Position Statement

Position Statement: Care of Poisoned Patients

American College of Medical Toxicology
Thomas G. Martin, MD, MPH

Int J Med Toxicol 2001; 4(2): 17


Background

  • Medical toxicology is a field of medicine that focuses on prevention, diagnosis and management of poisonings and other adverse effects of drugs, chemicals and biological toxicants.
  • Medical toxicology is a subspecialty of emergency medicine, pediatrics and preventive medicine and was approved by the American Board of Medical Specialties and the American Medical Association’s Council on Medical Education.
  • Certified regional poison information centers are a valuable source of telephone consultations with medical toxicologists available to all physicians in the US.
  • Centers for poison treatment are specialty treatment centers with goals of excellence in clinical care, teaching and research in medical toxicology.  The critical resources offered by centers for poison treatment are the dedicated leadership by experts in medical toxicology and ready availability of essential services and treatments. Facility Assessment Guidelines have been approved and published by the American Academy of Clinical Toxicology (AACT), then revised by the ACMT.
  • The American College of Emergency Physicians’ (ACEP) policy statement on Poison Information and Treatment Systems states that ‘high-quality poison treatment … will be enhanced by use of centers for poison treatment, where available, for serious or unusual poisonings’.
  • The Society of Critical Care Medicine (SCCM) has stated that "When a patient needs services that exceed the available resources of a facility, the patient should be transferred to a facility with the required resources and has established guidelines for transfer of critically ill patients."

Data

  • Poisonings are the third most common cause of fatal injuries in the US.
  • Currently there are over 300 physicians board-certified in medical toxicology offering consultations in North America.
  • Numerous studies and surveys have found that most hospitals have inadequate stocks of essential and more often required antidotes.
  • Patient Management by a Center for Poison Treatment is more cost efficient.

Position

The American College of Medical Toxicology believes that most poisoned patients can be appropriately managed by health care facilities meeting JCAHO standards for acute care services. However, victims of severe or unusual poisonings should be treated at a center for poison treatment, when regionally available. Proper care of patients with significant or ill-defined poisoning includes a consultation with a medical toxicologist.

References

  1. Banner W, Pentel PR: Medical Toxicology. JAMA 1994;271:1681-1682.
  2. Thompson DF, Trammel HL, Robertson NJ, et al: Evaluation of regional and nonregional poison centers. N Engl J Med 1983;308:191-194.
  3. American Association of Poison Control Centers: Criteria for certification as a regional poison control center. Vet Human Toxicol 1996;38:145-149.
  4. Pearigen PD: Regional poison treatment centers: Coming soon to a neighborhood near you? Emerg Med Serv 1992; April:83-84.
  5. Donovan JW, Martin TG: Regional poison systems – Roles and titles. J Tox Clin Toxicol 1993;31:221-222.
  6. Vale JA, Meredith TJ: Clinical toxicology in the 1990s: The development of clinical toxicology centers – a personal view. J Tox Clin Toxicol 1993;31:223-227.
  7. American Academy of Clinical Toxicology Facility Assessment Guidelines for Regional Toxicology Treatment Centers. J Tox Clin Toxicol 1993;31:209-210.
  8. American College of Medical Toxicology’s (ACMT’s) Center for Poison Treatment Facility Assessment Guidelines. http://www.acmt.net/CPT FAG.html
  9. Poison Information and Treatment Systems, Policy number 400172, Approved by the ACEP Board of Directors March, 2000 http://www.acep.org/library/index.cfm/id/641.
  10. Task Force on Guidelines Society of Critical Care Medicine: Guidelines for categorization for services for the critically ill patient. Crit Care Med 1991;19:279-285.
  11. Guidelines for the transfer of critically ill patients. Guidelines Committee of the American College of Critical Care Medicine; Society of Critical Care Medicine and American Association of Critical-Care Nurses Transfer Guidelines Task Force. Crit Care Med. 1993;21:931-7.
  12. Fingerhut LA, Cox CS: Poisoning mortality, 1985-1995. Public Health Rep. 1998;113:218-233.
  13. Baldwin JN, Rosenquist GC, Angle CR: Availability of pit viper antivenin at Nebraska hospitals. Nebraska Med J (April) 1979:86-87.
  14. Howland MA, Weisman R, Sauter D, et al: Nonavailability of poison antidotes. N Engl J Med. 1986;314:927-928.
  15. Dart RC, Duncan C, McNally J: Effect of inadequate antivenin stores on the medical treatment of crotalid envenomation. Vet Hum Toxicol 1991;33:267-269.
  16. Love JN, Tandy TK: J -Adrenoreceptor antagonist toxicity: A survey of glucagon availability. (Letter) Ann Emerg Med 1993;22:267-268.
  17. Scharman EJ, Rosencrance JG: Isoniazid toxicity: A survey of pyridoxine availability. (Letter) Am J Emerg Med 1994;12:386-388.
  18. Dart RC, Stark Y, Fulton B, et al: Insufficient stocking of poisoning antidotes in hospital pharmacies. JAMA 1996;276:1508-1510.
  19. Antidotes dangerously understocked in Colorado, Montana, and Nevada. Am J Health Syst Pharm. 1997;54:16, 19.
  20. Davis NM: Insufficient stocking of poisoning antidotes. Hospital Pharmacy 1997;32:1078, 1103.
  21. Woolf AD, Chrisanthus K: On-site availability of selected antidotes: results of a survey of Massachusetts hospitals. Am J Emerg Med. 1997;15:62-66.
  22. Pettit HE, McKinney PE, Achusim LE, et al: Toxicology cart for stocking sufficient supplies of poisoning antidotes. Am J Health Syst Pharm. 1999;56:2537-2539.
  23. Teresi WM, King WD: Survey of the stocking of poison antidotes in Alabama hospitals. South Med J. 1999;92:1151-1156.
  24. Whyte IM, Dawson AH, Buckley NA, et al: Health care. A model for the management of self-poisoning. Med J Aust. 1997;167:142-146.
  25. Clark RF, Williams SR, Nordt SP, et al: Resource-use analysis of a medical toxicology consultation service. Ann Emerg Med. 1998;31:705-709.



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