The document discusses the roles and functions of poison information centers (PICs). It describes how PICs were established in the 1930s-1980s to provide rapid access to toxicology information and assist with poison prevention. PICs are staffed by multidisciplinary teams led by medical toxicologists and aim to comprehensively address poisoning cases and enhance patient care through 24/7 information and laboratory services, education, and surveillance of toxic risks. Key roles of PICs include managing poisoning cases, conducting research, and training medical professionals to encounter poisoning.

1. CLINICAL
PHARAMCY

3.  In 1930’s – Louis Gdalman established the framework for the first poison control
center at Ruspresbyterian-St.Luke’s hospital.
 In 1950’s – Missouri pharmacist, Homer George lead a poison prevention
campaign in his hometown that eventually grew into a National poison
prevention week.
 In 1980’s – Dr. Joseph Veltri chaired a committee to improve poison center data
collection. This projectgrew into the Toxic Exposure Surveillance System(TESS)
the largest poisoning database in the world.

4. In addition pharmacists provide a key leadership roles in:
 American Association of Poison Control Centers
 American Academy of ClinicalToxicology
 The National Poison Prevention Week Council
 American Board of Applied Toxicology
Poison centers were established for two reasons:
To provide rapid access to information valuable in assessing and
treating poisonings.
To assist with poison prevention.

5.  To provide comprehensive, accurate and timely information to their clients
 To enhance the medical care of patients.
 Drug Information Center also exist with same goals as Poison Information center
HOWTO ORGANIZE A POISONCENTER
Poison center expenses and potential revenues are directly tied to call volume.
Therefore one of the most important considerations in organizing
a poison center should be the “ideal human exposure call volume”.
Maximal personnel, facility, and reference expenses can be predicted.

6. DIFFERENCES BETWEEN DIC & PIC
Poison Information
Center
CLIENTELE
 88% poison center calls are
placed by public
CALL VOLUME
 103 calls per day, it ranges from
33 to 213 calls per day.
Depending upon service
population size, poison center
awareness in that area,
poisoning rates.
Drug Information Center
 9-10% calls are placed bypublic, but
mostly by health care professionals.
 Fewer than 7 calls per day

7. HOURSOFOPERATION/COST
Operates 24hrs a day year round
More expensive Operates 9AM-5PM
STAFFING
They use a wider variety of health care
professionals
FUNDING
Public funding
They rely on pharmacists
Sponsored by hospitals ormedical centers
RESPONSETIME
Average response time is 5min.
CALLCOMPLEXITY
Less complex
15-30min or it may extend
to days.
More complex

8. • The poison information center is a specialized unit providing information on poisoning
to the whole community
Functions:
• Provision of toxicological information and
advise
• Management of poisoning cases
• Provision of laboratory analytical services
• Toxic vigilance activities
• Research education and training in the
prevention &treatment of poisoning

9. 1.Provision of information and advise:
• The main function of Poison information center is to provide information and advise
concerning the diagnosis, treatment & prevention of poisoning, as well as about the
toxicity of chemicals and risks they pose.
• To provide information on toxic chemicals, including data on risks to the environment
and on safe levels in food & environmental media as well as in the work place
• All information and advise should be adapted to the specific circumstances of the
suspected poisoning i.e. whether exposure to the poison is acute or chronic, and the
condition of the patient involved, taking into consideration the type of enquiry and the
enquirer’s technical understanding of the poisoning.
• The information service must be available 24hrs a day, seven days a week, throughout the
year.

10. 2. Patient management:
• It is necessary to confirm whether poisoning has actually occurred, to ensure that the
proper first-aid measures can be taken, and to assess what type of treatment, if any, is
required.
• The center exists to provide information, giving advise on the different aspects of
diagnosis and treatment that is appropriate to the enquirer’s understanding level.
• The close association between poison information services & poison treatment services,
facilitates the necessary updating and expansion of information on the diagnosis and
treatment of local poisoning cases, encourages follow of patients & stimulates essential
research on human toxicology and patient management.

11. 3. Laboratory services:
• A laboratory service for toxicological analysis and biomedical investigations is essential
for the diagnosis, assessment and treatment of certain types of poisoning. It is especially
important for clinical units treating poisoned patients: without analytical data, many
toxicological problems can’t be accurately assessed.
• Laboratory service can also determine the kinetics of the toxin, particularly its absorption,
distribution, metabolism & elimination.
• A laboratory should have adequate staff & equipment to carry out the analysis that are
essential in cases of poisoning with in the country or region. It requires at least one trained
analyst & one assistant, but larger numbers of personnel will be needed as the range of
techniques in use & the number of analysis being performed increases.

12. 4. Teaching & training:
• The center with educational responsibilities will train the medical practitioners & other
professional health workers likely to encounter the poisoning.
5. Toxicovigilence:
• It is the active process of identifying and evaluating the toxic risks existing in a
community and evaluating the measures taken to reduce or eliminate them.
• The role of a center in toxicovigilence is to alert the appropriate health and other
authorities so that the necessary preventive and regulatory measures may be taken.

13. PERSONNEL
1. Medical Director
2. Poison information specialists
3. Manager or Supervisor
1. MEDICAL DIRECTOR:Ultimately responsible for all medical aspects of the poison
center’s operation. The non physician poison information specialists provide medical care under
the direction and authority of the program’s medical director.
DUTIES
Regular review and authorization of all poisoning management protocols.
Authorization of poison center policies and procedures
Participation in staff training
Provision of on-call clinical support for poison center
staff
Participation in quality assurance activities

14. 2. POISONINFORMATION SPECIALISTS
 They directly interact with the public and health care professionals.
 Poison information specialists must be both clinicians and counselors. They must elicit a
complete history, correctly assess the potential severity of exposure using the most
appropriate management plan to the caller.
 In addition, poison information specialists must be able to focus callers who are unable to
give cohesive history.
Specialists should be able to communicate in a calm , reassuring manner at all levels of
education.
Both nurses and pharmacists are suitable poison information
specialists.
A national certification examination for specialists in poison information is offered each
may through the American Association Of Poison Control Centers.

15.  Many centers tend to use part-time specialists working an average of 20 hours per week.
 On-call responsibilities may be integrated into the schedule so that unexpected coverage is
handled fairly and efficiently.
 The on-call person may be paid a minimum hourly base rate. If he or she is called into the
work, the person is paid one and one- half times the regular rate of pay.
3. MANAGER/SUPERVISOR
 The manager is responsible for administrative aspects of the center’s operation.
 Ideally this person has established clinical, administrative and supervisory skills

16. DUTIES
Budgeting
Purchasing
Staff scheduling, supervision, training
Maintenance of continuous quality improvement program
Development of department policies and procedures
Preparation of administrative reports
Media response
Professional education
 The manager/supervisor should know all aspects of the poison
center’s program and have a complete knowledge base in clinical toxicology.
The manager should be able to assist specialists during the assessment of difficult cases and
substitute for specialists when the need arises.
 Many programs use pharmacists with postdoctoral training in clinical toxicology to fill this
position, however, experienced nurses and physicians work equally as well.

17. IDEAL LOCATIONS
 Emergency department
 Next to a large medical library
 Hospital pharmacies
 Schools of pharmacy
 DIC
 The center should be located at a leading hospital with emergency & intensive care
services as well as the medical library and lab.
 It should be linked directly with the hospital department where poison patients are
treated.
 The lab facilities of such hospitals should allow toxicological analysis
 It should operate 24hrs a day all year round.

18. Staff:
 PIC needs a multidisciplinary team of poison information specialist lead by physicians
with toxicological experience.
 The team may include physicians, nurses, analysts, pharmacists veterinarians and other
scientists from various fields including biology, chemistry, medicine and pharmacology.
 A poison information specialist helps to prepare & provide information & advise on
preventing and dealing with poisoning.
 A poison information specialist should work under the supervision of medical
toxicologist.
 Minimum of 2 poison information specialists should be on duty to answer calls.

19. Benefits
 It offers considerable direct health benefits by reducing morbidity & mortality from
poisoning
 Specific antidotes , therapeutic agents and medical equipment can be made more easily
available through coordination of stocks.
 Also help to prevent the unnecessary use of special antidotes and of sophisticated and
expensive treatments.
 Access to information and advise at poison information centers stimulate the interest of
local communities and makes them more committed to the prevention of poisoning.
 Help in promoting the awareness of special requirements concerning the control and
regulation of chemicals.

20. Equipment & facilities:
 Suitable office furniture & facilities for the storage of confidential data.
 Specific areas should arranged for answering telephone enquiries, consultation with
patients, preparation of documents, staff meetings and secretarial and administrative
work.
 Additional desk space is needed at centers using computer equipment and on-line
databases, air conditioning and humidity control may also be necessary.
 PIC’s should their own libraries & facilities for handling and reproducing documents.
 A fax machine is necessary which is recognized means of communicating information
rapidly among centers and hospitals during emergencies

21. RESOURCES
Micromedex’s poisindex(a database of more than 8,00,000 household products, chemicals,
and medications)
General product formulations are found in Clinical Toxicology Of Commercial Products by
Gosselin, Smith, and Hodge.
In addition they often maintain manufacture files with recent product formulations
Information required stems from a specialized branch of toxicology
Internal protocols, journals, medical literatures

22. ORGANIZATION & OPERATION
 The effective function of a poison information center depends on the availability of an
adequate volume of evaluated data to furnish a basis for the advise given.
 PIC’s should establish a mechanism for obtaining access to adequate data on
commercial products from manufacturers and should be regularly updated &its
confidentiality protected.
 Once a PIC becomes operational, i.e. able to offer an emergency response service, it
should function around the clock.
 The information handled by PIC relating to manufactured products and patients, must
be considered as confidential.
 Rapid identification of poisons or type of poison involved in an emergency is one of
the center's main task.