While individual practitioners may differ, this is the position of the College at the time written, after a review of the issue and pertinent literature.
In September, 1992, Medical Toxicology was accepted by the American Board of Medical Specialties as a sub-board of the American Board of Emergency Medicine, the American Board of Preventive Medicine, and the American Board of Pediatrics. Currently there are several hundred physicians certified by ABMS, or the American Board of Medical Toxicology in this specialty. As poisonings, intoxications, and environmental issues become more prevalent and appreciated by our medical colleagues and the general public, there may be an increased desire for the medical toxicology consultation. Because of greater acceptance and appreciation of the valuable input Medical Toxicology can contribute, it is appropriate that this body develop standards on how Medical Toxicology may interface in the hospital venue.
Prior certification in a primary specialty will be required. These specialties will primarily include Internal Medicine, Pediatrics, Emergency Medicine, or Preventive (Occupational) Medicine but could include any clinical specialty. Completion of a two year medical toxicology fellowship, or certification as a diplomate of the American Board of Medical Toxicology, or ABMS certification by the sub-board of Medical Toxicology will be an additional requirement for granting of staff privileges in the subspecialty of medical toxicology.
The credentials specified above should be required for a physician to be eligible for admitting and/or consultative privileges in Medical Toxicology for adult and pediatric inpatient or outpatient services. Inpatient services include the provision of medical care in emergency and critical care units.
Scope of Practice
Medical Toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning and other adverse health effects due to medications, occupational and environmental toxins, and biological agents. Medical Toxicology is officially recognized as a medical subspecialty by the American Board of Medical Specialties. Several examples of medical problems evaluated by Medical Toxicologists include:
- Unintentional and Intentional Drug Overdose: including therapeutic drugs (e.g. tricyclic antidepressants, calcium antagonists); drugs of abuse (e.g. cocaine, amphetamines, opioids); over-the-counter medicines (e.g. aspirin, acetaminophen); and vitamins (e.g. iron supplements; vitamin A).
- Hazardous Exposure to Chemical Products: such as pesticides; heavy metals (e.g. lead, arsenic, mercury); household products (e.g. cleaning agents); toxic gases (e.g. carbon monoxide, hydrogen sulfide, hydrogen cyanide); toxic alcohols (e.g. methanol, ethylene glycol); and other industrial and environmental agents.
- Drug abuse management, including in-patient care for acute withdrawal from addictive drugs, and outpatient Medical Review Officer services for industry and organization.
- Envenomations, such as snake bites, spider bites, scorpion stings.
- Ingestion of Food-Borne Toxins: such as botulism; marine toxins (e.g. paralytic shellfish toxin; ciguatoxin).
- Ingestion of Toxic Plants and Mushrooms.
- Independent Medical Examinations, assessing injury or disability resulting from toxic exposures.
ACMT Recommended Clinical Privilege Form
- MD or DO; AND
- Member or partner of Hospital Medical Staff; AND
- Privileges in Toxicology prior to January 1, 1990; OR
- Appropriate primary training (i.e., board certification or eligibility to Emergency Medicine, Internal Medicine, Pediatrics, Family Practice, or Occupational Medicine); AND
- Current Board Certification or eligibility by the American Board of Medical Toxicology (ABMT) or the ABMS recognized Certificate of Added Qualification (CAQ); AND
- Documentation of experience.
____ Approved with observation
____ Approved with observation
- Evaluation, treatment and management
- Arterial puncture and line insertion
- EKG interpretation
- Lumbar puncture
- Central venous line insertion
- Endotracheal intubation
- Chest Tube Insertion
- Ventilator Management
- Other (Please specify): _____________
- Swan Ganz insertion