FORGING A Poison Prevention AND Control System

Committee on Poison Prevention and Control

Board on Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
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Forging a Poison Prevention and Control System FORGING A Poison Prevention AND Control System Committee on Poison Prevention and Control Board on Health Promotion and Disease Prevention INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Forging a Poison Prevention and Control System THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract/Grant No. 240-02-0004 between the National Academy of Sciences and the Health Resources and Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Forging a poison prevention and control system / Committee on Poison Prevention and Control, Board on Health Promotion and Disease Prevention. p. ; cm. Includes bibliographical references and index. ISBN 0-309-09194-2 (hardcover) 1. Poisoning, Accidental—Prevention—Government policy—United States. 2. Poison control centers—Government policy—United States. [DNLM: 1. Poison Control Centers—organization & administration—United States. 2. Delivery of Health Care—methods—United States. 3. Health Policy—United States. 4. Poison Control Centers—economics—United States. 5. Poisoning—prevention & control—United States. QV 600 F721 2004] I. Institute of Medicine (U.S.). Committee on Poison Prevention and Control. RA1224.5.F67 2004 363.17'91—dc22 2004009703 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2004 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Forging a Poison Prevention and Control System “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Adviser to the Nation to Improve Health

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Forging a Poison Prevention and Control System THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Forging a Poison Prevention and Control System COMMITTEE ON POISON PREVENTION AND CONTROL Bernard Guyer (Chair), Zanvyl Krieger Professor of Children’s Health, Johns Hopkins University, Baltimore Jeffrey A. Alexander, Professor, Health Management and Policy and Organizational Behavior and Human Resources, School of Business; Faculty Associate, Survey Research Center; Senior Associate Dean, School of Public Health, University of Michigan, Ann Arbor Paul Blanc, Professor of Medicine; Endowed Chair in Occupational and Environmental Medicine; University of California, San Francisco Dennis Emerson, Emergency Nurse, St. Luke’s Regional Medical Center, Boise, ID Jerris R. Hedges, Professor and Chair, Department of Emergency Medicine, Oregon Health and Science University, Portland Mark Scott Kamlet, H. John Heinz III Professor of Economics and Public Policy and Provost, Carnegie Mellon University, Pittsburgh Angela Mickalide, Program Director, National SAFE KIDS Campaign, Washington, DC Paul Pentel, Professor of Medicine and Pharmacology; Chief, Division of Clinical Pharmacology, Hennepin County Medical Center, University of Minnesota, Minneapolis Barry H. Rumack, Clinical Professor of Pediatrics, University of Colorado School of Medicine, and Director Emeritus, Rocky Mountain Poison and Drug Center, Denver Health Authority David P. Schor, Chief, Division of Family and Community Health Services, Ohio Department of Health, Columbus Daniel A. Spyker, Director of Clinical Pharmacology, Genentech, Inc., San Francisco Andy Stergachis, Professor of Epidemiology and Affiliate Professor of Pharmacy, University of Washington, Seattle David J. Tollerud, Professor and Associate Director, Institute for Public Health Research, University of Louisville, KY Deborah Klein Walker, Associate Commissioner for Programs and Prevention , Massachusetts Department of Public Health, Boston Liaison from the Board on Children, Youth, and Families Mary Jane England, President, Regis College, Weston, MA

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Forging a Poison Prevention and Control System Study Staff Anne Mavor, Study Director Susan McCutchen, Research Associate Elizabeth Townsend, Senior Project Assistant IOM Board on Health Promotion and Disease Prevention Rose Marie Martinez, Board Director David Butler, Senior Program Officer Rita Gaskins, Board Administrative Assistant Jim Banihashemi, Financial Associate Consultant Delon Brennen, Johns Hopkins University

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Forging a Poison Prevention and Control System BOARD ON HEALTH PROMOTION AND DISEASE PREVENTION James W. Curran (Chair), Dean and Professor of Epidemiology, The Rollins School of Public Health, Emory University, Atlanta Ronald Bayer, Professor, Joseph L. Mailman School of Public Health, Columbia University, New York Dan G. Blazer, J.P. Gibbons Professor of Psychiatry, Duke University Medical Center, Durham, NC Helen Darling, President, National Business Group on Health, Washington, DC Stephen B. Fawcett, Director, KU Work Group on Health Promotion and Community Development, and University Distinguished Professor of Human Development, University of Kansas, Lawrence Jonathan Fielding, Director of Public Health and Health Officer, Los Angeles County Department of Health Services Lawrence Gostin, Professor of Law, Georgetown University; and Professor of Public Health, The Johns Hopkins University; and Director, Center for Law and the Public’s Health, Centers for Disease Control and Prevention, Collaborating Center Promoting Health Through Law, Washington, DC Ellen Gritz, Professor and Chair, Department of Behavioral Science, Frank T. McGraw Memorial Chair in the Study of Cancer, The University of Texas, M.D. Anderson Cancer Center George Isham, Medical Director and Chief Health Officer HealthPartners, Minneapolis, MN Mark Scott Kamlet, H. John Heinz III Professor of Economics and Public Policy and Provost, Carnegie Mellon University, Pittsburgh Joyce Seiko Kobayashi, Associate Professor, Department of Psychiatry, University of Colorado Health Sciences Center, and Director of Acute Crisis Services, Denver Health Medical Center Elena O. Nightingale (Member Emerita), Scholar-in-Residence, Institute of Medicine, The National Academies, Washington, DC Roxanne Parrott, Professor, Department of Communication Arts and Sciences, The Pennsylvania State University, University Park Thomas A. Pearson, Albert D. Kaiser Professor and Chair, Department of Community and Preventative Medicine, and Professor of Medicine, University of Rochester, NY Irving Rootman, Professor and Michael Smith Foundation for Health Research Distinguished Scholar, Faculty of Human and Social Development, University of Victoria, British Columbia David J. Tollerud, Professor and Associate Director, Institute for Public Health Research, University of Louisville, KY

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Forging a Poison Prevention and Control System Kathleen E. Toomey, Director, Division of Public Health, Georgia Department of Human Resources, Atlanta William Vega, Director, Behavioral Research and Training Institute, University Behavioral HealthCare, New Brunswick, NJ Patricia Wahl, Dean and Professor of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle Lauren Zeise, Chief, Reproductive and Cancer Hazard Assessment, Office of Environmental Health Hazard Assessment, Oakland, CA Liaison from the Institute of Medicine Jeffrey P. Koplan, Vice President for Academic Health Affairs, Emory University, Atlanta

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Forging a Poison Prevention and Control System Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Kelly J. Devers, Center for Studying Health System Change Susan S. Gallagher, Education Development Center, Inc. Lewis R. Goldfrank, Bellevue Hospital Center Maxine Hayes, State of Washington Department of Health Henri Manasse, Jr., American Society of Health System Pharmacists L. Joseph Melton III, Mayo Clinic College of Medicine Harold Pollack, University of Chicago Henry W. Riecken, University of Pennsylvania, Professor Emeritus Robert B. Wallace, University of Iowa Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report

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Forging a Poison Prevention and Control System before its release. The review of this report was overseen by Enriqueta C. Bond, Burroughs Wellcome Fund, and George F. Sheldon, The University of North Carolina. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Forging a Poison Prevention and Control System Acknowledgments The Committee is grateful to the many individuals who contributed information contained in this report and who were helpful to us throughout the study process (see Appendix A for a complete list of contributors). We would particularly like to thank the directors and staffs of the poison control centers for their willingness to describe current operations and programs and share insights on the challenges ahead. Without their cooperation, this report would not have been possible. We also extend our special thanks to the American Association of Poison Control Centers, whose staff provided the Committee with data from their 2000 and 2001 surveys and gave informative briefings on the current status of the Toxic Exposure Surveillance System and the national efforts in public education for poison prevention and control. The Committee also wishes to particularly acknowledge those individuals who prepared written material and contributed to the collection and preliminary analysis of data. Miriam Cisternas, MCG Data Services, prepared the material for the morbidity analysis used in Chapter 3. Lois Fingerhut, National Center for Health Statistics, prepared the mortality analysis material also found in Chapter 3. Holly Hackman and Jessica Cates from the Massachusetts Department of Public Health, contributed to sections describing federal agencies and their participation in poison prevention and control found in Chapter 9. Laura Copeland, Tracy Finlayson, Maureen Metzger, and Soheil Soliman from the University of Michigan assisted in collecting and summarizing data used by the Committee to characterize current poison control centers.

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Forging a Poison Prevention and Control System The Committee is most grateful to sponsors Carol Delany and Byron Bailey of the Maternal and Child Health Bureau of the Health Resources and Services Administration for their continued interest in and support of our work. Staff of the Institute of Medicine (IOM) and the National Research Council (NRC) made important contributions to our work in many ways. The Committee wishes to acknowledge Rose Martinez of the IOM for her good counsel throughout the study. We extend particular thanks to NRC staff member Susan McCutchen for her efforts as our research associate and the part she played in the preparation of this report. We are also grateful to NRC staff member Elizabeth Townsend, the Committee’s senior project assistant, who was indispensable in organizing meetings, arranging travel, compiling agenda materials, and in managing the production aspects of this report. We would like to thank Delon Brennen, consultant, who assisted us in our efforts throughout the study. Finally, we wish to thank Laura Penny, our editor.

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Forging a Poison Prevention and Control System Contents EXECUTIVE SUMMARY   1 PART I:  OVERVIEW     1   Introduction   23 2   Toward a Poison Prevention and Control System   34 PART II:  CURRENT STATUS AND OPPORTUNITIES     3   Magnitude of the Problem   43 4   Historical Context of Poison Control   80 5   Poison Control Center Activities, Personnel, and Quality Assurance   106 6   Current Costs, Funding, and Organizational Structures   136 7   Data and Surveillance   176 8   Prevention and Public Education   201 9   A Public Health System for Poison Prevention and Control   269 PART III:  CONCLUSIONS AND RECOMMENDATIONS     10   Conclusions and Recommendations   305

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Forging a Poison Prevention and Control System REFERENCES   318 APPENDIXES     A  Contributors   329 B  Committee and Staff Biographies   332 INDEX   339