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Providing rapid response to poisoning incidents

The Centre also has a specific public poisons information line aimed particularly at parents and those caring for young children. Dr Edel Duggan has been the Clinical Director of the Centre since 2010. She balances the role, which she occupies one day a week (she is also on-call all year around) with her position as Consultant Anaesthetist in Beaumont Hospital. Dr Duggan said the clinical directors of the Centre have tended to be anaesthetists because of their expertise in administering drugs.

“We use drugs every day, therefore in an overdose situation we are familiar with the effects of drugs and particularly in terms of pharmacology,” Dr Duggan told the Medical Independent (MI).

“In addition, the intensive care training that we receive is of great benefit in very serious cases of poisoning.”

In addition to Dr Duggan, the Centre has one manager and specialist in poisons information  (part-time); one clerical officer (full-time); and five specialists in poisons information (three full-time and two part-time). Dr Duggan said the staff are kept extremely busy by the high demand for the service, which is on the rise.

Healthcare professionals

In 2015, the Centre received a total of 9,691 enquiries. Of these, 9,356 were about cases of human poisoning. The remainder were non-emergency requests for general information and enquiries about animal poisoning. The proportion of calls from members of the public rose from 28 per cent in 2014 to 33 per cent in 2015. However, as in previous years, the majority of enquiries were from healthcare professionals (64 per cent). The remainder of enquiries were from other sources, such as nursing homes, schools, and veterinary practices.

“Our primary role is to provide information to healthcare professionals in managing poison patients,” according to Dr Duggan. “But we are getting an increasing number of calls from members of the public. In 2011, we opened up a poisons information line to target that group and to deal with those queries. Out from that we focus on poison prevention and an increase in poison awareness in the home, particularly parents of young children.

“In the first full year of operation, only 10 per cent of the calls were from members of the public, whereas last year one-in-every-three calls were from members of the public. So we were getting calls even before we had the public poisons information line. But we realised there was a benefit to encouraging more members of the public to phone our services and we could give advice on whether they needed to go to hospital immediately or provide first-aid advice in serious cases, or whether it was a non-toxic dose and the child could be just observed and they didn’t require an unnecessary visit to the emergency department.”

TOXBASE is the clinical toxicology database of the UK National Poisons Information Service, which has been available to emergency departments and intensive care units since 2001. In spite of this useful resource, Dr Duggan said the importance of the Centre in offering specialist advice in poisoning cases has not been diminished.

“We would recognise the signs and symptoms maybe a lot quicker than some of the doctors in a hospital scenario,” she stated.

“They might not have seen such a case in their entire career, whereas we would have had previous calls. The advice we offer is particularly important with new drugs that are coming on-stream. We may have heard of incidents in Europe or maybe the UK, with maybe more up-to-date information. We would like to encourage hospital doctors and healthcare professionals to contact us even if they have the evidence on the database; sometimes there may be more up-to-date advice that we might be aware of.”

Domestic setting

Of last year’s cases 82 per cent were accidental poisonings or therapeutic errors, while 15 per cent were intentional overdoses or recreational abuse. The remaining cases involved adverse reactions or cases of unknown intent.

Most poisonings occurred in the home or domestic setting (92 per cent). The remaining cases occurred in the workplace (2.7 per cent), nursing homes/hospitals/GPs (2.7 per cent), schools (0.7 per cent), and other public places (1.9 per cent).

A total of 5,221 enquiries related to children aged under 10 years of age. Of these cases, 86 per cent of cases were accidental. The remainder involved therapeutic errors or unknown circumstances.

Last year’s statistics also show 70 per cent of patients were asymptomatic at the time of the enquiry, while 24 per cent of patients had minor symptoms, such as mild vomiting, nausea, drowsiness, and mild local irritation. 

Dr Duggan described how the Centre handles typical queries. “We get details about when the poisoning occurred, what was taken,” she said. “We try and determine the worst case scenario and whether it was a toxic amount that was taken. If it is a child we focus on their age and weight as well, just to calculate the toxic dose.  If it is something serious, we can advise them to go into the emergency department, or to visit their GP. For the healthcare professional, it depends on the scenario as to whether they need an antidote and what symptoms they need to watch out for; the observation period is important.”

As in previous years, paracetamol was the most common drug involved in poisoning. Codeine was one of the more common drugs involved in poisoning, mainly because it is included as a compound ingredient in a number of analgesic products.

Liquid detergent capsules

Over 2,300 household products were involved in poisoning incidents last year. As in 2014, the most common products involved were fabric cleaning products. Other common products included bleach products, petroleum distillates, and general cleaning products.

“A few years ago we noticed there was an increase in the number of calls regarding liquid detergent capsules,” said Dr Duggan.

“So we went to the Health and Safety Authority at the time to highlight our concerns and they brought it to the European Commission. And as a result of that, there was a change to the packaging of these products and the labelling of these products and then there has been advertisements warning the parents of young children about their dangers.”

In addition, the intensive care training that we receive is of great benefit in very serious cases of poisoning.

Manufacturers should provide the Centre with information on their products to enable it to provide advice in a medical emergency. This role is assigned to the Centre in the Chemicals (Amendment) Act 2010 and the Plant Protection Products and Biocides Regulations (Statutory Instruments 624 and 625 of 2001). The information provided to the Centre should include the chemical composition of mixtures placed on the market.

Article 45 of the EU’s Classification, Labelling and Packaging of Substances and Mixtures (CLP) regulations currently stipulates that countries must appoint a body that is able to receive information on mixtures considered hazardous on the basis of  health or physical effects, primarily to use in case of medical emergencies. However, without additional clarification, countries have implemented this legislation in a variety of ways.

The level of information required by a poison centre on a product’s hazards, the registration process, the products that need to be registered, and the cost of compliance varies widely between Member States.  A new amendment aims to overcome these issues by harmonising poison centre registration across Member States and determining new methods for identifying and tracking registered products. New information will also be required on the non-hazardous components if they are above a certain threshold, although further safeguards have been introduced to protect intellectual property. New additions include a product categorisation code, a system for statistical analysis, and the requirement to declare the types and size of the packaging if a consumer or professional product is placed on the market

Implementing these regulations will require extra financing, according to Dr Duggan.

“The NPIC will require extra resources to update the IT infrastructure to ensure we are prepared for the new EU regulations that will come in to force in 2020,” she said.

“We are currently working with Beaumont Hospital to secure funding for this project. Beaumont Hospital, Healthy Ireland and the HSE have helped fund our poison-awareness educational material and our upcoming poison awareness day. The National Poison’s Information Service in the UK answer our calls at night from 10pm until 8am and provide an excellent service that is also cost-efficient. Naturally, we would like to be able to provide a 24-hour on-call service, but this would require a significant investment.”

Dr Duggan argued that it makes sense to provide the Centre with extra resources to allow it expand its services.

“We would like to expand,” she said. “Our workload is expanding, especially with this new EU regulation coming in. It will have a significant impact on our workload in the short-term and we are trying to address that at the moment. Staff are fantastic, they work very hard. The problem is there is no leeway within the system if people get sick or are on leave. There is huge value with having a poison centre in that it has been shown [to be] efficient in saving money for health systems. There are studies, such as one from the US a few years ago, that say for every dollar spent in a poison centre that the health system will save $13. Even in cases where it is serious, it has been shown that ringing a poison centre reduces the length of stay in hospital because they are given very specific information about the treatment of that patient.”

Dr Duggan said she is proud of the important role that the Centre plays in providing vital health information to both health professionals and the public and hopes it will continue to play this role well into the future.

“Hopefully we will be around for the next 50 years at least!” she said.

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