|Internet Journal of Medical Toxicology
A publication of The American College of Medical Toxicology
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Position Statement: Care of Poisoned Patients
American College of Medical Toxicology
Thomas G. Martin, MD, MPH
Int J Med Toxicol 2001; 4(2): 17
- 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
- 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."
- 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.
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.
- Banner W, Pentel PR: Medical Toxicology. JAMA 1994;271:1681-1682.
- Thompson DF, Trammel HL, Robertson NJ, et al: Evaluation of regional and
nonregional poison centers. N Engl J Med 1983;308:191-194.
- American Association of Poison Control Centers: Criteria for
certification as a regional poison control center. Vet Human Toxicol 1996;38:145-149.
- Pearigen PD: Regional poison treatment centers: Coming soon to a
neighborhood near you? Emerg Med Serv 1992; April:83-84.
- Donovan JW, Martin TG: Regional poison systems – Roles and titles. J
Tox Clin Toxicol 1993;31:221-222.
- 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.
- American Academy of Clinical Toxicology Facility Assessment Guidelines
for Regional Toxicology Treatment Centers. J Tox Clin Toxicol 1993;31:209-210.
- American College of Medical Toxicology’s (ACMT’s) Center for
Poison Treatment Facility Assessment Guidelines. http://www.acmt.net/CPT FAG.html
- 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.
- Task Force on Guidelines Society of Critical Care Medicine: Guidelines
for categorization for services for the critically ill patient. Crit Care Med
- 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.
- Fingerhut LA, Cox CS: Poisoning mortality, 1985-1995. Public Health Rep.
- Baldwin JN, Rosenquist GC, Angle CR: Availability of pit viper antivenin
at Nebraska hospitals. Nebraska Med J (April) 1979:86-87.
- Howland MA, Weisman R, Sauter D, et al: Nonavailability of poison
antidotes. N Engl J Med. 1986;314:927-928.
- 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.
- Love JN, Tandy TK: J -Adrenoreceptor
antagonist toxicity: A survey of glucagon availability. (Letter) Ann Emerg Med
- Scharman EJ, Rosencrance JG: Isoniazid toxicity: A survey of pyridoxine
availability. (Letter) Am J Emerg Med 1994;12:386-388.
- Dart RC, Stark Y, Fulton B, et al: Insufficient stocking of poisoning
antidotes in hospital pharmacies. JAMA 1996;276:1508-1510.
- Antidotes dangerously understocked in Colorado, Montana, and Nevada. Am J
Health Syst Pharm. 1997;54:16, 19.
- Davis NM: Insufficient stocking of poisoning antidotes. Hospital Pharmacy
- 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.
- 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.
- Teresi WM, King WD: Survey of the stocking of poison antidotes in
Alabama hospitals. South Med J. 1999;92:1151-1156.
- 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.
- 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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