United States in 1979 when it received conjoint status from the American Board of Medical Specialists (ABMS) and became a primary specialty 10 years later. Medical toxicology began administering examinations in 1974 and was recognized by the ABMS as a certificate of added qualification in 1994. Although AAP has remained active in the area of poisonings with its Section on Injury and Poison Prevention, founded in 1990, the organization no longer sponsors AAPCC meetings.
During the late 1970s, systems of emergency care were developed following passage of the Emergency Medical Services (EMS) Systems Act of 1973 (Pub. L. No. 93–154). The application of technology and centralized public service (communication) access points produced the opportunity for integration of poison control centers within EMS systems. Concurrent steps to enhance home safety (e.g., product labeling, smaller quantities of over-the-counter medications per package, prescription drug safety caps, childproof cabinet locks) coincided with a shift in awareness of mortality risk to include adult poisoning as a major emphasis of care. Given a growing emphasis on adult poisoning management and poisoning response with EMS services, an increasing number of leaders in medical toxicology, including the poison control center medical directors, began to come from a background in emergency medicine followed by a fellowship in clinical toxicology (see Chapter 5). Professional activities by medical toxicologists, pharmacists, and nurses also have grown dramatically in both the management and operation of poison control centers. Centers no longer use clerical personnel or sanitarians to manage exposures.
Certain aspects of poisoning prevention in the past 30 years have been independent of poison control center clinical functions. For example, the introduction by the FDA of imprint codes on tablets and capsules provided a much improved method of tablet and capsule identification. Although the system has major drawbacks (e.g., use of logos that are difficult to categorize, describe, and list), there has been faster determination of potential medication exposures (Marder et al., 2001; Symonds and Robertson, 1967).
Similarly, the use of safety caps on medications and chemical compounds has reduced the number of exposures in children and may have been the single most important reason for reduction in morbidity and mortality since the early 1970s (Anonymous, 1982; Arena, 1959; Palmisano, 1981; Rodgers, 1996; Walton, 1982). Although there have been various public campaigns to use other child safety devices, the only data that exist are related to safety caps. Child-resistant packaging was required for various prescription drugs beginning in 1974. Looking at the period from 1974 to 1992 and comparing it with a previous period, estimates show a reduction of 460 child deaths and a mortality rate reduction of 45 percent as a result of this packaging (Rodgers, 1996). Figure 4-1 from that study