Central Ohio Poison Center 2008 Annual Report
50th Year Anniversary Edition
1958–2008
Committed to Saving Lives Yesterday, Today and Tomorrow
• • • • • • • • • • • • • OUR MISSION
The mission of the Central Ohio Poison Center is to provide and promote the highest standard of care to the poisoned patient, health care providers and community.
TABLE OF CONTENTS
From the Directors...... 1 The Reality of Poison in 2008...... 2 50 Years of Caring: What We Do Everyday...... 3 Welcome Dr. Heath A. Jolliff...... 4 50 Years of Teaching: Professional Health Training...... 5 Central Ohio Poison Center Celebrates 50 Years...... 6 Be Poison Smart® A Legacy: Its Beginning and History...... 7 COPC Service Region and Calls by County...... 8 50 Years of Service: Call Volume and Human Exposures by Age...... 9 50 Years of Service: Reasons for Exposures and Medical Outcomes...... 10 50 Years of Service: Treatment Site of Callers and Management Site of Hospitalized Patients...... 11 50 Years of Education: Poison Prevention...... 12-13 50 Years of Collaboration: Community Partner Network...... 14 50 Years of Visiblity: News Media ...... 15 50 Years of Value: Financial Investment...... 16 50 Years of Consultation: Member Hospital Program...... 17 50 Years of Teamwork: The Staff...... 18 Publications...... 19 Presentations ...... 20 FROM THE DIRECTORS
A message from the Medical Director: Much has changed in the Central Ohio Poison Center since our beginning 50 years ago, except our mission.
50 Years Ago: Today: • COPC call center located in a closet and took one • 34 COPC professionals housed in a 3,200 square call every day or so foot facility and take 450 calls per day • 80% of calls from the general public and the • Almost all calls came from physicians additional 20% from health care professionals • Complete poison center reference library and • Three reference books and 1,000 5”x 8” index electronic toxicology database with information on cards were available more than 1.3 million poisons and products • Three board-certified medical toxicology specialists • Center was supported by a single pediatrician supporting efforts
50 years ago there was a much smaller variety of household products, but many of their ingredients were more dangerous, labels rarely listed ingredients and containers lacked child-resistant caps. Today, while we handle a wider variety of products in the home, the most dangerous ingredients have been banned, concentrations of chemicals are lower, child resistant caps are used and are saving lives and toxic ingredients are often listed on the product label.
50 years ago medications, aspirin being the most prevalent, caused 50% of the poisonings, with iron and barbituates also very common. Common household poisons included lead, kerosene, lye, iodine tincture, bichloride of mercury and “washing soda”. Today our most common medication poisonings are analgesics, such as acetaminophen and opiates, sedatives/hypnotics/antipsychotics and topical medications. The most common non-medication poisonings are cosmetics and personal care products, household cleaning substances and foreign objects, such as a coins and buttons.
50 years ago we frequently recommended removing a swallowed poison from the patient’s stomach, either by inducing vomiting or pumping the stomach at the hospital. Today, we recommend emptying the stomach in far less than 1% of poisoning.
50 years ago diphtheria and polio had recently been conquered, and poisoning was the most common medical emergency facing children. Today poisoning is the most common cause of accidental death in Ohio.
50 years ago the Central Ohio Poison Center was here to help prevent poisonings and, when poisoning happened, to give the best treatment advice possible. Today, our mission to protect people from poisoning and to ensure the highest standard of care for the poisoned patient, holds steadfast.
Marcel J. Casavant, MD, FACMT, FACEP Medical Director, Central Ohio Poison Center
Yesterday, today and in years to come, we strive to keep children and adults safe from the dangers of poisoning through education, prevention and treatment. I encourage you to read this report to discover what the poison center and its dedicated staff have accomplished throughout the last 50 years, the millions of lives we’ve helped and saved, and our plans for the future.
1 S. David Baker, PharmD, DABAT Managing Director, Central Ohio Poison Center The Realty of Poison in 2008
• Poisoning is the second leading cause In 2008, the COPC handled 239,763 calls of injury-related death to children and from the 44 counties we serve in Ohio: adults in the United States. • 149,699 human exposure calls and calls • Almost 2.5 million human exposures requesting poison or drug information
were reported to poison centers • 90,064 follow-up calls were conducted to monitor the victims’ condition and provide • The American Academy of Pediatrics’ additional advice statistics reveal that 60% of all children will need help from a poison • 57% of exposure calls concerned children five years of age and younger center before the age of six. • Over 16 % of exposure calls were • More than 4.3 million calls were from physicians and other health care managed by poison centers. professionals treating poisoned victims
SOMEONE calls a Poison Center every 13 seconds
A CHILD needs a Poison Center every 30 seconds
An ADULT needs a Poison Center every 39 seconds in the U.S.
1940s 1952 2
Mr. Gdalham starts recording management of poisonings American Academy of Pediatric’s study shows that on index cards –standard database 51% of children’s accidents are the result of ingestion of potential poisonings 50 years of Caring: What we do everyday
Everyday we impact hundreds of lives in your community:
• A two year old who ate a mushroom from the backyard • A seven year old who swallowed a battery • A teenager who overdosed on Benadryl with suicidal intent • A 25 year old who mixed cleaning chemicals was found seizing and vomiting • Both a 40 and a 90 year old who drank cleaner in a cup, thinking it was water
The Central Ohio Poison Center (COPC) saves Physicians, first responders and other health care hundreds of people like these everyday in your professionals call the poison center for consultation community. Supervised by a Board-Certified Medical and advice on treating poisoning victims when the Toxicologist, our trained and certified pharmacists patients do need to go to the hospital for additional and nurses tirelessly provide poison assessment and medical treatment. treatment, medication information and prevention information to callers 24 hours a day, 7 days a The COPC also educates people on poison week, every day each year, for 50 years. Our advice prevention to keep them safe and to reduce poison is confidential and offered at no charge to callers exposures. Poison information packets are sent to all through our toll-free hotline, 1-800-222-1222. callers who would like to receive them.
Over eighty-nine percent of the people calling The American Association of Poison Control Centers from home are treated over the telephone by and the Centers for Disease Control analyze poison our Nationally Certified Specialists in Poison center data for early warning signs of epidemics Information, keeping people at home and at ease and poisoning outbreaks. The Ohio Department of without unnecessary trips to the hospital. Our Health, local and county public health departments, specialists conduct follow up telephone calls with the Environmental Protection Agency, the Food and the families at home to provide additional advice if Drug Administration and Emergency Management needed and to ensure a positive outcome. Without a Agencies all benefit from the Central Ohio Poison poison center, half of our callers would have gone to Center’s toxico-surveillance. an emergency department, most unnecessarily.
1953 1957 3
First poison center launches in Chicago National Clearinghouse for poison control centers is established, distributing consumer product information to poison centers on index cards Welcome
Early in 2007, Dr. Heath Jolliff, DO, FACEP, FAAEM, joined the Division of
Pharmacology/Toxicology at Nationwide Children’s Hospital. Dr. Jolliff’s
roles include administrative, clinical and educational responsibilities.
He sees toxicology consults and admissions at Nationwide Children’s
Hospital, is responsible for training medical students and residents, and
conducts toxicology research. Dr. Jolliff also assists the poison center as Dr. Heath Jolliff, DO, FACEP, FAAEM an on-site and on-call medical toxicologist, a much needed role with our Medical Toxicologist increasing call volume. One of his initiatives for the poison center is to
start a fellowship to train future medical toxicologists. He is well published and has taught emergency
medicine and medical toxicology throughout the country.
Dr. Jolliff earned his BA at Wright State University in Dayton, and his DO at Ohio University in Athens,
Ohio. He completed his residency in Emergency Medicine at Grandview Hospital and Medical
Center in Dayton, Ohio and fellowship in Medical Toxicology at the Rocky Mountain Poison and
Drug Center/University of Colorado Health Sciences Center in Denver, Colorado. He has practiced
Emergency Medicine for the past twelve years and Medical Toxicology for the last eight. Dr. Jolliff is
Clinical Associate Professor of Emergency Medicine and Director of Medical Toxicology at the Ohio
University College of Osteopathic Medicine/OhioHealth-Doctors Hospital in Columbus, Ohio.
Dr. Jolliff is a great addition to the Central Ohio Poison Center. We are excited to have his experience,
clinical expertise, and enthusiasm for research and education.
1958 1958 1958 4
The Central Ohio Poison Center opens at The COPC has 192 calls in first year, staffed American Association of Poison Control Nationwide Children’s Hospital, Columbus, limited hours by one employee. Centers (AAPCC) is founded Ohio with Dr. Robertson as Medical Director 50 years of teaching: Health care providers and first responders rely on the Central Ohio professional Poison Center for expert advice during a poisoning incident and for health training training for future emergency situations. In 2008, 20% of calls to the Central Ohio Poison Center were from medical professionals including acute care hospitals, ambulances, EMT, HazMat, police, school RNs, physician offices and nursing homes. The Central Ohio Poison Center also provides a number of training opportunities for various health care professionals.
Professional Education The Central Ohio Poison Center is a major teaching center. Each month resident physicians from Emergency Medicine, Pediatrics, Family Medicine and Internal Medicine rotate through the poison center. During their monthly rotation, the residents learn the diagnosis, management and prevention of poisonings through direct patient care, telephone case calls and weekly case conferences. In 2008, 23 resident physicians trained at the COPC. Pharmacy students also receive toxicology education at the poison center. Annually, the COPC precepts PharmD students from three colleges of pharmacy in Ohio: The Ohio State University, University of Toledo and Ohio Northern University. Seventeen PharmD students rotated through the COPC in 2008. All students participate in weekly rounds with toxicologists, residents and staff, write an article for the member hospital newsletter, give a presentation, learn to identify pills and to chart in S.O.A.P. note form, provide home follow up to our patients, follow hospitalized patients, and manage nontoxic and minimally toxic exposures with oversight.
Pharmacology and Toxicology Lectures/Presentations The Central Ohio Poison Center physician toxicologists visit hospitals, organizations and schools throughout Columbus to give toxicology lectures to healthcare providers. In 2008, they delivered 32 presentations to update approximately 1500 health care providers on various toxicities and poisonings. See page 20 for list of presentations.
Mass Casualty Event Preparedness The Central Ohio Poison Center professionals are essential to all-hazard preparedness in our region and need to be prepared for any type of disaster, both natural or bioterrorism. The Central Ohio Poison Center helps to prepare our region by helping to design, conduct, and evaluate and participate in community disaster exercises. The Central Ohio Poison Center also provides assistance with agent identification, decontamination and treatment and relaying urgent information to several health departments and to 83 hospitals in our 44 county service area. Providing expertise in the selection of antidotes, the Central Ohio Poison Center devises pediatric dosing regimens and assists with the development of the health professionals training program.
1960 1960 1961 5
Federal Hazardous Substance Labeling Act Aspirin is the top poisoning substance in Dr. John Shultz becomes the signed children now and for many years to come COPC Medical Director the Central OHio poison center celebrates 50 years
Dr. Shultz served various director roles for the Poison Center Dr. William Robertson is a professor of Pediatrics at the University from 1966-1986 and had a private practice from 1965-1997 of Washington, School of Medicine and an Emeritus Medical while staying involved with the poison center. He is now the Director of the Central Ohio Poison Center. He has served as Medical Coordinator for Quality Improvement at Nationwide the Medical Director of the Washington Poison Center in Seattle Children’s Hospital and an Emeritus Medical Director for the since 1963. Central Ohio Poison Center.
Yesterday... Our History with Dr. John Shultz
In 1953, the American Academy role in the COPC history. He then recognized and television stations of Pediatrics and eight Chicago began his pediatric residency at televised a yearly show which was a hospitals started the first poison Children’s in 1962 and became big hit. The show addressed types center. Shortly after, the Columbus the Chief Medical Resident in of poisonings, new prevention tips Public Health Officer asked 1964-1965. Dr. Shultz became and materials, and advances in the Children’s Hospital to open an interested in presenting to women’s field such as inception of safety in-house center. The Chairman of groups on the poisons affecting caps. It wasn’t until the American Pediatrics at Children’s Hospital children and began monitoring the Association of Poison Control volunteered Dr. William O. emergency department where many Centers (AAPCC) was formed that Robertson to direct this initiative. of the poisoned patients were seen. poison prevention education was Dr. Robinson accomplished this with Upon completing his residency in more widespread. the help of Dr. Antoinette Eaton, 1965, he went into private practice Chief Resident of the hospital at and continued to work with the In the 1970s, there were 13 poison the time. poison center, indirectly supervising centers in Ohio, each managed for years. by hospital pharmacies. Dr. Shultz The Central Ohio Poison Center and others formed an association began operations in September Beginning in the late 1960s and of poison centers and worked 1958 and was located in back of early 1970s, aspirin was by far the on getting legislation passed for the Emergency Department of top substance poisoning children funding, standard therapies and Nationwide Children’s Hospital. for about a decade. Later when better care. Later, they worked with File cards were used for looking up safety caps were used, bottle sizes state representatives to reduce the information on various poisons for were adjusted, packaging changed number of poison centers in Ohio the poison-related call that came and regulations were placed on to three. In 1981, Dr. Phil Walson, in every day or two. All of the calls aspirin and other medications, a Board Certified Pediatrician and were about poison exposures in the exposures lessoned. Dr. Shultz Toxicologist, joined the poison children until the late 1960s when and poison center personnel set center and was instrumental in adult calls started coming in as well. up a monthly display case in the ensuring quality control and proper emergency department, stocking standards. In 1984, the COPC was When Dr. Robertson relocated to it with bottles of the substances first certified by the AAPCC and has Seattle, Washington a few years children were ingesting each maintained its certification to after starting the poison center month, such as aspirin and Old this day. in Columbus, Dr. John Shultz, a English furniture polish. resident in Family Practice, arrived to begin his three-month rotation Beginning in 1961, an annual at Children’s, beginning his integral Poison Prevention Week was
1961 1962 1965 6
First National Poison Prevention Week 462 poison centers in the U.S. COPC starts handling adult calls during Vietnam War Campaign Carol Fisher now helps coordinate outreach and development for Simply Living, an 800 member organization whose focus is on environmental sustainability.
Be Poison Smart! A Legacy: Its Beginning and History
Carol Fisher, BA, came to Nationwide Children’s Hospital in December 1992 to work on an education grant for training organizations and educating the public about poison prevention. Carol spent nine months talking to employees at health departments, early intervention programs and hospitals to learn about their poison prevention needs. Taking this information, along with guidance from Dr. Mary Ellen Mortensen, poison center Medical Director at that time, and input from poison center staff, Nationwide Children’s Hospital personnel, network partners and AAPCC educators, Carol developed Be Poison Smart!, a low cost, easy to use, poison prevention education program. The Be Poison Smart! program, which rolled out in early 1994, was primarily targeted to educate families with young children about poison prevention. It was a huge success. The program is now Ohio’s signature poison prevention program and was recognized by the Institute of Medicine (IOM) as one of the nation’s best poison prevention programs. The program incorporated Program-To-Go Totes containing “pretty poisons” (look-a-like products) to clearly demonstrate the dangers of harmful products that can be mistaken for benign ones. The program was designed to be self-sustaining which, through a train-the-trainer approach, trainees in community-based agencies and subsequent public outreach would multiply. The popularity of the program grew from Franklin County to many of the COPC’s 44 county regions and beyond. Carol’s primary challenge was keeping up with production and development of program materials. Julee Fuller, COPC Administrative Assistant, stepped in to help with the volume, to ensure the rapidly growing program’s success.
The Be Poison Smart! program was so successful that additional grants made it possible to expand the program to target different populations. Carol’s vision of program sustainability has become a reality.
® For more information on the Be Poison Smart! And Be Poison Wise! SM programs, see Expansion of Be
® Poison Smart! - Introducing Be Poison Wise! SM on page 13.
1966 1968 1970 7
Child Protection Act extends labeling statutes American Academy of Clinical Toxicology 597 Poison Centers in the U.S. to pesticides and other hazardous substances (AACT) established COPC Service Region and Calls by County
374 186 Due to the increased usage 434 39 45 44 75 1,097 of mobile phones and Voice 94 777 32 36 126 90 240 241 111 577 Over IP, the COPC handles 19 107 127 37 127 795 91 all calls that are routed to 449 38 228 1,792 112 254 334 us, whether they are in our 841 467 2,788 37 61 177 402 45 1,575 217 service region or in another 1,150 879 920 1,091 542 278 poison center service area. 2,853 525 679 3,660 1,437 2,006 1,459 The COPC handled an 40,587 2,527 6,129 1,138 additional 148,430 calls in 831 15,571 1,017 295 3,782 259 2,677 2,994 151 1,100 the state of Ohio outside of 1,160 878 2,311 1,726 795 5,202 2,253 our service region as well as 652 1,161 1,508 1,269 out-of-state calls. 388 753 2,361 2,932 STA TE OF OHIO 727 1372 1,666 5,926 state of OhiKEYo
Columbus Columbus 2,381 Cincinnati Cincinnati Cleveland Cleveland
Top 10 Substances Involved in a Poisoning
1. analgesic medications 6. topical products 2. Cosmetics/personal care products 7. Cold and cough preparations 3. Cleaning products 8. antidepressant medications 4. Sedatives/hypnotics/antipsychotics 9. Cardiovascular medications 5. Foreign bodies, e.g., coins, buttons 10. antihistamines
1970 1970 1971 8
Poison Prevention Packaging Act requires child-resistant 13 poison centers in Ohio- mostly managed Birth of “Mr. Yuk” poison symbol Introduction of microfiche technology to caps on many containers and limits the number of tablets in by hospital pharmacies poison information (Poisindex) children’s acetaminophen and aspirin bottles. 50 years of SERVICE: 2008 statistics
Call volume 2000-2008
250,000
200,000
150,000 Follow-up calls Incoming calls 100,000
50,000
0 2000 2001 2002 2003 2004 2005 2006 2007 2008
Note: Incoming calls include exposure and information calls
Human exposure calls by age
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0 >1 1 2 3 4 5 6-126-12 13-1913-19 20-2920-29 30-3930-39 40-4940-49 50-5950-59 60-6960-69 70-7970-79 80-8980-89 >90>90
1972 1976 Late 1970’s >1 1 2 3 4 5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90 9
Birth of “Mr. Yuk” poison symbol Introduction of microfiche technology to Toxic Substances Control Act (TOSCA) signed Brent Whitehead, PharmD becomes the first poison information (Poisindex) manager dedicated to Poison Control 50 years of SERVICE: 2008 statistics (continued)
Reasons for Exposures Unintentional 85.5%
Intentional 12.3% Unintentional Intentional Adverse Drug Reaction Other Adverse Drug the stats Reaction 1.7%
Other .5%
medical outcome of Poisoning exposure
Major Effect .7% Moderate Effect 8.28% Death 0.03%
Unrelated Effect 2.96%
No Effect Minor Effect Moderate Effect Major Effect Death Unrelated Effect
No Effect 44.83% Minor Effect 43.2%
1978 1978 1980 10
AAPCC introduces standards for regional poison EPA bans lead in paint COPC moves from Emergency Dept. to First toxicology fellow at COPC center designation which includes employing Pharmacy Dept. poison specialists and operating 24 hours a day 50 years of SERVICE: 2008 statistics (continued)
treatment site of callers
Treated at Home Treated at home 80% Referred to Health Care Facility
Referred to Health Care Facility 20%
management site of hospitalized patients Treated and Released Admitted to Admitted to Critical Care Admitted to Critical Care Noncritical Admitted to Noncritical Care 15.5% Care 8.9% Admitted to Admitted to Psychiatry Psychiatry Lost to Follow Up/Left AMA 6.6%
Lost to Follow Up/Left AMA 18.2%
Treated and Released 50.8%
1980’s 1980’s 1980’s >1 1 2 3 4 5 6-12 13-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90 11
First toxicology fellow at COPC Ohio Association of Poison Control Centers work Toxicology training begins for emergency medicine on state legislation for poison centers under the residents and doctor of pharmacy candidates leadership of Dr. Shultz 50 Years Of Education: poison prevention
In alignment with the Healthy People 2010 Guidelines, there is now heightened awareness of poisonings as a public health concern. National and local data reveal that 94% of poisonings occur at home, with the remaining 6% occurring at work, school, health care facilities, restaurants and other public areas. Eighty- three percent of the calls the Central Ohio Poison Center receives are from the public.
Although the most vulnerable population for poisoning exposures is children under six years of age, there has been a significant increase of poisonings among older adults due to medication errors; these older adults often suffer more serious consequences or death. To achieve our vision - every child is poison smart and every adult is poison wise - we employ several outreach initiatives to educate the community, especially caregivers of young children and the elderly, on poison safety and the poison center services we provide. Through these poison prevention activities, we have an opportunity to make a difference in the community. Dangerous poisoning incidents can be prevented through awareness and education.
Through education and outreach events in 2008, the Central Ohio Poison Center was able to inform thousands of people throughout central Ohio about poison prevention by: • Loaning 52 Program-to-Go Totes to teachers, day care providers, school nurses, police officers, fire departments/EMS personnel, regional social service agency staff, community leaders and local businesses, reaching close to 10,000 people. • Displaying materials at 20 health and wellness events, attended by more than 14,500 people. • Conducting 15 Train-the-Trainer classes, which prepared 158 future trainers, multiplying our poison prevention teaching capabilities. These trainees consist of pharmacy doctoral candidates, medical professionals, educators, social service providers, MOMs and MOPs (Mothers of Preschoolers) groups. • Distributing almost 300,000 educational materials: telephone stickers, magnets, wallet cards, key tags, brochures, poison prevention information packets and various other materials.
1981 1981 1983 12
COPC receives first National Certification by Dr. Phil Walson, the first Board Certified First Poison Information Specialist Exam is held the American Association of Poison Control Toxicologist, joins the COPC as Centers Medical Director ® Expansion of Be Poison Smart! - Introducing Be Poison Wise! SM
The COPC’s Be Poison Smart! ® program, which begun through training educators, social service has been educating the public and preventing providers and health care professionals, and poisonings for over ten years, is Ohio’s signature distributing supporting educational tools and poison prevention education program for the materials at senior centers as well as the elderly in community and is recognized by the Institute of the general public. Medicine as one of the nation’s best practices in poison prevention. The COPC’s Be Poison Smart! ® Pharmacy students from The Ohio State University program was so successful that federal funding and the Ohio Northern University contacted allowed us to further expand the program to the Central Ohio Poison Center to express their incorporate medication safety issues specific to the interest in educating the public about poison aging population. This new program is called Be prevention and medication safety and improving Poison Wise! SM and is a collaborative effort among the health education and communication of older the COPC and local experts from The Central adults. The COPC has trained 80 students so far Ohio Area Agency on Aging, The Ohio State and additional trainings are scheduled for a total University College of Pharmacy, The Ohio State of 150 PharmD candidates. University College of Nursing and Nationwide Children’s Hospital. The newest component of the program, possible through the award of another federal grant, Be Poison Wise! SM was finalized in the fall of 2007. is called Be Poison Smart and Be Poison Wise in The newly developed curriculum and materials Appalachia! This new initiative will focus on the became available throughout the service region specific needs of the Appalachian population in in 2008. The curriculum addresses areas such as 22 counties of the COPC’s service region. A pilot the nature of medication errors and prevention program will begin in 2009 with an anticipated tips to avoid medication errors, which often result rollout in 2010 for the entire region. in high health care costs. Program roll-out has
National Poison Prevention Week March 16-22, 2008 To celebrate the event, the Central Ohio Poison Center distributed over 80,000 pieces of poison prevention materials with the help of community partners, Member Hospitals, City and County Health Departments, libraries and selected pharmacies. For the month of March, we also featured an educational display in a high traffic area of Nationwide Children’s Hospital to promote poison prevention and highlight poison center activities to health care professionals, patients and visitors.
Mid 1980’s Mid 1980’s 1985 13
Dr. Braden becomes the COPC Medical Director Dr. Mortensen becomes the COPC COPC moves from Pharmacy to its Medical Director own location 50 Years of Collaboration: Community Partner Network
■ Central Ohio Area Agency on Aging To educate greater numbers ■ Coshocton County Health Department - Maternal and Child Health of residents across the COPC Center service area on poison ■ Delaware County General Health District ■ prevention, the COPC teams Genesis Health Care, Zanesville ■ Licking Memorial Health Systems with organizations that ■ Mahoning Valley SAFE KIDS Coalition, Youngstown have regional service areas. ■ Memorial Hospital of Union County/Union County Health Department/ These community partners Safe Communities Program, Marysville participate in our six-hour ■ Morrow County Health Department ■ ® Advanced Training Session and Northwestern Ohio Be Poison Smart! Initiative ■ Ohio Department of Health – Childhood Lead Poisoning Prevention are then eligible to teach the Program Basic Training Session to other ■ Ohio University’s College of Osteopathic Medicine’s Community Service service providers in their area. Program/OSU Extension - Athens County, Athens With the COPC’s support, each ■ Ohio Valley Poison Prevention Coalition community partner becomes • Belmont County General Health District • Bel Tech Community Education Program the local presence and • East Ohio Medical Complex resource for poison prevention • Barnesville Emergency Medical Service materials and training in their • Harrison County Help Me Grow regions. Our appreciation • Belmont County Health Department WIC Program and gratitude goes to these • Guernsey County Health Department • Monroe County Health Department Network Partners for their • Ohio Hills Health Services dedication and commitment • Noble County Health Department
to poison safety in their ■ The Ohio State University College of Nursing communities. ■ The Ohio State University College of Pharmacy ■ Union County Parish Nurse Association
Thanks to our Volunteers
Our dedicated friends from Grange Insurance contributed many hours of volunteered time in the assembly of educational materials. Again this year, their assistance was invaluable to making our outreach efforts possible. Our sincere appreciation and gratitude is extended to each person who lent a hand.
1985 Late 1980s 1990 14
The COPC open 24 hours each day Judith D’Orsi, BA becomes COPC EPA bans mercury in paint Managing Director The media plays an important role in informing the public about 50 years of VISIBILITY: timely poisoning issues. The COPC uses media outlets to publicize News media important topics of information from current poisoning exposures. The Central Ohio Poison Center informed the public on a wide variety of poisoning substances in 2008 from phthalates/bisphenol in baby and other plastic bottles, to melamine contamination in baby formula and other foods, to lead in dental work, artificial turf, and drinking water. The news stories enable the COPC to reach millions of residents, educating consumers about various household and everyday poisons.
December 17...... College Students Who Write on Their Hands, interview with Kathy Gray, Columbus Dispatch, Columbus, Ohio. December 8...... Industrial Toxins Near Schools, WBNS 10-TV, Columbus, Ohio. November 26...... Melamine in Baby Formula, Web MD Expert Interview. November 21...... Central Ohio Poison Center, Business First Magazine, Columbus, Ohio. November 11...... Formaldehyde, interview with Susan Burton, WSYX-6 News, Columbus, Ohio. October 3...... Melamine Food Contamination, interview with Susan Burton, WSYX-6 News, Columbus, Ohio. September 25...... EMS Toxicology. EMS Perspectives, GTC 3, Columbus, Ohio. July 2...... Fourth of July Poison Hazards, WBNS-10TV, Columbus, Ohio. May 28...... Lead Exposure and Violent Behavior, WBNS 10-TV, Columbus, Ohio. May 11...... Lead paint, interview with Misti Crane and Mark Ferenchik, Columbus Dispatch, Columbus, Ohio. April 22...... Artificial turf/High Lead Levels, WCMH 4, Columbus, Ohio. April 21...... Poison Help Public Service Announcement aired 360 times on: WBWR FM 98.9, WCOL FM 92.3, ...... WNCI FM 97.9, WTVN AM 610, WYTS AM. April 10...... Lead-Tainted Marijuana Poisons Users, WSYX-6 News Medical Unit, Columbus, Ohio. April 9...... The Dangers of Spiked Illicit Drugs, WSYX-6 News, Columbus, Ohio. April 4...... Lead Levels in Drinking Water, WBNS 10-TV, Columbus, Ohio. March 11...... Lead in Dental Crowns, interview with Joel Chow, WBNS 10-TV, Columbus, Ohio. March 4...... Be Poison Wise, Columbus Dispatch, Columbus, Ohio. February 28...... Lead Might Be Lurking in Dental Work, Columbus Dispatch, Columbus, Ohio. February 27...... Lead in Dental Work, WBNS 10-TV, Columbus, Ohio. February 21...... Salvia: Drug of Abuse, interview with Emily Riemer, WSYX-6 News, Columbus, Ohio. February 19...... Lead in Dental Devices, interview with Lindsey Seavert, WBNS 10-TV, Columbus, Ohio. February 4...... Phthalates in Baby Blood, interview with National News Desk Injury Board, ...... www.injuryboard.com, NBC News and ABC News.com. February 1...... Phthalate Exposure Among US Infants, WSYX-6 News, Columbus, Ohio. January 31...... Lindane Shampoo, WBNS 10-TV, Columbus, Ohio. January 23...... Bisphenol A, WSYX-6 News, Columbus, Ohio. January 22...... Bisphenol A, WBNS 10-TV, Columbus, Ohio. January 16...... Lead in Dental Work, interview with Lindsey Seavert, WBNS 10-TV, Columbus, Ohio.
1990 1991 1993 15
Nine poison centers in Ohio- mostly managed Lisa Whiting, RN becomes COPC Dr. Mike Kelley steps in as COPC by hospital pharmacies Managing Director Medical Director 50 Years of Value: 2008 Financial Statement Financial Investment
Poison Centers nationally are Revenue an Extraordinary Value and Investment Nationwide Children’s Hospital...... $1,067,417
• For every $1 invested in poison control centers, Member Hospital contracts...... $300,440 $7 is saved in direct health care costs. (Centers for Disease Control) HRSA Stabilization Grant...... $284,043
HRSA Incentive Grant...... $90,909 • According to the Institute of Medicine (IOM) report, in 2001 poisoning was the second State of Ohio...... $50,000 leading cause of injury-related deaths totaling over 30,800 deaths annually. A conservative Federal grant via state...... $166,320 estimate of the economic burden of poisoning United Way of Central Ohio...... $65,532 not including costs related to alcohol deaths is $12.6 billion per year (2002 dollars), based on Research revenue...... $30,618 the societal lifetime cost of injury. TOTAL REVENUES...... $2,055,279 • Poison centers are second only to childhood immunization programs in their ability to provide cost avoidance in public Expenses health delivery. Salaries and Benefits...... $1,856,644 • Almost 90% of calls are managed without the Facilities/Office Space/Depreciation...... $80,927 use of hospital services. Membership Dues/Micromedex/Toxicall...... $54,103 • 24-hour emergency and information hotline services are toll free. Printing and Publication...... $19,072 Supplies/Postage/Shipping...... $10,451 • $525 Million estimated in Direct Federal Savings (2005). Telephone/Communications...... $7,450
Conferences/Conventions...... $15,988 • $993 Million savings recognized from reduced length of hospital stay attributed to poison Travel...... $2,390 center assistance (2005). Books/Journals...... $3,062 • $653 Million cost avoidance from reduction AAPCC Support...... $2,500 of Emergency Department visits due to pre-hospital management of poison exposures Equipment Rental and Maintenance...... $2,692 by poison centers TOTAL EXPENSES...... $2,055,279
1994 1995 1996 16
Be Poison Smart! ® poison prevention education Three poison centers in Ohio – Cleveland, EPA bans lead in gasoline – Clean Air Act program rolls out in region Columbus and Cincinnati 50 Years of consultation: Member Hospital Program
Revenue Fifty-four health care facilities throughout Ohio have formal consulting agreements with the Central Ohio Nationwide Children’s Hospital...... $1,067,417 Poison Center and are considered Member Hospitals. Member Hospitals contact the poison center when
Member Hospital contracts...... $300,440 they desire assistance with a patient involving an exposure or when they just have a toxicology question.
HRSA Stabilization Grant...... $284,043
HRSA Incentive Grant...... $90,909 The Central Ohio Poison Center appreciates the funding support contributed by the Member State of Ohio...... $50,000 Hospitals and values our continued relationships with each: Federal grant via state...... $166,320 Adena Regional Medical Center Greene Memorial Hospital O’Bleness Memorial Hospital United Way of Central Ohio...... $65,532 Barnesville Hospital Harrison County Hospital Pike Community Hospital Research revenue...... $30,618 Belmont Community Hospital Hocking Valley Community Hospital Riverside Methodist Hospital TOTAL REVENUES...... $2,055,279 Berger Health System Holzer Hospital, Jackson Selby General Hospital Community Hospital - Springfield Kettering Medical Center Southeastern Ohio Regional Medical Coshocton County Memorial Hospital Knox Community Hospital Center Expenses Dayton Heart Hospital Licking Memorial Hospital Southern Ohio Medical Center- Salaries and Benefits...... $1,856,644 Department of Veterans Affairs Medical Lifecare Hospital of Dayton Portsmouth Facilities/Office Space/Depreciation...... $80,927 Center Madison County Hospital Southview Hospital and Family Health Doctors Hospital Marietta Memorial Hospital Center Membership Dues/Micromedex/Toxicall...... $54,103 Doctors Hospital of Nelsonville Marion General Hospital Sycamore Hospital Printing and Publication...... $19,072 Fairfield Medical Center Memorial Hospital of Union County The Children’s Medical Center, Dayton Supplies/Postage/Shipping...... $10,451 Fayette County Memorial Hospital Mercy Medical Center - Springfield The Ohio State University Medical
Telephone/Communications...... $7,450 Genesis Health System- Bethesda Mercy Memorial Hospital - Urbana Center Genesis Health System- Good Miami Valley Hospital Trinity Health Systems Conferences/Conventions...... $15,988 Samaritan Morrow County Hospital Upper Valley Medical Center Travel...... $2,390 Good Samaritan Hospital, Dayton Mount Carmel East Hospital Wayne Hospital Books/Journals...... $3,062 Grady Memorial Hospital Mount Carmel Medical Center Wilson Memorial Hospital
AAPCC Support...... $2,500 Grandview Hospital & Medical Center Mount Carmel St. Ann’s Hospital Wright Patterson Medical Center Grant Hospital Nationwide Children’s Hospital Wyandot Memorial Hospital Equipment Rental and Maintenance...... $2,692
TOTAL EXPENSES...... $2,055,279
1997 1997 1999 17
Dr. Marcel Casavant becomes COPC Bill Wolowich, PharmD steps in as COPC U.S. Senator Mike Dewine gets first federal Medical Director Managing Director “Poison Center Enhancement and Awareness Act” passed 50 Years OF TEAMWORK: The Staff
Medical Directors Administrative Staff Call Center Staff Julie Strauch, RN, SPI Medical Director Administrative Assistant Certified Specialists in Poison Robert Wirtz, RPh, PharmD, SPI Marcel J. Casavant MD, FACMT, Julee Fuller-Pyle Information FACEP Joell Buchanan, RPh, CSPI Poison Information Providers Business Development Manager Gabrielle Dickson, RN, CSPI Amanda Abelita Emeritus Medical Director Kira Bartlett, BS Daniel Garrett, RN, CSPI Beth Berry John Shultz, MD Carmen Hadley, RPh, CSPI Amanda Goetz, BA Community Outreach Educator Kathy Koontz, RN, BSN, CSPI Laurie Gooden, BS Emeritus Medical Director Erika Malis Adrienne Lacheta, RPh, SPI Loni Harbour-Estepp, BS William O. Robertson, MD, MPH Mark Laubacher, RN, BSN, CEN, Brian Ingram, BS CSPI Shift Supervisors EMT-P, CSPI Adel Lawal, BS Managing Director Ted Good RPh, CSPI Shelley Martin, RN, BSN, CSPI Athena Ling S. David Baker, PharmD, DABAT Jill Griffith RPh, PharmD, CSPI Patti Nussle, RPh, SPI Ann Nguyen Shawn Pruchnicki, RPh, MS CSPI Nancy Pham, BS Medical Toxicologists Jean Strauch, RN, BSN, CSPI Rikki Rychel, BS Heath A. Jolliff DO, FACEP, FAAEM Jenny Townsend, RN, CSPI Shana Toth, BA Michael Kelley, MD, MPH, Melissa Zemanek FACMT, FACEP Specialists in Poison Information James Davis, RN, EMT-P, SPI Bridget Lloyd, RPh, PharmD, SPI Brynn Hannay, RPh, PharmD, SPI Amanda Hafford, RPh, PharmD, SPI Shane Martin, RPh, PharmD, SPI
Congratulations:
Service from the Heart Award Dr. Marcel Casavant, MD was the recipient of Nationwide Children’s Hospital’s Service from the Heart Award for July. This award is given to recognize staff for special acts of caring, outstanding accomplishments, and/or exceptional customer service that goes beyond performance normally expected of the individual and that exemplifies the values and mission of Children’s Hospital.
Dr. Casavant received the award from his involvement with a patient admitted for heroin addiction. As the young man began to detox, a severe underlying mental illness and medical condition appeared. Dr. Casavant was able to establish trust with the patient so he would cooperate and receive his necessary tests and medical treatment.
Medical Toxicology Board Re-certification Congratulations to Dr. Marcel Casavant, MD, who received his Medical Toxicology Board re-certification in 2008. The re- certification is valid until 2018.
Certified Specialists in Poison Information (CSPI) Received Re-certification Congratulations to Mark Laubacher, RN, BSN, CEN, EMT-P, CSPI, who passed the re-certification exam for specialists in poison information in 2008.
2000 2000 2001 18
President William Clinton signs “Poison Center Number of poison centers in nation COPC receives first federal grant dollars Enhancement and Awareness Act” decreases to 71 Publications:
Articles in Peer-Reviewed Journals Fenzl M, Jolliff HA, Topinka M. Chemical Exposure Preparedness for Emergency Departments in a Midwestern City. American Journal of Disaster Medicine. 2008; 3(5):273-281.
Phan H, Casavant MJ, Crockett S, Lee A, Hall MW, Nahata MC. Seretonin Syndrome Following a Single 50 mg dose of Sertraline in a Child. Clinical Toxicology. (Phila). 2008 Nov; 46(9):845-9.
Spiller HA, Griffith JRK. Prolonged Cardiovascular Effects After Unintentional Ingestion of Tetrahydrozoline. Clinical Toxicology. 2008; 46:171-172.
Spiller HA, Griffith JRK, Bratcher R. Pregabalin Overdose with Benign Outcome. Clinical Toxicology. 2008; 30:1-2.
Spiller HA, Borys D, Griffith JRK, Klein-Schwartz W, Aleguas A, Solle D, Anderson DA, Sawyer TS. Toxicity of Modafinil Ingestion. Clinical Toxicology (Phila). 2008; 11:1-4.
Spiller HA, Griffith JRK, Anderson DL, Weber JA, Aleguas A. Poison Centers Detect an Unexpectedly Frequent Number of Adverse Drug Reactions to Lisdexamfetamine. Annals Pharmacotherapy. 2008; 42(7):1142-3.
Spiller HA, Bosse GM, Beuhler M, Gray T, Baker SD. Unintentional Ingestion of Bupropion in Children. Journal of American Medicine. July 26, 2008.
Letters Spiller HA, Griffith JRK. The Value and Evolving Role of the U.S. Poison Center System. Public Health Reports. 2008. (in review).
Abstracts Accepted at National Conference Griffith JRK, Spiller HA, Weber JA, Lintner CP, Casavant MJ, Baker SD. Toxicity from Duloxetine Ingestion. Clinical Toxicology. 2008; 46(7)611.
Griffith JRK, Phan H, Casavant MJ, Nahata MC, Baker SD. Evaluation of Zolpidem Exposures in the Pediatric Population. Clinical Toxicology. 2008; 46(7):599.
Spiller HA, Griffith JRK. Who Are We Serving With Pill ID Requests? Clinical Toxicology. 2008; 46(7):611.
Spiller HA, Borys D, Griffith JRK, Aleguas A, Sollee D, Anderson DA, Klein-Schwatrz W, Sawyer T. Retrospective Review of Modafinil Toxicity. Clinical Toxicology. 2008; 46(7):218.
Spiller HA, Winter ML, Griffith JRK. Benzonatate Ingestion Reported to the National Poison Center Database System (NPDS). Clinical Toxicology. 2008; 46(7):594.
2002 2003 2003 19
National poison emergency hotline- David Baker, PharmD, DABAT Be Poison Smart! ® program goes statewide 1-800-222-1222- is established becomes first COPC Managing Director with ABAT certification •
Presentations:
Casavant, MJ Jolliff, HA • Detox Care Lecture. Nationwide Children’s Hospital • Toxicity 101: 11 presentations in a lecture series Inpatient Rehabilitation Therapy Group, Columbus, Ohio. on a number of topics such as: drugs of abuse, • Lead Toxicity and Screening. Nationwide Children’s cardiotropic medications, toxic alcohols, theophylline, Hospital Pediatric Residents, Columbus, Ohio. anticoholinergics, carbon monoxide, and hydrocarbons, • Pediatric Board Review: Toxicology. Nationwide Children’s conducted at Ohio University College of Osteopathic Hospital Pediatric Residents, Columbus, Ohio. Medicine/Doctor’s Hospital, Columbus Ohio. • Poison Prevention Education. Nationwide Children’s • Toxicology 101: Two presentations at the Primary Care Hospital Pediatric Residents, Columbus, Ohio. Toxicology Conference. Ohio Health-Doctors Hospital • Pediatric Toxicology Emergencies. Nationwide Children’s Department of Emergency Medicine, Columbus, Ohio. Hospital, Columbus, Ohio. • Carbon Monoxide and Cyanide Toxicity. Ohio University • One Pill Can Kill – Yikes! Nationwide Children’s Hospital College of Osteopathic Medicine. OhioHealth-Doctors Lunch and Learn, Columbus, Ohio. Hospital. Medical Student Didactics, Columbus, Ohio. • Hypernatremia in Panhypopituitarism: Goals for • Acetaminophen Toxicity. Ohio University College of Correction. Nationwide Children’s Hospital, Columbus, Osteopathic Medicine. OhioHealth-Doctors Hospital. Ohio. Medical Student Didactics, Columbus, Ohio. • Toxicology Tutorial. The Ohio State University College of • Analgesic Overdose. Cleveland Clinic-Euclid Hospital Medicine, Columbus, Ohio. Grand Rounds, Cleveland, Ohio. • Alcohol Withdrawal. Nationwide Children’s Hospital • Toxicology in the News: Risk Assessment and Resident Lecture, Columbus, Ohio. Communication. Ohio University College of Osteopathic • Clinical Ethics. The Ohio State University College of Medicine. Emergency Medicine RPAC Educational Day, Medicine, Columbus, Ohio. Columbus, Ohio. • Pediatric Poison Emergencies. Nationwide Children’s • Chronic Acetaminophen Toxicity. Central Ohio Poison Hospital Pediatric Residency Lecture Series, Columbus, Center. Nationwide Children’s Hospital, Columbus, Ohio. Ohio. • Be Poison Smart! ®. Nationwide Children’s Hospital Pediatric Residency Lecture Series, Columbus, Ohio. • Acetaminophen Toxicity. St. Jude’s Children’s Hospital CME lecture and online at www.cure4kids.org, Memphis, Tennessee. • Acetaminophen Overdose. LeBonheur Children’s Hospital Grand Rounds, Memphis, Tennessee.
2003 2005 2007 20
Poison centers no longer recommend COPC relocates out of the basement to a COPC moves again to present location and Syrup of Ipecac larger facility handles over 450 calls each day •
2008 2008 21
COPC handles 239,763 calls Be Poison Wise! SM poison prevention education program rolls out Central Ohio Poison Center 700 Children’s Drive, Columbus, Ohio 43205 www.BePoisonSmart.com
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