Poison control Poison control CentersCenters

Ministry of Health & Population Occupational health department

Poison Control Centers

Currently an exceedingly large number of Currently an exceedingly large number of chemicals is imported, manufactured, chemicals is imported, manufactured, marketed, used, transported, stored and marketed, used, transported, stored and disposed of, thus creating huge benefits, but disposed of, thus creating huge benefits, but also health and environmental risks. also health and environmental risks. Explosives are used in different activities, Explosives are used in different activities, such as mining, police activities. Radioactive such as mining, police activities. Radioactive substances are used in clinical activities, substances are used in clinical activities, research, welding and piping testing. Handling research, welding and piping testing. Handling of such substances in an environmentally of such substances in an environmentally sound manner is of paramount importance for sound manner is of paramount importance for proper health and environmental protection as proper health and environmental protection as well as for the sound management of natural well as for the sound management of natural resources and life enjoyment. resources and life enjoyment.

With general lack of effective control on With general lack of effective control on handling of these chemicals, chemical handling of these chemicals, chemical emissions to the environment and inadequacy emissions to the environment and inadequacy of facilities for toxic waste disposal, there is a of facilities for toxic waste disposal, there is a potential for major health problems due to potential for major health problems due to exposure of the population to these chemicals. exposure of the population to these chemicals. Although the amount of pesticides used in Although the amount of pesticides used in agriculture has decreased considerably during agriculture has decreased considerably during the last decade, appreciable amounts are still the last decade, appreciable amounts are still being used.being used.

In 1998-1999 Egypt used 1365 tons of In 1998-1999 Egypt used 1365 tons of pesticides for agriculturepesticides for agriculture

Annual Egyptian imports of chemicals and Annual Egyptian imports of chemicals and chemical productschemical products

(40 million Tons)(40 million Tons)

0.02%1.1%1.3%2.5%3.4%6.3%9%

27.4%

49%

0

10

20

30

40

50

60

The major problems facing controlling The major problems facing controlling chemicals in Egypt arechemicals in Egypt are::

Inadequate capabilities to assess the potential toxicity Inadequate capabilities to assess the potential toxicity and to control the nature and purity of imported or and to control the nature and purity of imported or domestically produced chemicals.domestically produced chemicals.

Handling of chemicals by inadequately informed or Handling of chemicals by inadequately informed or trained personnel, especially operators in small-scale trained personnel, especially operators in small-scale enterprises.enterprises.

Shortage of management skills needed to deal safely Shortage of management skills needed to deal safely with technology transfer and with the storage, transport, with technology transfer and with the storage, transport, use or disposal of chemicals.use or disposal of chemicals.

Lack of effective mechanisms for coordinating the work Lack of effective mechanisms for coordinating the work of those responsible for different aspects of chemical of those responsible for different aspects of chemical safety.safety.

The major problems facing controlling The major problems facing controlling chemicals in Egypt arechemicals in Egypt are

Lack of means of dealing with chemical accidents, Lack of means of dealing with chemical accidents, including the treatment of victims and the subsequent including the treatment of victims and the subsequent rehabilitation of the environment.rehabilitation of the environment.

Inadequate proper management of chemicals and Inadequate proper management of chemicals and enforcement of regulations.enforcement of regulations.

Lack of reliable information sources to establish Lack of reliable information sources to establish properly coordinated infrastructures, controls and properly coordinated infrastructures, controls and procedures to deal properly with chemical safety.procedures to deal properly with chemical safety.

More and more people are being More and more people are being exposed to hazardous chemicals, both exposed to hazardous chemicals, both

occupationally and otherwise.occupationally and otherwise.

The occupational health dept. ( chemical register ) MOHP The occupational health dept. ( chemical register ) MOHP registers cases of intoxication with chemicals which received registers cases of intoxication with chemicals which received by emergency room of MOHP hospitals .by emergency room of MOHP hospitals .

Small outbreaks have been reported occasionally due to Small outbreaks have been reported occasionally due to pesticides, chlorine and other chemicalspesticides, chlorine and other chemicals

Increased chemical risk exposure

Poisoning cases 2002Poisoning cases 2002

CauseCause NumberNumber

Chemical poisoningChemical poisoning 1429814298

Scorpion stingScorpion sting 2893328933

Snake biteSnake bite 33293329

Dog biteDog bite 4590045900

Total animal biteTotal animal bite 1223712237

Percentile distribution of Percentile distribution of poisoning by cause and poisoning by cause and

sexsex

55%54%69% 73%

46% 45%31% 27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Chemicals Scorpion Snake Dog

FemaleMale

Distribution of chemical Distribution of chemical poisoning by age groupspoisoning by age groups

21.5

25.5 25.6

21.5

4.6

1.30

5

10

15

20

25

30

<5 5--16 17--24 25--44 45--59 >60

Distribution of Scorpion Distribution of Scorpion poisoning by age groupspoisoning by age groups

8.7

22.4

17.9

34.5

12.5

3.9

0

5

10

15

20

25

30

35

40

<5 5--16 17--24 25--44 45--59 >60

Distribution of Snake Distribution of Snake poisoning by age groupspoisoning by age groups

6

20.5 20

37.6

12.4

3.20

5

10

15

20

25

30

35

40

<5 5--16 17--24 25--44 45--59 >60

Distribution of Dog Distribution of Dog poisoning b y age groupspoisoning b y age groups

12.9

44

14

19

7.6

2.70

5

10

15

20

25

30

35

40

45

50

<5 5--16 17--24 25--44 45--59 >60

Death cases record Death cases record According to sexAccording to sex

CauseCause MaleMale FemaleFemale

Chemical Chemical poisoningpoisoning

295295 185185

ScorpionScorpion 3737 3131

SnakeSnake 55 22

DogDog 1212 55

Source: Health information system- MOHP

Death cases record Death cases record According to AgeAccording to Age

CauseCause Less than Less than 1717

More than More than 1717

Chemical Chemical poisoningpoisoning

170170 310310

ScorpionScorpion 6060 88

SnakeSnake 44 33

DogDog 1111 66

Source: Health information system- MOHP

Poison control centerPoison control center FunctionsFunctions

InformationInformationProvision of information on the Provision of information on the

signs and symptoms of signs and symptoms of poisoning, both by individual poisoning, both by individual chemicals and by mixtures of chemicals and by mixtures of

chemicals as found in chemicals as found in commercial products to aid commercial products to aid

diagnosis with such diagnosis with such information information

Toxicovigillance and advice on Toxicovigillance and advice on prevention of poisoning and prevention of poisoning and

development of preventive measures development of preventive measures

Management of poisoned Management of poisoned patientspatients

(Clinical Toxicology)(Clinical Toxicology)

Teaching and training in Teaching and training in prevention and control of prevention and control of

poisoningpoisoning

Conduction of researches, Conduction of researches, epidemiological studies for epidemiological studies for risk factors identificationrisk factors identification

Provision of laboratory Provision of laboratory analytical services for analytical services for diagnosis and prognosis and diagnosis and prognosis and to support the management to support the management of poisoned patientsof poisoned patients

HistoryHistory In 1997, a ministerial decree( MOHP) was agreed In 1997, a ministerial decree( MOHP) was agreed

to establish poison centers in 5 governorates to establish poison centers in 5 governorates

Collaborating with WHO in implementation of Collaborating with WHO in implementation of those poisons information and control centers at those poisons information and control centers at 5 governorates(Menia, Dakahlia, Behira, Ismailia 5 governorates(Menia, Dakahlia, Behira, Ismailia and Sohag)and Sohag)

Equipmentation of the above centers with the Equipmentation of the above centers with the functions, specially: PC hardware & relevant functions, specially: PC hardware & relevant software (intox and inchem CD ).software (intox and inchem CD ).

IsmailiaDakahlia

Menia

Behira

Sohag

LocationLocation

Constraints concerning Poison Control Center

•Budget limitation for training and staff.

•Weak response from the localities .

•Conflicts between preventive and curative health sectors .

•Newly graduated physicians are not interested.

•Unaware of policy and decision makers with information center ( management concept)

The development and The development and strengthening of implementation strengthening of implementation process started in 2 pilot centers process started in 2 pilot centers (Menia and Dakahlia) (Menia and Dakahlia)

ComponentsComponents Information systemInformation system

Information system for poisoning casesInformation system for poisoning cases Data retrieval softwareData retrieval software Reporting system for communication recordsReporting system for communication records

TrainingTraining Medical toxicologyMedical toxicology Information technologyInformation technology Information system Information system

CommunicationCommunication PublicationsPublications

Annual reportsAnnual reports Brochures and bookletsBrochures and booklets

TrainingTraining ToxicovigillanceToxicovigillance

Expected outputs from poison centersPreventive aspect of chemical risksRegulations for chemical safetyChemical risksTechnological disasters

Medical ToxicologyMedical ToxicologyGuidelines for acute poisoning managementDrugs Interaction

Information systemInformation systemInformation technologyData retrieval Data retrieval Data entry and analysis of poisoning cases and Data entry and analysis of poisoning cases and communication records communication records

.

Role of concerning Role of concerning ministriesministries

Within the MOHP, several health directorates and Within the MOHP, several health directorates and

districts are involved in chemical safety through : districts are involved in chemical safety through :

The General Directorate (G.D.) of Occupational Health The General Directorate (G.D.) of Occupational Health

which established a central unit for chemical safetywhich established a central unit for chemical safety

Chemical Safety UnitChemical Safety Unit: :

Aim:Aim:

Safe handling of chemicals throughout the whole process Safe handling of chemicals throughout the whole process (importation, transportation ,storage, use and waste (importation, transportation ,storage, use and waste management).management).

Function :Function : It has national chemical register-to-register all used chemicals It has national chemical register-to-register all used chemicals

(imported or manufactured locally).(imported or manufactured locally). Evaluating these substances, putting preventive measures to Evaluating these substances, putting preventive measures to

the whole process and reporting to the authorized agencies to the whole process and reporting to the authorized agencies to avoid exposure of Egyptian citizens to these hazards. avoid exposure of Egyptian citizens to these hazards.

Implementation of 5 poisons information and management Implementation of 5 poisons information and management centers at 5 governorates.centers at 5 governorates.

Training on :Training on :

- Information services. - Information services.

- First Aid services- First Aid services..

- Prevention handling and safe disposal- Prevention handling and safe disposal

- Environmental toxicology- Environmental toxicology

- Occupational toxicology- Occupational toxicology

Equipmentation of the above centers with : - Equipmentation of the above centers with : -

- PC hardware & relevant software.- PC hardware & relevant software.

- Specific medical equipments.- Specific medical equipments.

Implementation of toxicovigilance program for the Implementation of toxicovigilance program for the

different levels of health officials at all governorates.different levels of health officials at all governorates.

Supply the above unit with audiovisual training and Supply the above unit with audiovisual training and

educational materials on chemical safety matters educational materials on chemical safety matters

( guidelines, brochures ,posters).( guidelines, brochures ,posters).

Participation in the EMRO plan for preparedness to Participation in the EMRO plan for preparedness to

chemical accidentschemical accidents

The Directorate of Emergency Medical careThe Directorate of Emergency Medical care

is responsible for ambulance and immediate care of chemical is responsible for ambulance and immediate care of chemical

intoxication cases.intoxication cases.

The G.D. of Environmental HealthThe G.D. of Environmental Health

supervises hazardous materials and hazardous wastes supervises hazardous materials and hazardous wastes

generated by health establishments.generated by health establishments.

The G.D. of Food ControlThe G.D. of Food Control sets limits for food additives sets limits for food additives

and food contaminants, inspects and analyses imported and and food contaminants, inspects and analyses imported and

locally produced foods and those on the market for safety and locally produced foods and those on the market for safety and

investigates food poisoning outbreaks.investigates food poisoning outbreaks.

The D. of CentralThe D. of Central LaboratoriesLaboratories has laboratories has laboratories

which analyse vomitus,urine,blood of poisoned cases.which analyse vomitus,urine,blood of poisoned cases.

The research institute of Medical EntomologyThe research institute of Medical Entomology : :

carries out laboratory and field research to examine the carries out laboratory and field research to examine the

efficacy of public health pesticides and provide efficacy of public health pesticides and provide

information for registration of pesticides used for public information for registration of pesticides used for public

health and household purposes. These information are health and household purposes. These information are

utilized by theutilized by the Drug Policies and Planning Center Drug Policies and Planning Center

( DPPC ). The DPPC also participates in registration of ( DPPC ). The DPPC also participates in registration of

PH. Preparation under the responsibility of the central PH. Preparation under the responsibility of the central

directorate of pharmacy. directorate of pharmacy.

The General Organization for HealthThe General Organization for Health Insurance carries Insurance carries

out periodic medical examinations for workers exposed to out periodic medical examinations for workers exposed to

hazardous chemicals at work place.hazardous chemicals at work place.

The Ministry of Manpower and ImmigrationThe Ministry of Manpower and Immigration is is

responsible for the health of workers. Labour law no. responsible for the health of workers. Labour law no.

137/1981 has a special chapter devoted to occupational 137/1981 has a special chapter devoted to occupational

safety and health. The executive regulations and Ministerial safety and health. The executive regulations and Ministerial

Decrees set standards for work place exposures and specify Decrees set standards for work place exposures and specify

conditions to be observed to ensure safety in the use of conditions to be observed to ensure safety in the use of

chemicals.chemicals.

The Ministry of Housing and Utilities and New The Ministry of Housing and Utilities and New

CommunitiesCommunities issues standards and safety procedures for issues standards and safety procedures for

Industrial, commercial and other work places concerning Industrial, commercial and other work places concerning

chemical pollutants.chemical pollutants.

The Ministry of Water ResourcesThe Ministry of Water Resources implements implements

legislation to protect the River Nile and water ways from legislation to protect the River Nile and water ways from

pollution with all kinds of waste especially chemicals. pollution with all kinds of waste especially chemicals.

The Ministry of PetroleumThe Ministry of Petroleum implements chemical safety implements chemical safety

precautions in petroleum companies and has its own emergency precautions in petroleum companies and has its own emergency

plan for dealing with oil spills.plan for dealing with oil spills.

The Ministry of Interior- CivilThe Ministry of Interior- Civil defense Authority has plans for defense Authority has plans for

emergency actions towards chemical accident , trains personnel, emergency actions towards chemical accident , trains personnel,

inspects sites of potential riskinspects sites of potential risk

The customs AuthorityThe customs Authority and the General Organization for and the General Organization for

Control of Export and Import make sure that all imported Control of Export and Import make sure that all imported

chemicals comply with specifications and that restricted chemicals comply with specifications and that restricted

chemicals are not permitted. They co-operate with agencies for chemicals are not permitted. They co-operate with agencies for

which these chemicals are imported.which these chemicals are imported.

The Ministry of Agriculture deals with the The Ministry of Agriculture deals with the registration and safe handling of agricultural registration and safe handling of agricultural pesticides and monitors food for pesticide pesticides and monitors food for pesticide residues.residues.

The Ministry of Industry regulates the The Ministry of Industry regulates the importation and use of industrial chemicals importation and use of industrial chemicals and restricts the importation and handling of and restricts the importation and handling of hazardous chemicals . It prepared a list of hazardous chemicals . It prepared a list of chemicals used in industry. It also defines chemicals used in industry. It also defines places and methods of treatment and places and methods of treatment and disposal of hazardous chemical waste.disposal of hazardous chemical waste.

Poison Centers:Poison Centers:

Three centers were established at the Three centers were established at the

Universities of Ein Shams,Universities of Ein Shams, Alexandria andAlexandria and

CairoCairo..They carry out the following functions :They carry out the following functions :

Treat cases of chemical poisoning.Treat cases of chemical poisoning.

Carry out research.Carry out research.

legislationlegislation

Several Several legislationlegislation have dealt with the proper handling of hazardous have dealt with the proper handling of hazardous

chemicals, including pesticides, which are implemented by concerned chemicals, including pesticides, which are implemented by concerned

agencies.:agencies.:

Environmental law no.4 1994Environmental law no.4 1994

Labor law no 12 year 2003Labor law no 12 year 2003

Ministerial decree No. 55 year 1995 prohibits the use of 80 Ministerial decree No. 55 year 1995 prohibits the use of 80

agrochemical .agrochemical .

Egyptian activities in managing chemicalsEgyptian activities in managing chemicals

The Egyptian Environmental Affairs Agency (EEAA) is The Egyptian Environmental Affairs Agency (EEAA) is

the national body, which is responsible for drawing up the national body, which is responsible for drawing up

Egypt’s policy on the welfare of the environment and Egypt’s policy on the welfare of the environment and

natural resources, endorsing executive plans and natural resources, endorsing executive plans and

programs and the promulgation and follow-up of programs and the promulgation and follow-up of

legislation.legislation.

In response to Agenda 21, The Minister of Health has In response to Agenda 21, The Minister of Health has

approved a National Strategy of Health and Environment approved a National Strategy of Health and Environment

which was prepared in 1995, with assistance from the which was prepared in 1995, with assistance from the

WHO. And which had a chapter on chemical safety,WHO. And which had a chapter on chemical safety,

The MOHP is working towards a coThe MOHP is working towards a co--ordinated national ordinated national

activity in the field of chemical safety and it would be activity in the field of chemical safety and it would be

essential to have the strategy on chemical safety approved essential to have the strategy on chemical safety approved

by all concerned parties and to draw an integrated picture by all concerned parties and to draw an integrated picture

of the activities going on in that fieldof the activities going on in that field. . The necessary The necessary

information has to be collected from different agencies so information has to be collected from different agencies so

as to serve as a basis for this activity, to identify gaps and as to serve as a basis for this activity, to identify gaps and

suggest further actionsuggest further action..

Poison centers Poison centers SoftwareSoftware

Benefits of the softwareBenefits of the software To find out as rapid as accurate as the user To find out as rapid as accurate as the user

can the chemical name that he search for a can the chemical name that he search for a specific information.specific information.

To search either by generic or common To search either by generic or common names according to local data(Egyptian names according to local data(Egyptian common names).common names).

To set queries for cases scenarios by signs To set queries for cases scenarios by signs and symptoms, uses, color and state to reach and symptoms, uses, color and state to reach most possibilities.most possibilities.

Search a chemical by Search a chemical by generic namegeneric name

Search a chemical by Search a chemical by Common(trade) nameCommon(trade) name

Search a chemical by Color, Search a chemical by Color, state, uses and Signs & state, uses and Signs &

SymptomsSymptoms

Signs & Symptoms Color

State Uses

Search chemical via Search chemical via internetinternet

Selecting source and Selecting source and categorycategory

Source

Category

Output document(Pdf)Output document(Pdf)

Communication recordsCommunication records

Reporting data entry of Reporting data entry of poisoningpoisoning

Ministry of Health & PopulationMinistry of Health & PopulationOccupational Health Dept.Occupational Health Dept.Chemical Safety UnitChemical Safety Unit

Chemical Inventory sheetChemical Inventory sheet Date of Entry: Date of Entry: Chemical Name:Chemical Name: Importer:Importer: Exporter:Exporter: Origin:Origin: Quantity: ( X Kgm)Quantity: ( X Kgm) Port:Port: Class:Class: Status:Status:[MM1][MM1]   [MM1][MM1]

PublicationsPublications

PublicationsPublications

Management of acute poisoningManagement of acute poisoning Drugs interactionDrugs interaction Prevention of poisoning(3 parts)Prevention of poisoning(3 parts) Chemical risk assessmentChemical risk assessment INTOX CDINTOX CD Data retrieval software CD and Data retrieval software CD and

user manualuser manual

Recommendation Strengthening of national capabilities and capacities for management of chemicals

Basic elements of sound management of chemicals Basic elements of sound management of chemicals areare: : • adequate legislation,adequate legislation,• information gathering and dissemination,information gathering and dissemination,• capacity for risk assessment and interpretation, capacity for risk assessment and interpretation, • establishment of risk management policy,establishment of risk management policy,• capacity for implementation and enforcement,capacity for implementation and enforcement,• capacity for rehabilitation of contaminated sites and capacity for rehabilitation of contaminated sites and poisoned persons,poisoned persons,• effective education programs and effective education programs and • capacity to respond to emergenciescapacity to respond to emergencies..

recommendationrecommendation

Safe use of pesticidesSafe use of pesticides Health education Health education Environmental and biological monitoringEnvironmental and biological monitoring Personal protection and treatment programe are necessary  Personal protection and treatment programe are necessary   Measures should be planned to prevent major hazards Measures should be planned to prevent major hazards TrainingTraining Information activities, modification of data collection Information activities, modification of data collection system and registration. system and registration. Epidemiological studies on population at riskEpidemiological studies on population at risk Risk assessment.Risk assessment. legislation : revision - enforcement - awarenesslegislation : revision - enforcement - awareness Public awarenessPublic awareness Coordination : GOs - NGOs - institutions. Coordination : GOs - NGOs - institutions. National Chemical Safety Profile.National Chemical Safety Profile.