Illinois Poison Center
A Public Health Information and
Education Service
Why Poison Center Services?
Overview of the IPC
 History of Poison Centers in Illinois
 Mission
 Emergency Call Center Services
 Public Education
...
Poison Center History
 1953
 First poison control center in the
nation: Rush University
 Early 1960’s
 Over 100 poison...
Poison Center History
 1980s
 Poison centers around the state
gradually closed
 1990
 Three centers left in Illinois
...
Illinois Poison Center
 October 1997
 50% of funding from State of Illinois
 50% of funding raised privately and/or
fro...
Illinois Poison Center and MCHC
Program of Metropolitan Chicago Healthcare
Council (MCHC)
Poison Center History
 1997
 Rush poison center transitioned to
Metropolitan Chicago Healthcare Council
 Organized as a...
Illinois Poison Center
 1998: Certified by AAPCC in 1998
 Only AAPCC-certified regional poison
center in Illinois
 Oper...
Mission
The Illinois Poison Center is dedicated to
reducing the incidence and injury of
poisoning in our communities throu...
Emergency Call Center
 Available 24 hours a day, 365 days
a year via toll-free number
1.800.222.1222
Call Center Services
 Over 107,000 calls in 2006
 Almost 87,400 exposures
 Over 15,000 calls from health care
providers...
AAPCC Clinical Staff
Requirements
 Specialists in Poison Information
 Nurses, Pharmacist, Physician Assistants and
Physi...
Illinois Poison Center
Current Clinical Staffing:
16 Pharmacists and
nurses (13 FT/3 PT)
7 Poison information
providers (6...
Types of Calls
 The IPC provides treatment advice and
information for overdoses, medication
errors, occupational accident...
Emergency Call Center
36% Increase in Service since 2000
0
20000
40000
60000
80000
100000
120000
2000 2002 2004 2006
Tot a...
Emergency Call Center Services
HCF calls increased 21% since 2003
YearTotals
0
2,000
4,000
6,000
8,000
10,000
12,000
14,00...
Emergency Call Center Services
 IPC Staff that answer HCF calls have all
been passed a national exam in toxicology
and ar...
IPC CSPI exam scores
IPC scores average = 91% (101/110)
National average = 75% (82/110)
Value of Call Center Services
 Health Resources and Services
Administration (HRSA) estimates that for
every $1 dollar spe...
Value of Call Center Services
 90% of calls from general public are
managed at home with simple first aid
instructions
 ...
Value of Call Center Services
 When poison center services not available,
admissions increase by 16%
 10,843 admissions ...
Value of Call Center Services
 Length of Stay (LOS)
 New Jersey Study (2007) showed:
 Admitted patients where poison ce...
Value of Call Center Services
 Poison Centers save society money
through:
 Preventing unnecessary healthcare
visits
 De...
Public Education
 Goal #1 is to provide poison
prevention to families and
communities to create healthier and
safer commu...
Public Education
 Goal #2 is to raise awareness of the IPC
services so as to maximize the value of
the call center servic...
Public Education
 Service Region Size is a
significant barrier
 State of Illinois
 12.7 million people
 55,000 square ...
Theory of Change
 Problem
 Low utilization of poison center services
 Accidental poisoning a threat to community

Hist...
Theory of Change Planning Tool
Project A + Project B + Project C = Outcome D
• A+B+C are based on someone else’s research,...
IPC theory of change strategy
A + B + C + E = D
Media Hospital
Satellite
Network
Volunteer
Educators
Individuals,
Communit...
Measure and quantify the
processes
 It is assumed that processes will make a
difference over time
 Time may be months, y...
Media Processes – press
releases, interviews, “mentions”
(print)
0
50
100
150
200
250
300
350
400
2001 2003 2005
Releases
...
Media – web utilization (page
views)
0
50000
100000
150000
200000
250000
300000
2004 2005 2006
Public
Professional
Educato...
Media
 Broad ranging – 100’s of thousands if not
millions of people read an article in print,
web or hear about the poiso...
Hospital Satellite System
 Regional Hospital based education centers
throughout the state
 Train the trainer approach en...
Volunteer Educator Approach
Educators Trained
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2002 2003 2004 2005 2006
Onl...
Outreach Events per year
IPC Outreach Events
0
200
400
600
800
1000
1200
1400
1600
1800
1
2002
2003
2004
2005
2006
20%
34%...
Satellite Events
0
200
400
600
800
1000
1200
1400
1600
1800
2001 2002 2003 2004 2005 2006
Satellite and I PC
events
Online...
Satellite People Reached
0
50000
100000
150000
200000
250000
2001 2002 2003 2004 2005 2006
Satellites and I PC
Online Educ...
Community, professional and
government organizations
 Children’s librarians
 School Nurse associations
 EMS
 DCFS
 WI...
Types of events
 EMS group that has poison prevention
booth at local fairs, parade, community
celebrations.
 Pharmacy sc...
Community and School
Education
So, that is a lot of effort…
Case volume over time
0
20000
40000
60000
80000
100000
120000
2000 2002 2004 2006
Exposures
Total Calls
Penetrance changes by geography
(more successful in small metro and rural areas)
Poison Data for Illinois
0
2000
4000
6000
8000
10000
12000
14000
16000
2001 2002 2003 2004 2005 2006
I n/ enroute to HCF
T...
% Treated and Released of
In/Enroute to HCF
15% decrease in non-emergent poisoning that
presents primarily to ED.
41
42
43...
Causality
 Control group: National data?
 Change in number of severe poisonings
(acuity)?
 Population/Demographic chang...
Latino Outreach Results with
Sinai Community Institute
 Total calls increased
18%
 Calls from hospital
decreased 3%
0
50...
Latino Outreach Results with
Sinai Community Institute
 Treated and Released
decreased 17% from
2002/2003 baseline
 Tota...
Latino Outreach Results with
Sinai Community Institute
 23% reduction in
pediatric HCF
visits
 28% reduction in
Pediatri...
Latino Outreach Results with
Sinai Community Institute
 Essentially
unchanged from
baseline of
2002/2003
0
100
200
300
40...
Latino Outreach Results with
Sinai Community Institute
 36% reduction in
pediatric admissions
from poisoning
 State numb...
Theory of Change
 What works the best?
 Not sure if media, satellites or community
organizations is most cost effective
...
Professional Education
Expertise of Poison Center Staff in field of Poisoning
an Toxicology
 Undergraduate and Graduate E...
Undergraduate Education
 Medical and Pharmacy Students can come to
IPC for 2 weeks to 6 weeks at a time
 12 per year at ...
Post Graduate Education
 80 to 100 medical residents, pharmacy
residents and fellows rotate through
Toxikon and the IPC e...
Continuing Education
 Advanced HAZMAT Life Support (AHLS)
 577 providers Trained since 2002
 Bioterrorism Training and ...
Surveillance
 Software-driven Surveillance of National
Poison Database System (NPDS)
 Individual Reporting: High index o...
Software surveillance
 All exposure calls are logged into an
electronic program with two functions
 One function is the ...
Software Surveillance
 The coded fields from every poison center
in the U.S, are uploaded every 20 minutes
to New Jersey ...
Software Surveillance
 National Surveillance
 three standard deviations from moving 14 day
average for past three years ...
Individual Reporting
 Public Health Reporting by individuals
 Astute clinician realizes something is out of
the ordinary...
Examples of Food Borne Illness
Reporting
 March 2004
 Call to Illinois Poison Center
from HCF re: 2 individual with
seve...
Examples of Food Borne Illness
Reporting
 Fall, 2006
 Call from HCF regarding patient
with numbness, tingling and
revers...
Examples of Food Borne Illness
Reporting
 May, 2007
 Call from HCF re: patient
who had weakness, near
paralysis after in...
Winter 2005 - 2006
 Bootmate sealant
 Exposures reported to PCC led to
respiratory symptoms ranging from cough
to pneumo...
Research
 Current database with 600,000 cases of
poisoning
 Cases are easily retrieved and examined
Research
 Answer questions that have not yet been
answered
 Change the knowledge base of medicine
 Change the knowledge...
Research Example
Crack Cocaine Body stuffers
 Crack Cocaine Body Stuffers
 50 KUB
 No Foreign Body seen on x-ray
 In the Chicago area, ...
Research examples
 Rodenticides – long acting superwarfarins
 750 cases, no bleeding
 48 cases with f/u INR, 2 abnormal...
Heroin Body Stuffers
 Resurrection Program
 65 heroin body stuffers
 6 (9%) symptomatic, all within 1 hour of
ingestion...
2007 ICEP Resident Research2007 ICEP Resident Research
Award WinnerAward Winner
 Retrospective case series
 All carbamaz...
0
50
100
1 4 7 10 13 16 19 22 25 28 31 34 37 40
Initial (mgc/mL) Highest (mcg/mL)
InitiallyInitially supratherapeuticsupra...
InitiallyInitially therapeutictherapeutic concentration andconcentration and
continued to rise > 12 mcg/mLcontinued to ris...
InitiallyInitially subtherapeuticsubtherapeutic concentrationconcentration
and continued to rise > 12 mcg/mLand continued ...
Caffeine
Research – why?
 Change the practice of medicine
 Improve outcomes
 Improve public health
Research – Why?
 RRC requirement
 Career choices
 Academic vs. Community Practice
 Medical Toxicology Fellowship
 Cha...
Potential Examples
 Triage criteria: Do they change
practice? Value?
 Epidemiology of poisoning
 New trends
 Emerging ...
Research
Medical Admissions all Poisoned Patients
0
1000
2000
3000
4000
5000
6000
7000
8000
2002 2003 2004 2005 2006 2007
...
In summary, the IPC is the place
to call
But it is so much more…
It is a comprehensive public health
information and education service
Poison Center Services 2008
Poison Center Services 2008
Poison Center Services 2008
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2008 presentation on poison center services to Northwestern EM Residency

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Poison Center Services 2008

  1. 1. Illinois Poison Center A Public Health Information and Education Service
  2. 2. Why Poison Center Services?
  3. 3. Overview of the IPC  History of Poison Centers in Illinois  Mission  Emergency Call Center Services  Public Education  Professional Education  Public Health – Reporting, Surveillance  Research
  4. 4. Poison Center History  1953  First poison control center in the nation: Rush University  Early 1960’s  Over 100 poison information centers in Illinois  American Association of Poison Control Centers (AAPCC) formed
  5. 5. Poison Center History  1980s  Poison centers around the state gradually closed  1990  Three centers left in Illinois  None certified by AAPCC  By 1996  Two centers had closed  Rush center announced plans to close
  6. 6. Illinois Poison Center  October 1997  50% of funding from State of Illinois  50% of funding raised privately and/or from hospitals  Core functions  Call center for healthcare professionals and general public  Professional education
  7. 7. Illinois Poison Center and MCHC Program of Metropolitan Chicago Healthcare Council (MCHC)
  8. 8. Poison Center History  1997  Rush poison center transitioned to Metropolitan Chicago Healthcare Council  Organized as a not-for-profit 501(3c) under MCHC/Chicago Hospital Council  Name changed to Illinois Poison Center (IPC)
  9. 9. Illinois Poison Center  1998: Certified by AAPCC in 1998  Only AAPCC-certified regional poison center in Illinois  Operational requirements  24/7/365 call center  Professional education requirements  Staff requirements  Certified specialist in poison information (CSPI)  Medical toxicologist  Medical director  On-call staff support  Education and outreach requirements
  10. 10. Mission The Illinois Poison Center is dedicated to reducing the incidence and injury of poisoning in our communities through immediate expert telephone recommendations, innovative public and health care professional education and focused research. Our vision is an Illinois that no longer suffers from the harm of poisoning
  11. 11. Emergency Call Center  Available 24 hours a day, 365 days a year via toll-free number 1.800.222.1222
  12. 12. Call Center Services  Over 107,000 calls in 2006  Almost 87,400 exposures  Over 15,000 calls from health care providers (17% of calls); most from hospital based personnel  We are consultants to healthcare professionals on toxicology and poisoning
  13. 13. AAPCC Clinical Staff Requirements  Specialists in Poison Information  Nurses, Pharmacist, Physician Assistants and Physicians  Poison Information Providers  IPC prefers Pharm. Tech, Paramedics, BA/BS in a life science and health care experience  Medical Directors  Board certified in EM, Pediatrics or Preventative Medicine  Board Certified in Medical Toxicology
  14. 14. Illinois Poison Center Current Clinical Staffing: 16 Pharmacists and nurses (13 FT/3 PT) 7 Poison information providers (6 FT/1 PT) 3 Medical directors (1 FT/ 2 PT)
  15. 15. Types of Calls  The IPC provides treatment advice and information for overdoses, medication errors, occupational accidents, hazardous material incidents, venomous bites and more  51% of exposures involve children under the age of 6 years of age
  16. 16. Emergency Call Center 36% Increase in Service since 2000 0 20000 40000 60000 80000 100000 120000 2000 2002 2004 2006 Tot al Calls
  17. 17. Emergency Call Center Services HCF calls increased 21% since 2003 YearTotals 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 2001 2002 2003 2004 2005 2006 YearTotals
  18. 18. Emergency Call Center Services  IPC Staff that answer HCF calls have all been passed a national exam in toxicology and are considered Certified Specialists in Poison Information  Stability, additional training, monthly educational lectures add to depth of experience of staff
  19. 19. IPC CSPI exam scores IPC scores average = 91% (101/110) National average = 75% (82/110)
  20. 20. Value of Call Center Services  Health Resources and Services Administration (HRSA) estimates that for every $1 dollar spent on poison control services $7 dollars in health care costs are saved  IPC budget ~4,000,000 so about $28,000,000 saved  Caveat: based on 1980’s and early 1990’s data.
  21. 21. Value of Call Center Services  90% of calls from general public are managed at home with simple first aid instructions  70% of callers would seek healthcare if poison center services are not available  Estimated ED cost of $1,000  Potential savings: $45,000,000
  22. 22. Value of Call Center Services  When poison center services not available, admissions increase by 16%  10,843 admissions in 2005 per hospital discharge data  Extrapolation of an additional 1700 admissions  Average cost of admission from poisoning is $10,843  Potential savings: over $18,000,000
  23. 23. Value of Call Center Services  Length of Stay (LOS)  New Jersey Study (2007) showed:  Admitted patients where poison center was consulted had mean LOS of 3.9 days  Admitted patients where poison center was NOT consulted had mean LOS of 6.9 days  Hospital stay for poisoning $1,500 per day average per IDPH data  Potential savings: $56,000,000
  24. 24. Value of Call Center Services  Poison Centers save society money through:  Preventing unnecessary healthcare visits  Decreasing admissions to hospitals  Decreasing the LOS at hospitals Estimated potential savings for Illinois is ~$119,000,000 ($30 saved for every $1 spent)
  25. 25. Public Education  Goal #1 is to provide poison prevention to families and communities to create healthier and safer communities
  26. 26. Public Education  Goal #2 is to raise awareness of the IPC services so as to maximize the value of the call center services in decreasing medical costs.
  27. 27. Public Education  Service Region Size is a significant barrier  State of Illinois  12.7 million people  55,000 square miles
  28. 28. Theory of Change  Problem  Low utilization of poison center services  Accidental poisoning a threat to community  Historically little poison prevention education led by Illinois Poison Centers  Strategies  Media, Regional Education Centers, Volunteer Educators, Professional/community organizations  Assumptions  Little history of poison prevention education led by poison centers, “space” could be filled with
  29. 29. Theory of Change Planning Tool Project A + Project B + Project C = Outcome D • A+B+C are based on someone else’s research, collective experience, historical principles, preponderance of evidence • A, B and C are the most compelling strategies to achieve and outcome D (success of the program)
  30. 30. IPC theory of change strategy A + B + C + E = D Media Hospital Satellite Network Volunteer Educators Individuals, Community and Professional organizations 1) Increased awareness 2)Decreased unintentional poisoning Newspaper TV Radio Web 12 hospital educators in various regions in the state “Online educators” Faith-based Ethnic Professional Government
  31. 31. Measure and quantify the processes  It is assumed that processes will make a difference over time  Time may be months, years, generations  The only thing one can control is the process and hope the assumptions are correct
  32. 32. Media Processes – press releases, interviews, “mentions” (print) 0 50 100 150 200 250 300 350 400 2001 2003 2005 Releases I nterview s Mentions
  33. 33. Media – web utilization (page views) 0 50000 100000 150000 200000 250000 300000 2004 2005 2006 Public Professional Educator Total
  34. 34. Media  Broad ranging – 100’s of thousands if not millions of people read an article in print, web or hear about the poison center on radio or TV  Passive  Difficult to measure at an individual basis  Constant updating to ‘new threats’
  35. 35. Hospital Satellite System  Regional Hospital based education centers throughout the state  Train the trainer approach encouraged  Educators are regional experts for their volunteer educators and “online” educators  Quarterly meetings – teleconference  One annual face-to-face all day meeting  Beginning to encourage the interaction with more community groups
  36. 36. Volunteer Educator Approach Educators Trained 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2002 2003 2004 2005 2006 Online Satellites/IPC 40% 33%
  37. 37. Outreach Events per year IPC Outreach Events 0 200 400 600 800 1000 1200 1400 1600 1800 1 2002 2003 2004 2005 2006 20% 34% 70% 26%
  38. 38. Satellite Events 0 200 400 600 800 1000 1200 1400 1600 1800 2001 2002 2003 2004 2005 2006 Satellite and I PC events Online Educator Events Total Events
  39. 39. Satellite People Reached 0 50000 100000 150000 200000 250000 2001 2002 2003 2004 2005 2006 Satellites and I PC Online Educators Total
  40. 40. Community, professional and government organizations  Children’s librarians  School Nurse associations  EMS  DCFS  WIC  Casa Central  HispanoCare  Over 20 additional community organizations throughout the state
  41. 41. Types of events  EMS group that has poison prevention booth at local fairs, parade, community celebrations.  Pharmacy schools and students  School Nurses who provide poison prevention during NPPW  Librarians who have a poison prevention ‘story time theme’
  42. 42. Community and School Education
  43. 43. So, that is a lot of effort…
  44. 44. Case volume over time 0 20000 40000 60000 80000 100000 120000 2000 2002 2004 2006 Exposures Total Calls
  45. 45. Penetrance changes by geography (more successful in small metro and rural areas)
  46. 46. Poison Data for Illinois 0 2000 4000 6000 8000 10000 12000 14000 16000 2001 2002 2003 2004 2005 2006 I n/ enroute to HCF Treated and Released
  47. 47. % Treated and Released of In/Enroute to HCF 15% decrease in non-emergent poisoning that presents primarily to ED. 41 42 43 44 45 46 47 48 49 50 2001 2004 % t r eat ed and r eleased
  48. 48. Causality  Control group: National data?  Change in number of severe poisonings (acuity)?  Population/Demographic change?  Change in training of staff? Still intriguing Data
  49. 49. Latino Outreach Results with Sinai Community Institute  Total calls increased 18%  Calls from hospital decreased 3% 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 2002 2004 2006 Tot al Calls Calls from HCF
  50. 50. Latino Outreach Results with Sinai Community Institute  Treated and Released decreased 17% from 2002/2003 baseline  Total calls increased 18%, T and R decreased 17%  Poison prevention vs. calling IPC? 0 200 400 600 800 1000 1200 1400 1600 2002 2004 2006 Calls from HCF Treat ed and Released
  51. 51. Latino Outreach Results with Sinai Community Institute  23% reduction in pediatric HCF visits  28% reduction in Pediatric T and R 0 50 100 150 200 250 300 350 2002 2004 2006 Peds calls from HCF Treat ed and Released-- Pediat ric
  52. 52. Latino Outreach Results with Sinai Community Institute  Essentially unchanged from baseline of 2002/2003 0 100 200 300 400 500 600 700 2002 2004 2006 Medical Admissions all ages
  53. 53. Latino Outreach Results with Sinai Community Institute  36% reduction in pediatric admissions from poisoning  State numbers for control unchanged  Decrease in ED visits and Admissions = >$219,000 saved from baseline 0 5 10 15 20 25 30 35 40 45 50 2002 2004 2006 Pediatric admissions
  54. 54. Theory of Change  What works the best?  Not sure if media, satellites or community organizations is most cost effective  Community Organizations may be better partners in hard to reach populations  Easier to raise foundation money if working with community organizations
  55. 55. Professional Education Expertise of Poison Center Staff in field of Poisoning an Toxicology  Undergraduate and Graduate Education  Medical students  Pharmacy students  Medical and Pharmacy Residents  Continuing Education for practicing professionals  Advanced HAZMAT Life Support (AHLS)  Bioterrorism Training and Curriculum Development Program (BTCDP)  Individual Lectures for institutions
  56. 56. Undergraduate Education  Medical and Pharmacy Students can come to IPC for 2 weeks to 6 weeks at a time  12 per year at IPC  26 per year with Toxikon (affiliated educational organization)  Individual lectures at Pharmacy and Medical Schools  About 12 per year at 3 different schools of pharmacy and 3 school of medicine
  57. 57. Post Graduate Education  80 to 100 medical residents, pharmacy residents and fellows rotate through Toxikon and the IPC every year  Most emergency medicine residencies in Chicago send their residents for education with the IPC and Toxikon
  58. 58. Continuing Education  Advanced HAZMAT Life Support (AHLS)  577 providers Trained since 2002  Bioterrorism Training and Curriculum Development Program (BTCDP)  624 people educated since 2004  Individual Lectures (~ 10 to 30 per year) to institutions that request presentations to staff
  59. 59. Surveillance  Software-driven Surveillance of National Poison Database System (NPDS)  Individual Reporting: High index of suspicion, clinical awareness  Driven by experience
  60. 60. Software surveillance  All exposure calls are logged into an electronic program with two functions  One function is the medical record:  Recorded history, physical, assessment and plan  The second is database  All products are coded, route of exposure, location of exposure, clinical effects noted
  61. 61. Software Surveillance  The coded fields from every poison center in the U.S, are uploaded every 20 minutes to New Jersey (essentially real-time)  The data is then analyzed with software developed in conjunction with the CDC (BIOSENSE)
  62. 62. Software Surveillance  National Surveillance  three standard deviations from moving 14 day average for past three years creates a notification  Total Call Volume (by center)  Human Exposure Volume (by center)  Clinical Effects  Procedure  Alert at national office  National office investigates data  If signal is worrisome, local poison center contacted for ‘follow back”
  63. 63. Individual Reporting  Public Health Reporting by individuals  Astute clinician realizes something is out of the ordinary and reports it to other agencies  Recognition can occur in various points of patient care
  64. 64. Examples of Food Borne Illness Reporting  March 2004  Call to Illinois Poison Center from HCF re: 2 individual with severe muscle breakdown  Recent ingestion of Buffalo Fish  Dx: Haff Disease
  65. 65. Examples of Food Borne Illness Reporting  Fall, 2006  Call from HCF regarding patient with numbness, tingling and reversal of hot and cold  Patient recalls eating grouper at restaurant that night  Dx: Ciguatera Poisoning
  66. 66. Examples of Food Borne Illness Reporting  May, 2007  Call from HCF re: patient who had weakness, near paralysis after ingestion of “puffer fish”  Dx: Tetrodotoxin poisoning  FDA recall
  67. 67. Winter 2005 - 2006  Bootmate sealant  Exposures reported to PCC led to respiratory symptoms ranging from cough to pneumonitis to pulmonary edema  Initially noted by Detroit Poison Center  Investigation showed over 179 exposures with mild to severe clinical effects in midwest and eastern U.S.  Product recalled
  68. 68. Research  Current database with 600,000 cases of poisoning  Cases are easily retrieved and examined
  69. 69. Research  Answer questions that have not yet been answered  Change the knowledge base of medicine  Change the knowledge base of the public  Change the practice of medicine
  70. 70. Research Example
  71. 71. Crack Cocaine Body stuffers  Crack Cocaine Body Stuffers  50 KUB  No Foreign Body seen on x-ray  In the Chicago area, x-rays are of no value in the diagnostic work up of a crack cocaine body stuffer  Packaging in Chicago may be different than the packaging in other parts of the country
  72. 72. Research examples  Rodenticides – long acting superwarfarins  750 cases, no bleeding  48 cases with f/u INR, 2 abnormal, both lab error  No cases of true coagulopathy
  73. 73. Heroin Body Stuffers  Resurrection Program  65 heroin body stuffers  6 (9%) symptomatic, all within 1 hour of ingestion  3 (4.6%) needed naloxone
  74. 74. 2007 ICEP Resident Research2007 ICEP Resident Research Award WinnerAward Winner  Retrospective case series  All carbamazepine exposures reported to our regional poison center between January 1, 2001 and December 31, 2005 were investigated.  Inclusion criteria were all acute poisonings with concentrations greater than 12 mcg/mL at any given time.
  75. 75. 0 50 100 1 4 7 10 13 16 19 22 25 28 31 34 37 40 Initial (mgc/mL) Highest (mcg/mL) InitiallyInitially supratherapeuticsupratherapeutic concentrationconcentration and continued to rise > 12 mcg/mLand continued to rise > 12 mcg/mL
  76. 76. InitiallyInitially therapeutictherapeutic concentration andconcentration and continued to rise > 12 mcg/mLcontinued to rise > 12 mcg/mL 0 20 40 1 2 3 4 5 6 7 8 9 10 11 Initial (mcg/mL) Hightest (mcg/mL)
  77. 77. InitiallyInitially subtherapeuticsubtherapeutic concentrationconcentration and continued to rise > 12 mcg/mLand continued to rise > 12 mcg/mL 0 10 20 30 1 2 3 4 5 Initial (mcg/mL) Highest (mcg/mL)
  78. 78. Caffeine
  79. 79. Research – why?  Change the practice of medicine  Improve outcomes  Improve public health
  80. 80. Research – Why?  RRC requirement  Career choices  Academic vs. Community Practice  Medical Toxicology Fellowship  Change the useful knowledge base, change the practice of medicine  Cool Trips: North American Congress of Clinical Toxicology  2008 Toronto  2009 San Antonio  2010 Denver
  81. 81. Potential Examples  Triage criteria: Do they change practice? Value?  Epidemiology of poisoning  New trends  Emerging trends in drug abuse  Coricidin  Alternate routes of exposure
  82. 82. Research Medical Admissions all Poisoned Patients 0 1000 2000 3000 4000 5000 6000 7000 8000 2002 2003 2004 2005 2006 2007 Year numberofadmissions 2002 2003 2004 2005 2006 2007
  83. 83. In summary, the IPC is the place to call
  84. 84. But it is so much more… It is a comprehensive public health information and education service
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