/methodology, 1, 2, 5-6, 26, 30-33, 34, 172-175, 305-306, 309
committee reviewers, ix-x
incidence data, 53-79 (passim)
Poison Control Center Advisory Working Group study (1996), 136-137
poison control centers
cost-benefit/cost-effectiveness, 142, 153-157, 170
used by, 118-120
Research recommendations, 18-19, 39, 287, 309-311, 314-317
access to services, 10, 18, 19, 118, 270, 274, 275, 316, 317
Rocky Mountain Poison and Drug Center, 31, 89, 116, 132-133
S
Safety equipment, 84, 203, 204-205, 218
child-resistant caps, 84-85, 99, 106, 204, 205, 210, 218, 287
Sentinel events, 106, 115, 117-118, 188-190
Sex differences, see Gender factors
Snake bites, see Insect/snake bites
Special Supplemental Nutrition Program for Women, Infants, and Children, 209
State and Territorial Injury Prevention Directors Association, 33
State government
biological and chemical terrorism, 85
block grants, 14, 15, 92-93, 147, 148, 311
classification systems, 3
committee study methodology, 33
emergency department data, 179
emergency preparedness/response, 12
health departments, 35, 93, 133, 274-282, 289, 307
hospital discharge data systems, 179, 194
Maternal and Child Health Block Grants, 11-12, 98, 276, 283, 285-286, 308
poison control centers and, 1-2, 35-36, 93, 100, 114, 116, 132-135, 161, 276-278
committee conclusions/ recommendations, 7, 9, 307, 312-313
funding, general, 24, 36, 92-93, 98, 136-137, 147, 148, 284, 311, 313
historical perspectives, 86, 87, 88-89, 91-93, 98
Maternal and Child Health Block Grants, 11-12, 98, 276
public education, 213-215, 234-268
regionalization, 7-8, 10, 36-37, 88-89, 93, 94, 142, 143, 306, 312
websites, 234-268
Poison Prevention and Control System (proposed), 12, 273-282, 285-286, 309
surveillance efforts, 17, 179, 189-190
Toxic Exposure Surveillance System and, 6, 309, 316
Substance abuse, 5, 28, 29, 99
see also Alcohol use and abuse
data coding, 51, 62, 181
Drug Abuse Warning Network, 19, 181, 196-197
Haddon Matrix, 202
incidence data, 62, 67
MEDMARX, 197-198
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National Household Survey on Drug Abuse, 182
Substance Abuse and Mental Health Services Administration (SAMHSA), 181, 182, 196, 229, 282, 287, 293
Suicide and attempts, 3, 5, 27, 29-30
incidence data, 51, 61, 68, 71
Surveillance, 176-200
see also Centers for Disease Control and Prevention;
Data needs;
Incidence and prevalence;
Reporting;
Toxic Exposure Surveillance System
Agency for Toxic Substances and Disease Registry, 39, 90, 115, 126, 189, 195, 283, 292
Hazardous Substances Emergency Events Surveillance System, 181, 198
committee recommendations, 9, 16-17, 314-317
committee study charge, 2, 26
data coding, 50-51, 61, 63, 73, 74-75, 78-79, 99, 178-184, 186, 187-188
definitions and classification systems, 3, 4, 176-177
historical perspectives, 90
overview and distribution of poisonings in United States, 43-79
poison control centers, 9, 10, 11, 37, 90, 115, 190-192
Toxic Exposure Surveillance System (TESS), 111, 113, 115, 117, 134, 137, 178, 184-191, 211
Poison Prevention and Control System (proposed), 14-15, 37, 305
sentinel events, 106, 115, 117-118, 188-190
state government, 17, 179, 189-190
Symptoms
see also Diagnosis
incidence data, 46, 55, 56, 58, 59, 61
T
Technical assistance, 12, 225
federal assistance to health departments, 289
Internet, 12, 309
patient care, 26, 305
Telephone services, 5, 6, 29, 37, 106, 107-113, 116, 130, 210-211, 212
American Association of Poison Control Centers (AAPCC), 113
call volume, 110, 143, 144, 164, 187, 309
committee recommendations, 9
committee study charge, 2, 26
core activity of poison centers, 14, 107-113, 116, 123, 125-127, 130, 307
cost factors, 143, 144, 152-155, 160
definition of poisoning, 4, 34-35
drug overdoses, 51, 61, 68, 71
evaluation of, 211, 218
historical perspectives, 81, 83, 88, 92, 94, 97, 103
incidence data, 52, 53, 55, 69, 70-71, 72, 73-74, 94, 178, 184-190
race/ethnicity data, 208-209
national number, 25, 52, 55, 92, 97, 103, 113, 210, 211
physician consultations, 53, 112
quality assurance, 127-129, 167,
sentinel event reporting, 117-118, 188-190
specialists in poison information/ poison information providers, 123, 124-125, 127, 130, 143-145, 153-155
Toxic Exposure Surveillance System (TESS), 111, 113, 115, 117, 134, 137, 178, 184-190, 211
Terrorism, see Biological and chemical terrorism
Texas, 116, 133, 214
Theoretical models
Haddon Matrix, 115, 201-204
program development and evaluation, 206-208
Toxic Exposure Surveillance System (TESS), 4, 6, 28, 29, 48, 49-50, 113, 115, 117, 127, 177
biological/chemical terrorism, 114
Centers for Disease Control and Prevention (CDC), 6, 17, 18, 189, 315-316, 317
committee/conclusions recommendations, 12, 17-18, 25, 315-316
data needs/methodology described, 6, 17-19 (passim), 178, 184-190, 199-200
definition of poisoning, 34-35, 45-46, 79
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emergency preparedness, 115
funding, 17-18, 90
historical perspectives, 90, 91, 92
incidence data, 66, 68-74, 76
Internet, 66, 68-74, 76
Poison Prevention and Control System (proposed), 35, 309
telephone services, 111, 113, 115, 117, 134, 137, 178, 184-190, 211
Toxicology
see also Dosage factors
certification of professionals, 15, 24, 83, 122
committee study methodology, 1, 26
definitional issues, 2, 3, 4, 24(n.1), 27, 45-46
poison control centers, 15, 38, 87, 107-108, 118-119, 122
telephone services, 107-108
training of professionals, 15, 24(n.1), 38, 118-119, 122, 125
Training, see Professional education
U
United States Pharmacopoeia, 197-198
Utilization of health care services, 53, 121, 129, 169, 180, 195, 196, 198, 209
see also Access to services;
Incidence and prevalence;
Public education/outreach;
Telephone services
V
Venom, see Insect/snake bites
W
Women, see Gender factors
World Health Organization, 16-17
see also International Classification of Diseases
World Wide Web, see Internet
