The document discusses the history and functions of poison control centres. It begins by defining poisons and how poison control centres were established in response to increased accidental poisonings after World War II. It then describes the development of poison control centres globally and some key centres in India, including their services and organizational structure. Major functions of poison control centres include providing toxicology information and advice on poisoning management to minimize health impacts and costs.

1. Poison Control Centres
by
Dr K P Singh
PG Final Year
Deptt. Of forensic Medicine
UCMS Delhi -95
06/10/2017 Friday

2. “Worry is the stomach’s worst poison” Alfred Nobel

3. What is poison ?
As Paracelsus, 16 th centaury the father of modern toxicology
said, “All things are poison and nothing is without poison.
It is the dose that determines the poison”. Thus every drug is
potentially a poison when used erratically

4. Poison
A poison is a solid, liquid or gaseous substance ,which if
introduced in to the living body, or brought in contact with any part
produces ill effects or death by its local, systemic or both types of action.
This definition is unsatisfactory as a substance in particular
dose causes beneficial effects whereas in the same dose it can cause
the toxic effects.
Drugs that are used for the treatment of diseases in higher
doses will produce toxicity.

5. Who definition
A poison is any substance that causes harm to a living being.
This can result from contact with the body e.g. a caustic, or following
absorption into the body. Absorption can occur following ingestion, by
passage through the skin or mucous membranes, by inhalation or by
injection.
A foetus can be poisoned by a substance crossing the
placenta. Almost any substance can act as a poison if a sufficiently large
dose is absorbed.

6. PCC
A poison control centre is a medical facility that is able to
provide immediate, free, and expert treatment advice and assistance
over the telephone in case of exposure to poisonous or hazardous
substances.
Poison control centres answer questions about potential
poisons in addition to providing treatment management advice about
household products, medicines, pesticides, plants, bites and stings,
food poisoning, and fumes.
More than 72% of poison exposure cases are managed simply
by phone, greatly reducing the need for costly emergency room and
doctor visits

7. History of PCC
World War II there was a proliferation of new drugs and chemicals in the
marketplace, and consequently suicide and childhood poisonings from these
agents drastically increased.
Around this time up to half of all accidents in children were poisonings
with a substantial number of fatalities. These factors led to the medical
community developing a response to both unintentional and intentional
poisonings.
In Europe in the late 1940s special toxicology wards were set up;
initial wards were started in Copenhagen and Budapest, and
the Netherlands began a poison information service.

8. Poisons Information Services
First information Center appeared in the Netherlands in
1949.VVP
1961, a telephone answering service was introduced in Leeds
,England.
On 2 September,1963, a National Poisons Information Service
was established at Guy’s Hospital, London..

9. In the United States the first poison information centre was
started in Chicago in 1953. By 1957 there were 17 poison control
centres in the US, with the Chicago centre serving as a model; these
centres dealt mainly with physician enquiries by giving ingredient and
toxicity information about products, along with treatment
recommendations.
Over time the poison control centres started taking calls from
the general public. The majority of poison centres were not part of a
patient treatment facility; they strictly provided information.

10. In 1958 the American Association of Poison Control
Centres (AAPCC) was founded to promote cooperation between poison
centres in different cities and to standardize the operation of these
centres. An additional part of the AAPCC's activities was poison
prevention and education programs for both physicians and the general
public.
In 1968 the American Academy of Clinical Toxicologists (AACT)
was established by a group of medical doctors. The AACT’s main
objective was to apply principles of toxicology to patient treatment and
improve the standard of care on a national basis.

11. In the 1960s and 1970s a rapid proliferation of poison centres
emerged and by 1978 there were 661 centres in the USA.
This trend reversed during the 1980s and 1990s with a number of
centres closing or merging. In 2000 there were 51 certified centres in the
USA.
Today there are 55 centres operating in the US.

12. A similar movement evolved in Europe but unlike the American
movement the majority were centralized toxicology treatment centres
with integrated poison information centres.
The French developed an inpatient unit for the treatment of
poisoned patients in the late 1950s. In England the National Poison
Information Service was developed at Guy's Hospital under Dr Roy
Goulding.

13. At around the same time Dr Henry Mathew started a poison
treatment centre in Edinburgh.
In 1964 the European Association for Poison Control Centres
was formed at Tours, France. Australasian centres were also
established in the 1960s.
The New Zealand centre started in Dunedin in December 1964,
while in Australia, the New South Wales Poisons Information Center was
established in 1966.

14. Modern PCC
Poison control centres provide excellent service and savings.
Recent research shows that every dollar invested in the poison centre
system saves $13.39 in health care costs and productivity.
While poison control centres have traditionally provided expert
consultations by telephone, on December 30, 2014 an online option was
launched by a group of U.S. poison centres to meet the growing
demand for accurate web-based health
information.webPOISONCONTROL® is a free, confidential, online triage
tool also available as a downloadable app.

15. The app is based on age, weight and substance implicated, it
provides case-specific guidance for poison exposures – limited to
unintentional, single ingestions of medicines, household products or
berries in asymptomatic individuals.
The application uses ingredient-based algorithms to generate a
recommendation including whether an emergency room visit or call to
poison control is required.
If it’s safe to stay home, then home treatment
recommendations, specific symptoms to expect, and symptoms of
greater concern that would require a call to poison control or a visit to an
emergency room.

16. The main functions of PCC
1. Provision of toxicological information.
2. Advice on the management of poisoning cases
3. Training to the professional and paraprofessionals on first-aid,
management and prevention of poisoning.
4. It also provides toxicological laboratory services
5. In developing contingency plans for chemical disaster with other
responsible bodies.
6. The centre responds to chemical disasters.
7. The center carries out epidemiological and experimental studies to
find out the toxic risks and mechanisms.

17. National Poison Information Centre, Delhi
National poisons information centre was established in 1995 at
department of pharmacology, All India Institute of Medical Sciences,
New Delhi.
The center provides information on poisoning management. It
holds teaching and training program on poisoning prevention and
management.

18. NPIC Delhi
It also plays an important role in developing
contingency plans for chemical disasters and
conducts research related to antidotes, environmental and biological
monitoring of the chemicals and toxico-kinetics.

19. NPIC Delhi
The centre provides information on management and treatment
protocols of various poisonings all over the country.
The centre provides round the clock service all 365 days of the
year. Besides this, the center has the backup of latest literature on
poisoning.
Toll Free No. - 1800 116 117
Tel No.- 26589391 , 26593677

20. Organizational Setup
NPIC CHIEF-Dr. Y. K. Gupta COORDINATOR Prof. & Head
Dr. Sharda S Peshin - FACULTY INCHARGE
Professor (4) Addl. Prof.(4) Asst. Prof.(1)
SCIENTISTS
Senior Residents Dr. Thomas Kaleekal Dr . Amita Srivastava
Dr . Madhuri Gupta Dr. SS Samuel(Roster duty & on call)(7)
Junior Residents (8)(Roster duty)
M.Sc. Students(6)(Observers) pdf

21. NPIC Delhi
The Poison Information Consultant after taking an exact history
and the relevant details about the product consumed will provide the
precise and concise information on the product involved, likely signs and
symptoms, pre-hospital treatment, supportive and symptomatic care,
antidote therapy including dosage and availability
• Pdf-Functioning

22. NPIC Delhi
Also the entire information is recorded in a specific Performa for
evaluation of data and further follow-up.
The Poison Information Centre also conducts studies on the
pattern of poisoning in a particular area and developing a prevention
programme.

23. NPIC Delhi
N.P.I.C. has readymade information cards covering the signs
and symptoms, prehospital and hospital management protocols
including therapeutic drugs and antidote dosing schedule on
Organophosphates, Carbamates, Organochlorines,

24. NPIC Delhi
Aluminium phosphide, Ethylene dibromide,
Rodenticides, Corrosives, Tricyclic
antidepressants, Benzodiazepines, Phenytoin,
Methyl alcohol, Carbon monoxide, Paracetamol,
Opioids, Datura, Yellow Oleander, Scorpion sting,
Copper sulphate and Cyanide

25. Various poisoning manuals and books are available at the
centre.
The Centre is also in the process of setting up a National
Antidote Bank that will stock all essential antidotes.
Antidote list-pdf

26. Poison Information Center, IMCU,
Government General Hospital, Chennai - 600 003.
The First Poison Information Center in South India was formally
inaugurated on December 5th 2001 by the Hon'ble Minister for Health &
Family Welfare

27. Amrita Institute of Medical Sciences Cochin,
Established a full-fledged a multispecialty teachin hospital,
Kerala, in July 2003 with poison information and analytical services .
An Analytical Laboratory attached to the Centre tests for
common poisons or drugs in body fluids, as well as in water and
medicinal preparations, and other commercial products.

28. AIMS
The Centre was converted into a separate department of
Toxicology shortly thereafter, and today offers extensive facilities
pertaining to poisons and poisoning to all hospitals, government doctors,
private practitioners, as well as the lay public of Kerala State (and
neighbouring regions).
It is for the first time that such a department exclusively devoted
to toxicology has been started in a hospital in the entire country.

29. AIMS
In less than a year since its inception, the department was
officially recognised by the World Health Organization as an authorised
Poison Control Centre.
There are only 4 other such recognised
Centres in the entire country. Recently, the Centre was accorded
membership of the American Academy of Clinical Toxicology, another
unique distinction.

30. AIMS
The Department has state-of-the-art software packages
(POISINDEX from Micromedex, USA and INTOX from the WHO) that
have detailed information on more than 1 million poisons and drugs
encountered worldwide.

31. Facilities Offered: AIMS
Toxicological analysis of blood, urine, or stomach contents
(vomitus, aspirate, or washing) for evidence of any poisonous substance
or drug.
Screening of urine for substances of abuse.
Toxicological analysis of water samples for pesticides and
chemicals.
Toxicological analysis of medicinal and other commercial
products for toxic adulterants or contaminants.

32. AIMS
Toxicological screening for common chemicals and poisons in
chronic, undiagnosed ailments (skin disease, respiratory illnesses,
gastrointestinal disorders, neurological disorders).
Advanced treatment facility at AIMS for all kinds of cases of
poisoning (due to chemicals, drugs, plant products, animal bites or
stings, food poisons, etc.).

33. AIMS
Instant access to detailed information (free of charge) on
poisons and poisoning through telephone, email, postal mail, personal
contact, etc.
Free expert guidance on diagnosis and treatment of all kinds of
poisoning

34. AIMS
Poison Centres provide immediate, round the clock
toxicity assessment and treatment recommendation over
the telephone for all kinds of poisoning situations affecting
people of all ages, including ingestion of household products,
overdose of therapeutic medication, illegal foreign
and veterinary drugs, chemical exposures on the job or
elsewhere, hazardous material spills, bites of snakes, spiders
and other venomous creatures, and plant and mushroom
poisoning.

35. AIMS
When a call about a poisoning is received, the
poison information specialist obtains a history from the caller, assesses
the severity of the poisoning, provides treatment recommendations, and
refers the patient for further medical attention when necessary.

36. AIMS
Referrals to health care facilities when made are later followed
up with phone calls to assess progress, and provide additional
recommendations until any medical problems related to the poisoning
are resolved.

37. AIMS
Information from the beginning of the call to the final outcome
are noted on preformatted case sheets, and quantifiable data is filled in
by darkening respective bubbles on the sheet.

38. AIMS
The data generated is periodically analysed by the Centre and
is also monitored for quality assurance of the information specialists.
upto 75% of poisonings reported to Poison Centres are managed
entirely by telephone consultations without further necessity of
additional costs for the health care system.

39. Staffed By
A Physician – Medical director
A Pharmacist - Technical Director
An Administrator
Poison Information Spl-2 to 5,
A secretory
Staff member devoted to community education.

40. How to Contact the Centre:
• 0484-4008056 (direct)
• or 0484-2801234, ext: 8056 or 6034
• 09895282388 (24 hrs)
• toxicology@aims.amrita.edu
• poisonunit@aims.amrita.edu

41. NIOH
In India, besides this centre, there are other Poison information
centres at National Institute of Occupational Health, Ahmedabad
Established in 1969.
Phone: 079 -22686351
Fax: 079 -22686110
Email : nioh@nioh.org
Website : http://www.nioh.org

42. Scope of Activities
Situated at Ahmedabad in Gujarat, the National Institute of
Occupational Health (NIOH) conducts research on occupational and
environmental health to provide a safe, healthy and comfortable work
environment and living, through multidisciplinary approach viz.
education, service and related activities.
NIOH has two Regional Centres at Kolkata and Bangalore to
cater the need of Eastern and Southern parts of the country.

43. Thrust Areas
Epidemiological and environmental monitoring and corollary
toxicological studies in hazardous occupations for recognition and
evaluation of risk factors Development of tools for early diagnosis of
health impairment and design of appropriate intervention measures for
the prevention of hazards at work places.
Occupational and environmental epidemiology Toxicology
(metal, pesticide, reproductive and neurobehavioral) Environmental
pollution (air, water, noise, thermal) Development of safety norms
(chemical physical agents) Operational research Women and children
health Agricultural health . PDF Photos

44. International Recognition
NIOH is a declared WHO Collaborating Centre for Occupational
Health in South-East Asia region.
Participating institute for International Programme on Chemical
Safety (IPCS) - a programme organized jointly by WHO, International
Labor Organization (ILO) and United Nations Environmental Programme
(UNEP).

45. Human Resource Development
One of the major functions of this Institute is to develop human
resources. In this direction, NIOH has carried out number of training
programmes. These training programmes were carried out for medical
officers working in the ESIS, PHCs, and industries, industrial hygienists,
medical inspectors of factories, factory inspectors, safety officers,
NGOs, etc. The period of these training programmes ranges from one
week to three months.
NIOH has also started three months certificate course of
Associate Fellow of Industrial Health (AFIH) for the medical officers
working in the industry in collaboration with Mahatma Gandhi Labour
Institute, Ahmedabad.

46. Recognition for Doctorate/Masters by a
University
The M.S. University, Vadodara; Gujarat University, Ahmedabad;
University of Kolkata and University of Jadavpur have recognized the
Institutes’ scientists as Ph.D. guides.

47. Major Achievements of NIOS
Undertook studies on the industries such as Slate Pencil and Agate
Industry, Quartz Grinding, Stone Quarries, Mica Processing and also developed
an exhaust system with Bag filters to reduce the risk of silica exposure.
Studies in various industries viz., Asbestos-Cement, Asbestos Mining,
Milling, etc. over a period of time reported reduction in fiber levels from as high
as several hundred fibers per cubic centimeter of air to less than permissible
levels.
It also helped Government in reducing the permissible level from 2 fibre/ml to 1
fibre/ml.
First to show through epidemiological studies a very high prevalence
byssinosis especially in blow (30%) and card rooms (38%) of textile mills. .

48. Byssinosis was also reported for the first time in Jute Mill
workers.
Reported low prevalence of pneumoconiosis and absence of
more severe cases of pneumoconiosis in Indian coal miners.
It also reported very high prevalence of non pneumoconiotic
respiratory morbidity in coal miners. Successfully undertook gloves
awareness programmes in different tobacco cultivating regions.
The Bureau of Indian standards, Tobacco Board, Ministry of
Commerce (Go I) has acknowledged the development for incorporation
in standards and specification of use by the tobacco farm workers of AP
and Karnataka.

49. Poison Control Training and Research Centre at
Chennai , March 12, 2007
The government of Tamilnadu has set up a facility in Chennai,
the state capital, for treatment of poison victims of a Called Poison
Control Training and Research Centre, it has been located in the nodal
government hospital.
It can handle emergency situations like mass poisoning. It
would not only offer treatment but also provide information services and
counseling. An intensive care unit, a library, a museum, an antidote
bank, and a decontamination room are among the other special features
of the centre .

50. State Health Secretary V.K. Subburaj announced that a
certificate course would be offered to village health nurses at the centre
and that in course of time similar centres would be set up in all district
headquarters.
He also revealed that the state had registered about 20,000
cases of snake or insect bites last year and that during the same period
25,000 persons had committed suicide by consuming pesticide.

51. Ian D Simpson, an official of the World Health Organisation,
who also took part in the Saturday's commissioning function, said half of
the snake-bite mortality in the world was from India and hence
indigenous knowledge on this subject had to be tapped more and more.
The West was badly equipped on this front, he stressed.

52. The Drug and Poison Information Center (DPIC)
at P. D. Hinduja Hospital & Medical Research Centre
The Drug and Poison Information Center (DPIC), established in
October 2007,is aimed at providing the complete range of
emergency Drug & Poison decontamination treatment services
information and to serve as a primary resource for poison
education, prevention and treatment advisory.

53. DPIC
The center functions from 7am to 7pm and can be accessed by
a direct dial facility number 022-2446 4600.
You Tube
Twitter
Face book
Links
Instagram

54. DPIC
On receiving the call, detailed information about the patient is obtained.
For e.g. patient's name, gender, age, weight, medical history, symptoms,
status of the patient, location of patient at the time of admission, initial
treatment, content and quantity of the drug / poison consumed.
In addition to this, the name and designation of the doctor, his contact
details (E-mail, fax no, phone no,) and name of the hospital is also
obtained, so as to provide him with relevant information with the help of
Micromedex Database.
The specific queries are answered once all the relevant information
about the patient details is made available to the staff.

55. DPIC
After answering all the queries requested by concerned doctor,
he is requested to fill a feed back form. The doctor will evaluate the
response by using parameters like clarity, accuracy, timeliness and
completeness of provided information. Feed back given by the doctor
/hospital helps the DPIC to maintain the quality of service and serve in
better way. DPIC maintains confidential, records of each case.

56. DPIC
Each case is written up as a medical chart. Once the case is
completed, follow up is done; the case is filed along with all the cases
for that day.
To ensure treatment excellence, the DPIC is in the process of
developing a network of poison centers worldwide.
DPIC is being very helpful for doctors to save lives by
combining the use of online tools with a team of health professionals.

57. Western Australian P InformationCentre
This centre serves more than half of the area of Australia
including Western Australia, South Australia, the Northern Territory, the
Australian Capital Territory and a small region of western New South
Wales. The centre provides telephonic consultation to medical
professionals and the general public in cases of acute and chronic
poisonings.
The centre provides toxicological advice on the management of
exposures to prescription and nonprescription pharmaceuticals,
household and industrial chemicals, plants, animals, pesticides and
other agricultural products.
The centre also conducts formal training in clinical toxicology
and toxinology for all its staff members. The centre also undergoes
many research activities.

58. The American Association of P C C
It is a nationwide organization of poison centres and interested
individuals with the objectives:
1. To provide a forum for poison centres and interested
individuals to promote the reduction of morbidity and mortality from
poisonings through public and professional education and scientific
research.

59. 2. To set voluntary standards for poison center operations.
The activities of this centre include:
i. Certification of regional poison centers and poison centre personnel.
ii. Interaction with private and governmental agencies whose activities
influence poisoning and poison centers.
iii. Development of public and professional education programs and
materials.
iv. Collection and analysis of national poisoning data.
The association also grants awards and research fellowships.

60. Victorian Poisons Information Centre
This centre is located at the Royal Children’s Hospital, Melbourne. The
centre provides timely and safe information in cases of poisonings and
suspected poisonings.
Telephonic advice is provided on first-aid treatment of poisonings or
suspected poisonings with or without referral to the hospital. To the
health professionals information is given about formulations of products
and management of poisoned patients

61. National Poisons Information Service, UK
This centre also responds to queries relating to toxic exposures to drugs
and chemicals. The queries from doctors and other healthcare
professional are answered. The NPIS on-line database , Toxbase is
available for consultation.

62. Thanks