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June 30, 2009
Exclusive: Possible Budget Cuts to Poison Control Centers a Blow to Emergency Preparedness (Part One of Two)
“Family Security Matters (FSM)” – a powerful phrase that evokes a variety of images, concerns and issues. FSM was born out of a post 9/11 world to provide state of the art information and a forum for our readers at a time when terrorism threatens our domestic security. Yet there are other contemporary dangers to the health and well being of our families beyond Jihad and geoglobal threats. And the security, safety and health of the family, our family…well, it matters.
To address this wide range of threats, we need a safety net to rely upon when all else fails. We need sentinels, guardians to watch out for us, even when we’re not paying attention. And we need reliable information that can readily be utilized by the public and professionals; information that our family is able to rely upon. Where do you find such protectors, such information sources? At your regional poison control center (PCC).
This is why the news coming out of California – the likely closing of their statewide poison control center system – is so problematic from a terrorism and WMD preparedness perspective, as well as a potentially dangerous turn of events for our families and the security, health and well being of our children. Just as family security matters, your local poison centers MATTER…to you, to me, to our community and nation. They are a critical resource and safety feature the loss of which will result in incalculable harm.
Poison Control Centers (PCCs) are one of the most important weapons against a wide array of disruptive challenges that we all face in a post 9/11 world. As a concentrated body of highly skilled, well-trained specialists in the field of poisons, PCCs provide the expertise, training and guidance to first responders, law enforcement, fire/rescue, hospitals, emergency management and public health on all things poisonous – biological toxins, chemical weapons, industrial chemicals, radiation as well as being one of the few 24-hour-a-day expert resources providing near unlimited, science based access to best practices in acute medical management. When chlorine tankers derail, PCCs are behind the scenes offering guidance. When people come down with strange illnesses, PCCs are called. When anthrax is spread in the U.S. (think 2001) PCCs were hand in glove “go to” people along with infectious disease, CDC and public health experts.
Most of us associated with FSM are concerned about the potential for another WMD assault on the U.S. Near universal agreement is the notion “not if but when” it happens again on U.S. soil. And most FSM readers, and writers, have families – and care about their health and safety.
Poison Centers – The Threat They Face and the Good They Do
Poison Control Centers are one of the few entities that serve us well in peace and under threat of WMD or terrorism, but we should take caution from an old song…”you don’t know what you’ve got until it is gone.”
How could the governor or elected officials of California even consider cutting funding for their PCC system? It’s especially concerning against the backdrop of California being a heavy drug state – translation, risk to children and teens. Plus, a growing number of worldwide entities are developing biological and/or nuclear programs (Syria, Iran), an overburdened FDA that admittedly cannot handle the volume of new drugs for scrutiny – translation, more approved meds requiring post approval surveillance (guess who does that? PCC). The implications to the citizens of California cannot be more obvious. Well, at least to those of us not breathing the thin air in Sacramento.
The folly of California looms larger, especially when one considers the cost the Governor is trying to save is a mere $5.9 million. His state is in debt to the tune of $23 billion. To put that into perspective, with a population estimated at 36,756,666 according to the U.S. Census Bureau, that $5.9 translates to 16 cents per man, woman and child in California. Eliminating those under 18, the one-time annual cost per person for a year of “free” services 24/7 access is around 23 cents – less than a one-time cost of a quarter per adult in California to keep the PCC doors open for an entire year.
And the idiotic reply from the states leaders? Find the info PCCs provide elsewhere. Really? That logic is tantamount to saying we’ll eliminate obstetrics but I’m sure you can find an experienced cab driver to deliver your child. Adding the moronic to the idiotic is the notion on the part of California’s leaders that cutting $5.9 million will contribute to balancing a more than $23 BILLION deficit. Now I’m no accountant, but cutting $5.9 million to rescue $23 billion makes no sense; $5.9 million is nearly infinitesimal in the grand scheme of things. When you then assess how the $ 5.9 million provides for the common good for 36 million people, or what undesirable outcomes are predictable as a result of losing the PCC, you have to ask yourself: did John Connor return to turn off the brain to the Terminator?
As if we didn’t already recognize the idiocy of our elected leaders, a state that is drowning in billions of dollars worth of debt, they think cutting $5.9 million dollars for one of the few worthwhile public benefit health care programs of all time – poison centers – will balance a budget that is $23 billion in the red? This is the equivalent of passing out thimbles to bail out the Titanic, or using home fire extinguishers to put out the California wild fires.
Let’s look at the fiscal situation from a different perspective. How many of us would invest in something that had an almost 7 -1 return on investment and wasn’t associated with Bernie Madoff? The average call to a PCC costs about $43 (not to the caller or patient) and saves the health care system almost $300. How can PCC do this? Because it safely decides who can be treated at home versus sent to the hospital.
California now…what state will be next? New York? The annual support from New York State for the 5 New York State PCC and one educational center is approximately $5 million to protect 19,490,297 citizens, according to Census Bureau estimates. The cost per person is roughly 34.5 cents; 40 cents if we take out children and teens. Given that New York is strategically, economically and symbolically one of the most important states in the Union, the issue of defunding should never rear its ugly head. But NY PCC funding was threatened in the past. That cannot occur again. It is critical to ensure support in Albany remains strong. And the capital in your state, too! The strategic value of New York City and its PCC is a “no brainer;’ but other regions are just as critical. The Long Island PCC protects more than 2 million people who are near a nuclear research facility, across the water from Millstone Nuclear, and reside near numerous known and less identified strategic entities, chemical sources, and where the executive and employment pool for NYC and, in the summer, probably half of the media, national corporate leadership and entertainment industry reside.
It is a fair bet your home town deserves the protections of a PCC too. For 25 cents per person annual cost, can we afford not to support this vital system that provides daily service to any and all of us in one way or another?
What do poison centers do that matter so much?
I think we can all agree PCCs are cost effective, contribute to the well being of society, provide specialty care that cannot be replaced by the Internet. But PCCs are far more than that. PCCs are leaders in public preparedness – providing guidance to the government on WMD, helping regionally the strategic national stockpiles forward deployed to communities throughout the country, advising and assisting on local industrial chemical threats and HAZMATS, etc.
PCCs provide state of the art emergency advice and treatment information to hospitals, police, and parents every day. PCsC also work with community groups to help with education, legislation and protections for consumers. In fact, PCCs have the largest database to monitor consumer products that people are often poisoned by. Not to put too fine a point on this, but virtually everyone can relate to the story of the 3-year-old who got into grandmom’s pocketbook when the adults left the room for “a second” and the child gobbled down the contents of the Zip Lock bag filled with the “water pill,” “sugar pill,” “heart pill,” “pain bill” and – well, you get the point. And who did the parent or ED physician call? PCC! One study showed that 90 percent of the people who called a PCC had the emergency managed over the phone by center staff (physician, pharmacologist, nurse, pharmacist).
Members of the public aren’t the only ones who rely upon PCC and toxicologist guidance. Health care professionals – from pediatricians and internists to emergency physicians and others – consult with PCC experts 1,400 times a day – 511,000 times a year. And while California’s state budget director thinks PCC can be replaced, consider patients managed with PCC expertise have shorter hospital lengths of stay (3.5 days) when sent to a HCF on the order of a full three days on average compared to patients managed by other than PCC guidance (6.5 days). Given the cost per day at a HCF, that represents more than 2100 in savings per patient. When PCC services were not available in one state for two years, the number of patients going to a HCF quadrupled. Do the math. It is penny wise and pound foolish to abandon PCC funding.
PCCs identify new risks to the health of children and teens – whether they are dangerous prescribing trends in psychoactive medications, new kinds or drugs and/or patterns of abuse or the changing patterns of alcohol abuse and ultimately use it to develop risk reduction and preventive strategies. Some risks may be quite obvious, such as child resistant containers or education campaigns encouraging parents and grandparents to hang up their pocketbooks so that toddlers can’t get into the medications likely to be found therein, but PCCs have also identified patterns of medication errors affecting the elderly, and assisted in reducing multi-drug interactions through surveillance and education, making prescribing patters safer for all age groups.
Besides providing medication safety and WMD education programming to health care professionals from students to senior practitioners, developing prevention strategies to keep kids safer, conduct research on drug safety after the medications have been approved by FDA (and have resulted in package warnings or products removed from the market), training first responders, guiding HCF on preparedness planning and being a real time source of human exposure data, PCC are a resource for the more than 2.7 million Americans who are poisoned annually (over 1 million involve children under 5 years of age). PCC also help coordinate care between facilities and can optimize outcomes by knowing the capabilities and weaknesses each hospital has in terms of the poison exposure. The fact that many health care facilities (HCF) under stock vital antidotes – a public health issue for sure – has not escaped PCC who persist in trying to enhance HCF capabilities. This local knowledge cannot be replaced by the great Oz behind a curtain and an 800 number in a far off land as some bean counters have suggested.
It is well recognized without PCC it is likely 600,000 additional poisoning victims will be sent to a HCF annually – figure out for yourself what it costs the moment you walk into an ER.
What does it mean to lose a poison center?
Losing a poison center is effectively losing an entire medical specialty. Think about the implications of losing any medical specialty. Remember when obstetrics was threatened because of malpractice? That’s pretty scary if you are pregnant. What would happen if states cut pediatrics? Not good if you have kids. Well, PCCs are one of the few entities that provide true “womb to tomb” expertise, and are staffed by highly trained experts in the field of medical toxicology. Just as cardiologists are specialists in all things about hearts, except perhaps broken ones, but we’ll discuss romance at another time, toxicologists are specialists in all things poison. Given there are literally millions of poisons – from industrial chemicals to WMD to medications (anything can be a poison, even water can be toxic to some patients) to venoms to food borne illnesses (mostly toxin mediated) to herbal products (yes they are biologically active even if “natural”) – it’s not an easy discipline to master, let alone replace. You cannot replace this or any medical specialty with a laptop and Internet access any more than you can let a computer deliver a baby. It takes expertise to diagnose, to distinguish between good and bad information. Would the average person or non-toxicologist know just by reading a text book that the antidote listed on page 200 is no longer in favor because it causes seizures? Or the wide range of places you can or cannot use a certain treatment? That’s why specialties take time to learn.
As an aside, your “average” PCC is staffed by physicians, toxicologists and certified specialists in poison information (CSPI) – it takes a minimum of five years (residency and fellowship training) after four years of medical school to become a medical toxicologist. Clinical toxicologists have a doctorate in pharmacology plus advanced training in poisons. CSPI nurses and pharmacists receive specialty training, must handle hundreds of calls, and take a certification test just to handle the incoming calls. Many have advanced training in emergency preparedness, WMD or HAZMAT. Poison centers are staffed by professionals who have received extensive specialty training. It is not an on the job or read-as-you-go group of folks. The expertise in the full realm of poisons cannot be replicated by reading a journal article, the Internet or calling Aunt Minnie for advice. And yet California, including its budget officer think we should return to the pre Poison Control era of “do it yourself medicine” using the rationale “we managed back then.” Given the enormous debt the Golden State is in, he might want to stick with his own profession, and not try to tamper with another one.
And who are PCC biggest consumers/patients? Not surprisingly, children. Over half of our calls involve children who are under six years of age. Another significant group is adolescents. In fact early studies suggest teens trust us more than other resources and will call PCCs for advice and guidance especially when considering drug use or other potentially dangerous actions. As the nation continues to age, PCCs are at the forefront of identifying ways to enhance medication safety to our elder citizens who often must take multiple drugs. Moreover, PCC are the safety net for the FDA. Once a drug is approved after testing on limited numbers of selected (usually healthy male volunteers) persons, it gets prescribed to the wider population; that is where the real safety test occurs. And who monitors such events? PCCs are one of the sets of eyes and ears watching for adverse events.
PCCs provide counsel, comfort, guidance, and often can keep a child out of the hospital or prevent an unnecessary ride to the emergency department. Don’t believe me? Ask any parent how he or she values having a PCC available. Is there any reader who has not called a PCC or hasn’t known someone who did?
A Typical Day in the Life of a Poison Center
“My 4-year-old son swallowed her grandmothers pills thinking they were candy” – call from parent to Poison Center. “We have 10 people choking with eye problems in a small mall, our detectors say nerve agent but before we give everyone a potentially unnecessary and toxic antidote, we thought we’d call you (poison center) [as an aside toxicologists wisely prevented the use of the antidote]” –call from Fire Rescue to Poison Center. “We have an unconscious teenager with crazy symptoms – can you help us sort it out?” – call from Hospital ER to Poison Center. “We need help organizing our antidote stockpile for the region” – call from Regional City Preparedness Planner to Poison Center. “My 15-year-old son bought uranium doped marbles off the Internet – are these dangerous?” – call from parent to Poison Center. “What is the best way to protect our hospital in case of a WMD attack?” – call from Hospital executive to PCC. “Can you teach our clinical staff how to recognize the various biological and chemical threats?” – call from Chief of nursing to PCC. “What are the best ways to prevent unintentional medication errors and poisonings?” – media calls to PCC. “I think this 40-year-old may have eaten the wrong type of mushroom from her garden, is it toxic?” – call from Emergency Department to PCC. “My pet scorpion bit me, am I gonna die?” – call from 13-year-old. “I accidentally gave my child two of her pills instead of one, will she be alright?” – call from concerned father.
Part Two will discuss the role poison control centers play in WMD preparedness.
FamilySecurityMatters.org Contributing Editor Dr. Robin McFee is a physician and medical toxicologist. An expert in WMD preparedness, she is a consultant to government agencies, corporations and the media. Dr. McFee is a member of the Global Terrorism, Political Instability and International Crime Council of ASIS International. She has authored numerous articles on terrorism, health care and preparedness, and coauthored two books: Toxico-Terrorism by McGraw Hill and The Handbook of Nuclear, Chemical and Biological Agents, published by Informa/CRC Press.
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