Poison Information Centre

1. -PROF.(Dr.)BISWAJIT SUKUL,MD
HEAD OFTHE DEPT. Of FSM
MEDICAL COLLEGE,KOLKATA
STRUCTURAL AND FUNCTIONAL
ORGANIZATION OF POISON
INFORMATION CENTRE

2. OBJECTIVES
• HISTORY
• DEFINITION
• FUNCTIONS OF A PIC
• STRUCTURAL ORGANIZATION OF A PIC
• SYSTEMATIC APPROACH TO POISON INFORMATION
QUERY
• COMAPRISON BETWEEN PIC & PCC
• BENEFITS

3. HOW DID THE CONCEPT COME
INTO EXISTENCE?
• After WW-II, proliferation of new drugs and chemicals in
marketplace
• Drastic increase in suicide & childhood poisoning, with
substantial number of fatalities
• Need for development of special toxicology wards in late
1940s in Copenhagen & Budapest, with a poison information
service in Netherlands

4. Fig 1:- 1967 press photo showing Dr.
Louis Gdalman delivering consultation
about poisons over telephone
Fig 2:- First poison information service established by
Dr. Louis Gdalman at St. Luke’s Hospital (Chicago,
Illinois)

5. Cont.….
• 1950’s:- Missouri pharmacist Homer George led a poison prevention
campaign in his hometown that eventually grew into a National
Poison Prevention Week
• 1980’s:- Dr JosephVeltry chaired a committee to improve poison
centre data collection. The project grew into TESS (Toxic Exposure
Surveillance System), the largest poisoning database in the world

6. HOW DID INDIA COME INTO PICTURE?
• Chemical disaster in Bhopal where Methyl Isocyanate & other
reaction products released from Union Carbide Plant ; >2500
deaths & nearly 150,000 people were disabled
• Following this tragedy, an interministerial group met in 1986 &
strongly supported the idea of setting up PIC in India
• 2 centres started functioning since 1993, one at AIIMS, New
Delhi & other at NIOH
• Recently, two more centres, one at Chennai and the other at
Cochin have been added

7. WHAT DOES PIC MEAN?
A specialized unit providing specialized advise on the diagnosis
and management of poisoning(including consumer products,
pharmaceuticals, substance of abuse, environmental chemicals,
natural toxins, pesticides and industrial chemicals) in patients of
any age, exposed by all routes and in any
circumstance(accidental, intentional, unintentional, occupational or
environmental), catering the information to both medical and
non-medical personnel

8. FUNCTIONS
PROVISION OF
TOXICOLOGICAL
INFORMATION AND
ADVICES
MONITORING
ADVERSE EFFECTS
OF DRUGS &
HANDLING
SUBTANCE ABUSE
MANAGEMENT OF
POISONING CASES
TOXICOVIGILANCE
ACTIVITIES,
RESEARCH,
EDUCATION AND
TRAINING
PROVISION OF
LABORATORY
ANALYTICAL SERVICES
DEVELOPING
CONTINGENCY
PLANS FOR &
RESPONDINGTO
CHEMICAL
DISASTERS

9. PROVISION OFTOXICOLOGICAL
INFORMATION AND ADVICES
•Concerning diagnosis, prognosis, treatment and
prevention of poisoning
•Available to all who may benefit from it (both medical
and non-medical personnel)
•Identifying toxicity of chemicals and the risk they pose

10. MANAGEMENT OF POISONING CASES
•Establishment of own toxicology unit and treatment
facilities
•Should be closely connected with facilities that
provide care for poisoned patients
•Appropriate co-ordination for rapid delivery of
antidotes and samples for laboratory analysis

11. PROVISION OF LABORATORY ANALYTICAL
SERVICES
•Identification, quantification and characterization of
toxic substances in both biological and non-biological
samples
•Understanding pharmacokinetics of the toxin(s)
•Research and monitoring of population at risk from
exposure to toxic chemicals

12. TOXICOVIGILANCE ACTIVITIES, RESEARCH,
EDUCATION ANDTRAINING
•Active process of identification and evaluation of toxin
risks in a community
•Development , implementation and evaluation of the
measures undertaken to reduce/eliminate the risk

13. DEVELOPING CONTINGENCY PLANS FOR &
RESPONDINGTO CHEMICAL DISASTERS
•Alerting the appropriate health and other authorities
for necessary preventive and regulatory measures, in
collaboration with health and other authorities
•Training of physicians and other professional health
workers likely to encounter cases of poisoning

14. STRUCTURAL ORGANIZATION OF A
POISON INFORMATION CENTRE
LOCATION
FACILITIES
EQUIPMENT
ORGANIZATION AND OPERATION
STAFF RECRUITMENT

15. LOCATION
• LOCATED IN BEST AREA & OPERATING MOST EFFECTIVELY
• Preferably in a leading hospital with emergency and intensive care services
with medical library and laboratory
• Linked directly with hospital department where poisoned patients are
managed
• Centrally situated in geographic and demographic area it caters to
• Easy access with restrictions for unauthorized persons

16. FACILITIES
• Suitable room equipped with basic furniture (desks, chairs,
working table, lockable file cabinets with bookshelves and a
bed for rest between duty periods)
• Office room large enough to permit efficient storage and
retrieval of documents and holding meetings
• With new function>>>additional space required>>>location
should be such for future expansion

17. • One room for answering services containing telephones, basic files,
protocols and books
• An area set aside as library where there can be easy access of
information
• Private area for personal hygiene and rest for the on duty staff
• Separate private area for medical director (work, interview and
consultation)
• Area for receiving patients

18. FOR CALL CUM RECEPTIONIST
One room with enough space for:-
• Poison information specialist
• Receptionist
• Refrigerator, for storing antidotes
FOR ANALYTICAL LAB, ONE ROOM WITH
ENOUGH SPACE FOR:-
• TLC
• UV-vis spectrophotometry
• HPLC
• GC/GC-MS
• Store rooms for chemicals, general store room

19. EQUIPMENT
• A reliable, dedicated telephone
• Preferably connected to emergency telephone services & all calls
concerned with toxicologic emergencies are directly connected to it
• Telephone number toll free, easily remembered & accessible
• Refrigerator for storing antidotes
• Typewriter, word processor & good quality printer
• Own slide, overhead and video projection equipment for training

20. ORGANIZATION & OPERATION OF PIC
During planning, following questions should determine the functioning
of PIC:-
1.To whom will it be available initially? (medical/non-medical/both)
2.How will it be expanded subsequently?
3.How will the existence be advertised to user population?
4.Initial & subsequent staff requirement?
5.Is the communication system adequate?
6.How will the centre collect the full range of data?

21. Regarding the data:-
Reliability, accuracy and usefulness of the data
Compilation, record and storage for future reference
/retrieval
Management and planning of data
Who will have access to the data and the authority to modify
data files?

22. OPERATION OF PIC:-
BEFORE BECOMING OPERATIONAL:-
• Planning of the budget
• Printing forms (in local language) for collecting information on local
commercial products
• Compilation of files on chemicals used in those products (including
pharmaceuticals, local natural toxins., etc.)

23. AFTER BECOMING OPERATIONAL:-
• Basic training of staff
• Should function around the clock
• Decision to consider information on local manufactured products as
confidential rests essentially with the medical director of the PIC and
essentially with the poison information specialist
• Rapid identification of nature of poison (constitution, origin, uses and
toxicity)

24. STAFF RECRUITMENT
PIC headed by DIRECTOR experienced in toxicology with sufficient personnel
 Employed on full scale basis
 With personal leadership
qualities
 Promote research and raise
funds
 3 full time medical toxicologists(catering to the
medical function of PIC)
 2 Administrative directors (financial, administrative
& non-medical aspects of the center)
 6-8 poison information specialists, such that at least
one person being on duty at any given time
 Support staffs
 Part-time experts in psychiatric & veterinary
medicine

25. MEDICALTOXICOLOGIST……
• Qualified physician with experience in treatment of poisoning
cases, emergency medicine, public health, pediatrics, internal
medicine, intensive care and forensic medicine
• Clinical experience in occupational diseases & in diseases
caused by pollutants of environmental origin
• Experience in clinical toxicology

26. POISON INFORMATION SPECIALIST……
• Deals directly with enquirers and provides timely responses to
their requests
• Skilled clinical toxicologists drawn from many different
disciplines, including various branches of medicine, pharmacy,
nursing, chemistry, life sciences & veterinary sciences
• In some countries, a poison information specialist is a specially
trained medical doctor only

27. ADMINISTRATIVE & SUPPORT
STAFF…..
• A computer specialist (dedicated member of staff or IT
specialist)
• Under the supervision of senior administrator/administrative
director
• Librarian, if a center has its own library
• Own security guard at night, to ensure rapid response

28. ADVISERS IN SPECIAL
AREAS…..
• Specialists collaborating with the center should be able to
provide specific information on subjects within their
recognized fields, when necessary
• This may include areas such as public health, psychiatry,
occupational medicine, pediatrics, nephrology, teratology,
anesthesiology, veterinary medicine, pharmacy and
environmental health

29. FINANCIAL ASPECTS
• Government to recognize cost-effectiveness of the service
provided by PIC
• Once autonomy of the center guaranteed, other sources of
funding acceptable (fund raising campaigns, philanthropic
groups.,etc.)
• Funds from national & international organization concerned
with chemical safety may be useful in specific projects

30. SYSTEMATIC APPROACHTO
POISON INFORMATION QUERY

31. • Date and time received
• Requester’s name, residence, method of contact and category
(e.g., health care discipline, patient, public)
• Method of delivery (e.g., telephone, personal visit, mail)
• Classification of request
• Question asked

32. • Patient-specific information obtained
• Response provided & References used
• Date & time answered
• Estimated time in preparation and for communication
• Materials sent to requesters
• Outcome measures suggested

33. A 28 yrs old pregnant woman with past medical history of Asthma was admitted
to Emergency Medicine department of a tertiary care hospital with ingestion of
20 tablets of Metoprolol (25mg).The EMD PGs have asked the PIC for the
management of Metoprolol poisoning in this case
General toxicity
profile of the drug
Toxicity in special
population
Toxicity in individual
patient
Narrowing the research to
individualize the response

34. COMPARISON BETWEEN PIC & PCC
• Common goal to provide comprehensive, accurate and timely
information
• Both use the information to enhance medical care of patients
• Have similar information retrieval process and physical
layouts

35. PARAMETERS PIC PCC
• PUBLICVS HEALTH
CARE PROFESSIONALS
9-10% calls 88% calls
• HOURS OF OPERATION 9AM-5PM (in initial phases
of PIC setup/small PIC
center)
24 hours a day year-round
• COST AND STAFF Less no. of staff required
compared to PCC, cost-
effective
Greater number of staffs,
hence more expensive
• AVERAGE RESPONSE
TIME
15-30 min 5 min (require immediate
response)

36. BENEFITS OF A PIC
ESTABLISHMENT
• Direct health benefits by reducing morbidity and mortality
• Mild poisoning cases that can be treated by first-aid measures
alone/by non medical personnel are quickly recognized
• In severe poisoning cases, direct referral to hospitals where
such cases are managed, thus avoiding delays

37. Cont.…..
• Delivery of specific antidotes, therapeutic agents and medical
equipment
• Help to prevent unnecessary use of special antidotes and
expensive treatments by risk stratification
• Contribute to international fund of knowledge about human
toxicology and management from epidemiological data
collected