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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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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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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Forging a Poison Prevention and Control System 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