IOWA STATEWIDE POISON CONTROL CENTER 2 0 0 2-2 0 0 3 A N N U A L R E P O R T From the Director... Linda Kalin It has been three years since the Iowa Statewide Poison Control Center (ISPCC) was established to provide around-the-clock poison control services to Iowa s 2.9 million citizens. During that time, the Center has experienced a 15% increase in calls answering nearly 35,000 calls for help in 2002. This was accomplished with no increase in staffing or cost to the public. Thousands of Iowans have avoided adverse health effects because of the vital information we provided in emergency situations, as well as through distribution of poison prevention materials and public and professional presentations. In addition, over 20,000 children and adults last year were safely managed at home, entirely by telephone, without the need for using more costly health care resources! I invite you to review this 2002-03 Annual Report for the Iowa Statewide Poison Control Center. This report provides information on the demographics and substances involved in poisonings reported to the Center during FY 2002-03, as well as the treatment and outcomes of these cases. Highlights of the 2002-03 year include: Our staff of eight nurses answered a total of 34,829 calls including 26,482 human exposures Over half of these poisonings involved a child under the age of six 76% of calls (20,067) were safely managed at home by telephone resulting in dramatic cost savings to health care systems and taxpayers Began serving as a training site for pharmacy students from the University of Iowa and Drake University Enhanced capacity to meet the needs of non-english speaking and hearingimpaired populations Distributed over 98,000 poison prevention materials to people in Iowa Throughout this busy year, we also relocated to a new office. The challenge of moving a service that cannot be shut down for any time was managed by briefly staffing both the old office and new office to ensure continued emergency service. The ISPCC has been working closely with several state and local authorities to improve Iowa s preparedness to handle natural or manmade disasters. As always, the ISPCC is positioned to play a vital role in any large or small-scale emergency. The center s staff is available on a moment s notice to disseminate accurate information on poison exposures to the 120 Iowa hospitals we serve. We are also among the nation s 62 poison centers providing critical elements in the nation s developing bioterrorism response network. We remain committed to providing quality poison control services for the State of Iowa. We are thankful for the support of the people we serve, our state legislature, Iowa Department of Public Health, HRSA, and our sponsoring organizations Iowa Health System and University of Iowa Hospitals and Clinics who allow us to do our work and carry out our mission. Mission of ISPCC To reduce morbidity, mortality, and costs associated with poisonings, through providing statewide 24-hour telephone management, consultation, poison prevention information, public and professional education and research for the people of Iowa. Our Vision To be a certified poison control center dedicated to providing accessible 24-hour poison center services of the highest quality through excellence in customer satisfaction, cost-effectiveness, quality outcomes, access and improved patient care. To provide telephone management and information, education and research while serving as an active local, state and federal public health partner accountable to customers and stakeholders.
Types of Calls Human Exposures 26,482 Animal Exposures 1,231 Information Calls 7,671 Drug Identification 3,926 Drug Information 939 Environmental Information 352 Poison Information 657 Prevention/Safety Information 1,287 Other Information 510 Other Calls 96 Total Incoming Calls 35,480 Followup Calls 28,056 Total Calls 63,536 Calls by County: Poison Center Utilization Poison center utilization and awareness of its services directly results in decreased injury or deaths and reduces unnecessary emergency department visits and inappropriate use of medical resources. In an effort to raise awareness about poison center services, the center s public education efforts target counties with low utilization rates (<7) through media opportunities, partnerships and general outreach. Patient Age Poisonings remain a major health hazard among young children. Children under six years of age account for the majority (54%) of the poisonings managed by the ISPCC during FY 02-03, approximately the same in FY 01. Although the incidence of poisoning is still greater in children, most severe poisonings and poisoning deaths occur in adolescents and adults due to their intentional nature. 33% 7% 6% 54% 0-5 Years 54% 6-12 Years 6% 13-19 Years 7% >19 Years 33% Reason Unintentional 22,189 General 14,988 Environmental 965 Occupational 759 Therapeutic error 2,687 Misuse 1,829 Bite/sting 332 Food Poisoning 615 Unknown 14 Intentional 3,354 Suspected suicide 2,108 Misuse 628 Abuse 493 Unknown 125 Other 250 Contamination/tampering 51 Malicious 190 Withdrawal 9 Adverse Reaction 601 Drug 432 Food 53 Other 116 Unknown reason 33 Unknown reason 88 Total 26,482
Management Site Managed on site (home, school, etc) (76%) 20,067 Managed in health care facility 5,448 Treated/evaluated and released 2,652 Admitted to critical care unit 1,032 Admitted to noncritical care unit 2,453 Admitted to psychiatric facility 509 Patient lost to follow-up/left AMA 809 Other 371 Refused referral 576 Unknown 20 Total (human exposures) 26,482 Medical Outcome As a component of its Performance Improvement Program, the ISPCC continually monitors patient outcomes. Over 88% of all cases reported to the ISPCC resulted in either no effect or only minor effects. Few cases had poor outcomes. Of the 26,482 human exposures managed by the ISPCC, less than one percent (0.064%) resulted in the death of the victim. In 2002-03 there were a total of 17 deaths associated with poisonings, 11 were intentional acts. In other words, 99.9% had successful outcomes. No effect 3,910 Minor effect 6,194 Moderate effect 1,123 Major effect 117 Death 12 Death, indirect report 5 No followup, nontoxic 8,217 No followup, minimal toxicity 5,261 No followup, potentially toxic 915 Unrelated effect 728 Total 26,482 Summary of Death Causes Age / Gender Substance 19 year / male Sewer gas (H2S) 25 year / male Sewer gas (H2S) 51 year / female Acetaminophen, opiates, Trazodone, Paxil, Ambien, Vicodin 19 year / male Temazepam, Citalopram, Methadone 25 year / male Trazodone, Zyprexa 52 year / female Darvocet N-100, Alcohol, Acetaminophen 22 year / male Carbon monoxide 22 year / male Dextromethorphan 27 year / female Methadone 39 year / male Seroquel, Remeron, Ethanol 35 year / female Mouthwash, Robitussin, Tylenol, Brandy 39 year / male Methamphetamine 28 year / male Oxycontin 49 year / female Morphine, Trazodone, Risperdal, Valium, Levodopa, Cyclobenzaprine, Trihexyphenidyl, Propoxyphene, Effexor, Neurontin 68 year / male Anhydrous ammonia 2 year / female Pseudoephedrine, Diphenhydramine, Phenylpropanolamine 58 year / male Acetaminophen
Top 10......Medications/ Products Involved in Pediatric Poisonings Cosmetics/Personal Care Products (perfumes, soaps, mouthwash, nail/hair/dental products) Household Cleaning Substances Pain Relievers (Tylenol, Aspirin, Ibuprofen) Topical Ointments and Creams Cold/Cough Medications Foreign Bodies/Toys Plants Pesticides/Rat Poisons Vitamins Gastrointestinal Medications (Antacids, Laxatives) Education Outreach and Awareness Public Programs Conducted: 56 Professional Programs Conducted: 34 Media Contacts: 60 Materials Distributed: 98,000 Cost Savings Our trained staff, experience and resources enable us to quickly distinguish between emergencies requiring hospital care and cases that can be managed at home. Last year, the ISPCC managed 3 out of every 4 patients outside of a hospital emergency room. Studies show that when no poison center is available, many of these cases will end up in the emergency department, or call 911. As a result, we are effective in reducing the trauma and the costs associated with unnecessary medical procedures or emergency department visits. Poison control centers have been called the second most important public health program in the United States, second only to the childhood immunization program in reducing illness and injury to the public. At the same time the ISPCC was reducing costs, it was providing emergency treatment recommendations to the physicians and nurses caring for poisoned patients in all Iowa hospitals....most Frequent Poisonings For All Ages Pain Relievers (Tylenol, Aspirin, Ibuprofen) Cosmetics/Personal Care Products Household Cleaning Products Antidepressants Plants Topical Preparations Sedative/Hypnotics Pat Gunia, RN, BSN, CSPI presented her poster, co-authored with Janet Gray, RN, BSN, CSPI, at the annual meeting of the North American Congress of Clinical Toxicology held in Palm Springs, California, Sept 24-29, 2002. Foreign Bodies Pesticides/Rat Poisons Cold/Cough Medications
On Our Team ISPCC 2002-03 Staff and Board Members Medical Director Edward Bottei, MD, FCCP BotteiEM@ihs.org Managing Director Linda Kalin, RN, BS, CSPI KalinLB@ihs.org Education Coordinator Tammy Noble, RN, BSN, CSPI NobleTF@ihs.org Education Coordinator- Iowa City Mary Ross, RPh, MBA Mary-b-ross@uiowa.edu Specialists in Poison Information Denise Brumm, RN, CSPI Randy Crouch, MS, RN, CSPI Pat Gunia, RN, BSN, CSPI Sue Ringling, RN, BSN, CSPI Kim Byrne, RN, CSPI Janet Gray, RN, BSN, CSPI Chris Mueller, RN, CSPI Sue Stampe, RN, BSN, CSPI Financial Review (July 1, 2002- June 30, 2003) In fiscal year 02-03, the annual operating budget for the ISPCC was $799,772. Personnel expenses comprised 83% of poison center direct expenses. State funding (tobacco settlement funds) through the Iowa Department of Public Health provided 55% ($437,000) of the funding for Center operations with additional funding from the federal government (HRSA, Maternal and Child Health Bureau). Independent sources, primarily its founding sponsors, St. Luke s Regional Medical Center/Iowa Health System and the University of Iowa Hospitals and Clinics, continue to underwrite a significant portion (15%) of its operating costs. A St. Luke s Children s Miracle Network grant of $15,997 funded all poison prevention materials including telephone stickers, magnets, brochures, and maintaining the ISPCC website. ISPCC Board of Directors: CHAIR Mark Johnson, St. Luke s Regional Medical Center VICE CHAIR Paul Abramowitz, PharmD, University of Iowa Hospitals & Clinics SECRETARY Judy Glover, St. Luke s Regional Medical Center TREASURER Ann Madden Rice, University of Iowa Hospitals & Clinics DIRECTORS Paul Berger, Jr., MD, St. Luke s Regional Medical Center William Hesson, University of Iowa Hospitals & Clinics Barbara Muller, MD, University of Iowa Hospitals & Clinics John Staley, PhD, University of Iowa Hospitals & Clinics James Zahnd, Iowa Health System
How to Reach US Address: 2910 Hamilton Blvd. Suite 101 Sioux City, IA 51104-2423 Telephone Numbers: Emergency Hotline 800-222-1222 Administration 712-279-3710 Education 712-279-3717 319-356-2600 Fax 712-234-8775 Website: http://www.iowapoison.com