The Future of Poison Prevention and Control Services in the United States
Note: This report represents information on this subject as of June 2006.
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This informational report is in response to Resolution 423 (A-05), which was introduced by the Washington Delegation and adopted as amended by the House of Delegates at the 2005 Annual Meeting. Amended Resolution 423 asks:
That the American Medical Association (AMA) review the Institute of Medicine (IOM) recommendations for the future of the nation’s network of poison [control] centers, take appropriate action, and provide an informational report to the House of Delegates.
The Council on Science and Public Health (CSAPH) reviewed the recommendations of the IOM’s report entitled, Forging a Poison Prevention and Control System,1 and recommended that the AMA send a letter of support to the Secretary of Health and Human Services. In this report, the CSAPH describes the intent of the IOM report and its recommendations, and provides a copy of the AMA’s letter (PDF, 45 KB, requires Adobe® Reader®) to the Secretary of Health and Human Services that supports the recommendations of the IOM report.
IOM Report: Forging a Poison Prevention and Control System
Charge to Committee. The IOM was asked by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) to assist in developing a more systematic approach to understanding, stabilizing, and providing long-term support for poison prevention and control services. Within this context, the IOM’s Committee on Poison Prevention and Control was asked to examine the future of poison prevention and control services in the United States. The specific tasks included in the charge were to review:
1. The scope of services provided, including consumer telephone consultation, technical assistance, and/or hospital consultation for the care of patients with life-threatening poisonings, and education of the public and professionals;
2. The coordination of poison control centers with other public health, emergency medical, and other emergency services;
3. The strengths and weaknesses of various organizational structures for poi¬son control centers and services, including a consideration of personnel needs;
4. Approaches to providing the financial resources for poison prevention and
control services;
5. Methods for assuring consistent, high-quality services, including the certifi¬cation of centers and methods of evaluation; and
6. Current and future data systems and surveillance needs.
The Committee was asked to consider these questions in light of future demographic and population trends, and in the context of the threats of biological and chemical terrorism.
Key Findings of the Committee. An overall finding of the IOM Committee was that poisoning is a much larger public health problem than is generally recognized, and there is no comprehensive system in place for its prevention and control.
One overarching issue is that there is no universally agreed upon definition of poisoning. Thus, to arrive at reasonable estimates of the magnitude of poisoning in the United States, the Committee adopted the definitions used by key federal health agencies and organizations that monitor poisoning. The Committee estimated that four million poisoning episodes (including actual and suspected exposures) occur in the United States annually, with approximately 300,000 cases resulting in hospitalization. Poisoning was the second leading cause of injury-related mortality in 2001 with an estimated 30,800 deaths. The economic burden of poisoning is estimated to be $12.6 billion per year. While about one-half of the calls to poison control centers are for exposures to children five years of age or younger, the number of poisonings due to unintentional drug overdose or suicides in adolescents and young adults, or improper use of medications in the elderly, also is significant. The Committee also emphasized new concerns about biological or chemical terrorism that have elevated poisoning to an important national security issue.
A second overarching issue identified by the Committee regarded the historical development of poison control centers and their integration into the broader areas of public health and emergency medical services. Currently, there are 63 regional poison control centers in the United States that collectively serve almost the entire U.S. population. The key function of these poison control centers is to provide timely, professional treatment advice to the public and health care professionals in response to telephone queries concerning poisoning exposures. In 2002, more than 2.3 million human exposure calls were received by all poison control centers combined.
The Committee identified a number of shortcomings associated with the current “network” of poison control centers. These shortcomings included: (1) financial instability; (2) failure to operate as a “system” and to share strategies and resources; (3) lack of an effective linkage to the broader public health system; (4) a proprietary data collection and reporting system, known as the Toxic Exposure Surveillance System (TESS), that is not fully available to federal and state agencies engaged in protecting the population from consumer product or intentional hazards; and (5) lack of data on service quality and outcomes, and lack of certification of poison control centers by an independent body. The Committee concluded that the current network of poison control centers does not constitute the complete “system” of poison prevention and control services needed by the United States.
IOM Committee Recommendations. The Committee proposed the creation of a Poison Prevention and Control System that would provide the best prevention and patient care services to the diverse population of Americans who are exposed to hazardous substances, and would also protect the nation from threats posed by biological or chemical terrorism or by other emerging public health emergencies. A network of regional poison control centers was considered a vital, but not exclusive, element in the overall system. Specific recommendations of the Committee, grouped according to the tasks listed in the Committee’s charge, are as follows:
Scope of Core Poison Prevention and Control Activities
Recommendation 1. All poison control centers should perform a defined set of core activities supported by federal funding that is tied to the provision of these activities. The core activities include: (1) manage telephone-based poison exposure and information calls; (2) prepare and respond to all-hazards emergency needs (especially biological or chemical terrorism or other mass exposure events); (3) capture, analyze, and report exposure data; (4) train poison control center staff, including specialists in poison information and poison information providers; (5) carry out continuous
quality improvement; and (6) integrate their services into the public health system.
Recommendation 2. Poison control centers should collaborate with state and local health departments to develop, disseminate, and evaluate public and professional education activities.
Coordination of Poison Control Centers with Other Public Health Entities
Recommendation 3. The U.S. Department of Health and Human Services (DHHS) and the states should establish a Poison Prevention and Control System that integrates poison control centers with public health agencies, establishes performance measures, and holds all parties accountable for protecting the public.
Recommendation 4. The Centers for Disease Control and Prevention (CDC), working with HRSA and the states, should continue to build an effective infrastructure for all-hazards emergency preparedness, including bioterrorism and chemical terrorism.
Strengths and Weaknesses of Poison Control Center Organizational Structures
Recommendation 5. HRSA should commission a systematic management review focusing on organizational determinants of cost, quality, and staffing of poison control centers as the foundation for the future funding of this program.
Financial Support for the Poison Prevention and Control System: Poison Control Centers and State and Local Infrastructures
Recommendation 6. Congress should amend the current Poison Control Center Enhancement and Awareness Act to provide sufficient funding to support the proposed Poison Prevention and Control System with its national network of regional poison control centers. The Committee estimated the support for the “core” activities of poison control centers, based on the current level of service, to be slightly more than $100 million per year. Expansion of services to include the growing all-hazards emergency needs (especially biological and chemical terrorism) and enhancements to current surveillance and data collection activities would require additional funding. The Committee also recommended an additional $30 million to assure that all the essential services of public health related to poisoning are accomplished.
Recommendation 7. Congress should amend existing public health legislation to fund a state and local infrastructure to support an integrated Poison Prevention and Control System. The Committee recommended that the Secretary of Health and Human Services develop a budget proposal to support the goals of this recommendation.
Assure High-quality Poison Control Center Services
Recommendation 8. A fully external, independent body should be responsible for certification of poison control centers and specialists in poison information.
National Data System and Surveillance Needs: A Uniform Definition of Poisoning
Recommendation 9. The Secretary of Health and Human Services should instruct key agencies to convene an expert panel to develop a definition of poisoning that can be used in surveillance activities (including the Toxic Exposure Surveillance System) and ongoing data collection studies.
Privacy Barriers to Data Collection
Recommendation 10. DHHS should undertake a targeted education effort to improve health provider awareness of poisoning data collection as it relates to the Health Insurance Portability and Accountability Act (HIPAA) and state privacy regulations to mitigate their unintended chilling effect on poison control center consultation, including follow-up.
Availability of TESS Data
Recommendation 11. The Director of the Centers for Disease Control and Prevention should ensure that exposure surveillance data generated by the poison control centers and currently reported in the Toxic Exposure Surveil¬lance System (TESS) are available to all appropriate local, state, and federal public health units and to the poison control centers on a "real-time" basis at no additional cost to these users.
Research Needs
Recommendation 12. Federally funded research should be provided for (1) studies on
the epidemiology of poisoning; (2) the prevention and treatment of poisoning and drug overdose; (3) health services access and delivery, (4) strategies to improve regulations and facilitate researchers' input into regulatory procedures; and (5) the cost efficiency of the new Poison Prevention and Control System on population-based outcomes for general and specific poisonings.
Recommendation of the CSAPH
Upon review of the IOM report, Forging a Poison Prevention and Control System, and the report’s recommendations, the CSAPH recommended that the AMA support the IOM Committee’s call for the creation of a Poison Prevention and Control System that would both strengthen our nation’s network of regional poison control centers and integrate this network into the broader public health infrastructure. The Council believes that current AMA policies, as well as the AMA’s key advocacy focus of “improving the health of the public,” provide support for its recommendation. In particular, AMA Policies H-130.971, H-425.986, and H-130.946 (AMA Policy Database) express AMA’s support for a strong network of poison control centers, a strong public health infrastructure, and a strong and coordinated response to terrorism and other disasters.
The CSAPH recommended that the AMA’s support for the recommendations in the IOM report be conveyed in a letter (PDF, 45 KB) to the Secretary of Health and Human Services because DHHS would be the principal federal agency to implement these recommendations.
Reference
1. Committee on Poison Prevention and Control, Board on Health Promotion and Disease Prevention, Institute of Medicine. Forging a Poison Prevention and Control System. Washington, D.C.: The National Academies Press; 2004.
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