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July 1, 2009
Exclusive: Possible Budget Cuts to Poison Control Centers a Blow to Emergency Preparedness (Part Two of Two)
Poison Centers and Weapons of Mass Destruction Preparedness
“All politics are local” – Tip O’Neil – former Speaker of the House
If all politics are local, so is preparedness. The emergency response axiom “think globallyand act locally” remains as true today as on 9/11. While emergency planners continue to look to Washington for global guidelines, the reality is that a mass casualty event, even in our nation’s capital, will be a local incident, whether from terrorism, natural disaster or other disruptive challenge. Each community has its own resources, vulnerabilities, character and capabilities. Local knowledge is critical. Without it, there can be a steep learning curve when planning for or eliciting a response to emergencies. Time is an unforgiving master when lives are on the line. Knowing the key players, how well equipped the health care facilities and first responders are, what a community is able to do is essential to orchestrating a positive course of action in an emergency. Poison Centers have that local knowledge.
It is widely recognized in preparedness circles that PCCs are essential for the safety of a community. From a WMD perspective, the regional response is likely to be highly effective if PCCs are critical components of a counterterrorism task/response force. First there is the expertise concerning the realm of poisons likely to be used by terrorists. Then there is the ability to teach first responders the critical basics about initial management, personal protection, decontamination and treatment. Toxico-surveillance, interacting with law enforcement, first responders, Hazmat and others as guide, repository of information and cases – the value of which has been proven in numerous drills and exercise involving chemicals and biologicals.
Terrorism is one of the defining issues of the early 21st century and WMD are the demons we’ve inherited from the 20th and earlier centuries. WMD – whether biological, chemical or nuclear/radiological, are ubiquitous and a persistent threat worldwide. The threat from deadly toxicants and toxins will continue to rise – whether from chlorine tanker spills from our rail system or the intentional use of chlorine with improvised explosives in Iraq, the highly public assassination with Polonium 210, spreading anthrax through the mail system or salmonella in salad bars, even the suspected use of chemical weapons in Sri Lanka – if there is intent and capability, there is a threat.
There are a significant number of state sponsored biological weapons programs worldwide. Moreover, numerous terrorist groups are interested in or have already utilized a form of WMD, such as Aum Shumrikyo, which released nerve agent in Tokyo subways and continues to exist in Japan and other domestic and international groups. Thus, the risk of using hazardous materials or specifically developed weapons remains high. Pandemics although currently of ‘natural’ causes, could also be intentionally started using a wide array of biologicals.
Last year I wrote about inconsistencies and plain inadequate preparation in our approaches to radiation protection and biosurveillance largely by the Department of Homeland Security (link to 2 articles); how after 8 years post 9/11 and anthrax 2001 there still is a disconnect. One of the few surveillance models that works and the government recognized early to its credit – tapping into the nationwide poison center system. PCCs provide real time data on emerging trends – those that might indicate a more aggressive form of respiratory illness (think avian flu, anthrax, new flu or), unusual chemical exposures or new dangers afflicting our children and teenagers.
PCCs keep track of emerging threats from the Internet (where, yes, you can still buy Uranium doped marbles or Vietnamese centipedes (BIG, ugly and BITE) and mating rattle snakes) to identifying deadly imports like the millions of dangerous toys from China.
Additionally, PCCs guide health care facilities on their preparedness planning, professional training and antidote management – for both routine and WMD threats. PCCs keep abreast of emerging risks, such as chemical weapons used by the Sri Lankan army on its people, trends in organophosphate poisonings, and emerging threats or new treatments, through a robust collaboration with the national and international community of toxicologists.
Toxicologists are uniquely positioned as a well trained, well organized, highly integrated group of professionals with the expertise and often the community and government relationships to provide guidance and leadership in planning for and responding to terrorism, especially when the events may include a toxicant or toxin. Toxicologists knowledgeable in preparedness can be a vital resource within the profession and to the multiple disciples necessary to plan for and respond to a terrorist or hazardous material threat to protect our community and country.
Virtually all WMD are or have the potential to contain poisons. Many biological weapons are actually toxins – clearly chemicals are traditional toxicants (poisons) and radiation is the ultimate mass murderer – and poison centers are one-stop shopping for the exact type of expertise necessary to handle the full range of WMD. As poison experts, we understand preparedness resource management (antidotes, decontamination, medications). PCCs also have been at the forefront of helping manufacturers adapt to a wider range of patients (elderly, children, women who are pregnant) than what their antidotes were originally developed for (male war-fighters). PCCs have professionals used to handling every stage of life – fetus to near death, and all populations from pediatrics and the pregnant to adolescents and the elderly. For 25 cents per person, can we afford to lose this expertise?
Way back in 2002, when NASA was developing their WMD preparedness plans (and by their own admission were not prepared), they made it clear that poison centers were a critical component to national preparedness.
At a time when one of our biggest WMD, pandemic and general health care vulnerabilities continue to be the lack of surge capacity in hospitals, especially emergency departments, the fact that PCCs reduce the burden of hospitalizations should not go overlooked either.
At the moment, we are living in an inter-threat period – well at least in the U.S. Globally the use of chemicals, biologicals and other toxicants persists. The vulnerabilities we face and the threats we prepare for are many and varied. But it is important to put them into a hierarchy. WMD are high impact, lower likelihood events than daily drug overdoses, toddlers accidentally being poisoned, therapeutic errors, snake bites and industrial accidents, which are generally lower impact but ubiquitous events. Poison Centers are the convergence point of emergency medicine, disease surveillance, public health, emerging threat identification, clinical care, medication expertise, hospital preparedness, patient information and parental peace of mind. And for all that, including the knowledge that there will be a highly trained, concerned and available health care professional – physician, pharmacologist, nurse or pharmacist with extensive training in the full realm of poison management – it will cost the average citizen of California less than a quarter!
A Call to Action to Save PCCs
Calling all soccer moms and dads, security moms and dads, grandparents and anyone who ever was a child, who is concerned about public preparedness, the threat of WMD, the child who swallowed a penny, granny’s medications, or experimented with pot, goldfish, drugs or alcohol as a teen or takes too many medications as an adult or senior citizen: we need your outrage and phone calls to state legislatures. Already, several states have had to cut poison centers. We cannot allow the continuation of a faulty logic among our elected that the slack from losing PCCs can be picked up by well-meaning covering centers or medical personnel from other specialties. That is shortsighted, foolish and dangerous.
Poison centers are Mom, Chevrolets and apple pie. Okay, we’ll leave out GM, but you get the point.
This is not a partisan issue. It is a “for the common good” issue, and a low cost one at that.
The problem with being one of the best kept secrets in health care is that you don’t notice PCCs are gone until you need them. In spite of working with the media, having our own “week” (poison prevention week in March), being the “go to” team for bio and toxico-surveillance for CDC, providing critical planning, training and expertise to first responders especially in the post 9/11 WMD era, being the speed dial source of comfort for mothers everywhere, PCC still have a ways to go in solidifying the perception of being an invaluable public benefit and one of the best bargains in town!
What can we do to prevent the closing of PCC in California and our own home states?
California isn’t the only state where PCCs are in jeopardy. New York, Michigan, Utah, Texas and Washington are just a few of the states where funding cuts are possible or already occurring. Given the magnitude of public good, tangible and intangible, it is ludicrous for our leaders to even look at PCCs as a source of budget relief. With the wanton waste in government, there ARE other places to cut. The problem is that unless the public get vocal, the value of PCCs gets lost amidst political pressure from lobbyists, and well-funded special interest groups. Yet just ask a legislator in front of the TV cameras why he or she will deny a 5-year-old of potentially life-saving medical expertise found mostly at PCCs in order to save relatively small dollars – that strategy and use of media is effective. And to be fair, most legislators down deep want to do what is right, and recognize it is bad politics to screw moms and kids.
“The truth to any problem can usually be found when you follow the dollar.” – Willard Gilmore
Cutting $5.9 million to balance a $23 billion deficit makes little to no sense. It’s sure to fail on the merits and will likely lead to exponentially higher cost burdens to the state in the foreseeable future. Besides, for a state the size of California, or New York or Michigan or, the per capita “cost to benefit” of PCC, whether enhancing our capability to prepare for and respond to a WMD or in the daily protection of our children and other members of society, is a high value product at bargain basement prices.
So where do we get the funding?
Cutting real waste in government is always a good start but the political capital required to make that happen is elusive. To be an effective watchdog and cut into pet projects of political adversaries who have become the coalition of the expedient as is usually the case in most state capitals, well, that is unlikely to be a realistic solution.
Now I’m loathe to spending other peoples’ money, especially because I figure most earned it fairly and should not be subject to the punitive progressive (regressive) selective “wallet-ectomy” that successful people face every April 15th, but I suspect the Governor and First Lady of California could probably write a check for the entire system and not miss it. I’d also bet if you asked every wealthy celebrity parent to kick in $25K per child to keep the poison centers open…well, Brad and Angelina could support one center all by themselves! So could Mel Gibson. And if the Osmonds were California residents, at $25k per child, the entire system is funded!
Let’s face it…in the grand scheme of things we’re talking small change. That California can’t come up with $5.9 million to protect the public interest should be considered gross negligence on the part of every elected official – from legislative to executive branch.
So for small change, PCCs could do a bake sale. Or start a “900” phone service. At $2 per minute, based on PCC call volume, that could support a center. I’ve on occasion suggested implementing a 900 number at our center in parallel with the nationwide poison 800 number (1.800. 222.1222). It’s not one of my more stellar suggestions and not surprisingly, it only gained a few supporters. Alternatively, poison center personnel could play guitar in the metro stations.
Better yet, let’s contact our legislators. The tiny amount of money initially being saved will evaporate in a New York minute when the costs from inadequate or inappropriate treatment occur without expert guidance. The amount of money being saved compared to the state debt, any state debt, is miniscule. Find it elsewhere. Poison Centers should be one of those “untouchable” public good entities that, barring malfeasance, should remain as perennially supported.
Until the California governor, who traditionally has been a friend of children, and his advisors, and the state legislators get some common sense (if not some fiscal sobriety and a reality check), perhaps it is time to revisit letter writing, personal visits, and calling the above mentioned leaders, suggesting some rational thought in Sacramento (or other state capital).
As a last resort, perhaps mailing a Tylenol® tablet to the elected of your choice to the capital might get some attention. If it was okay to have a tea bag revolution, then the Tylenol® approach might work. Given acetaminophen (the active ingredient in Tylenol ®) is one of the most commonly used medications in overdoses – intentional and unintentional – the symbolism is clear. And the notion that our leaders are clueless which is giving me a headache, and probably the budget is giving Governor Terminator one as well, the tablets….the mail “a pill to the hill” might be of therapeutic benefit, too! Or we could just mail a quarter to our local poison center – if 20,000,000 people sent quarters, well heck, that’s enough to keep the poison system in California open. Or New York’s or … yours.
Seriously – we’re talking 25 cents to a dollar per person per year for most states to keep PCC doors open. How hard is that? We can do better as a society. We must.
Remember, it goes beyond California. We need to make sure regardless of our state residence, that our legislators recognize poison centers are the common good and should be supported.
Conclusion
Is it too late for California? The clock is ticking. But it is not too late for the other states’ PCCs. Let us not wait until the eleventh hour to take a stand. PCCs are one aspect of public preparedness we all have a stake in, a voice for and the opportunity to support. But we must act quickly and together: for the sake of our community and family. Family security matters. So do poison centers.
Another blow to preparedness: California budget cuts threaten to close statewide poison control system. Your local poison center may be next! For the sake of your children and emergency response, don’t let it happen.
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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