Regional Center for Poison Control and Preventions e rv i n g M a s s a c h u s e t t s a n d r h o d e i s l a n d • A N N U A L R E P O R T

2004

�

Table of Contents e x e c u t i v e r e p o rt a n d M i s s i o n 2

F i n a n c i a l r e p o rt 4

p u b l i c e d u c at i o n 6

p r o F e s s i o n a l e d u c at i o n 7

S TAT I S T I C S

W h o M d o W e s e rv e a n d W h y d o t h e y c a l l ? 8

p e n e t r a n c e r at e s 9

W h e r e d o p o i s o n i n g s h a p p e n ? 1 1

W h e r e d o t h e c a l l s c o M e F r o M ? 1 1

W h e r e a r e p o i s o n i n g s M a n a g e d ? 1 1

W h o a r e t h e p o i s o n e d ? 1 2

W h at a r e t h e M o s t c o M M o n a g e n t s ? 1 3

W h at Wa s t h e r e a s o n F o r t h e p o i s o n i n g ? 1 4

W h at Wa s t h e r e s u lt o F t h e p o i s o n i n g ? 1 5

s u M M a ry o F d e at h c a s e s 1 6

A P P E N D I X

a . c e n t e r s ta F F 1 7

b . a d v i s o ry c o M M i t t e e 1 8

c . M o s t c o M M o n s u b s ta n c e s b y c at e g o r i e s 1 9

d . h o s p i ta l c a l l e r s a n d F u n d i n g pa rt n e r s 2 0

e . p u b l i c at i o n s 2 2

�

Executive Report TheRegionalCenterforPoisonControlandPreventionservingMassachusettsandRhodeIsland(the

Center)hasservedbothstatessinceJanuary2000.TothistheCenteraddsanadditional45yearsofexperience

inprovidinginformationontheevaluationandtreatmentofpoisoningsastheMassachusettsPoisonControl

System,and19yearsexperienceastheRhodeIslandPoisonCenter.Thisreportprovidesinformationon

thedemographicsandsubstancesinvolvedinpoisoningsreportedtotheCenterduring2004,aswellasthe

treatmentsandoutcomesofthesecases,inadditiontotheCenter’spoisoningpreventionefforts.

InMarch2004,MassachusettsGovernorMittRomneymetwithrepresentativesoftheCenter,tofollowuponthe

Center’sextensivelegislativeoutreachacrossbothMassachusettsandRhodeIslandin2003.GovernorRomney

signedaproclamationacknowledgingPoisonPreventionWeekandappearedwiththeCenter’sstaffattheState

Houseindemonstrationofthestate’scommitmenttothisvitalservice.Othermediaeventsincludedtelevision

interviewswithChannel10ofProvidenceandChannel5ofBoston,publicserviceannouncementsonseveral

Massachusettsradiostations,andaninterviewonaSpanishlanguagecallinshowonProvidence’s990AM.

2004alsosawthepublicationoftheInstituteofMedicine’sreportonPoisonControlCentersintheUnitedStates,

Forging a Poison Prevention and Control System (http://www.iom.edu/report.asp?id=19901),andtheNortheast

InjuryPreventionNetwork’sPoison Data Book (available at http://www.edc.org).Bothreportsspeaktotheneed

forincreasedattentiontopoisoninginjuriesonanationalandregionallevel,andsuggestthatpoisoncontrol

servicesshouldbebetterintegratedinthefederalandstatehealthpublicinfrastructure.

TheoriginalHealthResourcesandServicesAdministration(HRSA)incentivegrantthatendedin2003wasrenewed

foranothertwoyears.TheNewEnglandConsortiumofPoisonControlCenterscontinueditscollaborationwitha

seriesofregionaltoxicologymeetings,onlineprofessionaltrainingmodulesandquarterlynewsletters.

What is a poisoning? Apoisoningiscausedbyanysubstancethathasatoxic,ordamagingeffect,tothetissuesand/or

systemsofthebodyuponexposure.Exposurescanoccurthroughingestion,inhalationorthroughdermal

andocularcontact.

Anysubstancemaybecomeapoisonifitusedincorrectly,inthewrongamount,orbyapersonwithaparticular

sensitivitytotheproduct.Commonpoisonsincludehouseholdproducts,industrialandenvironmental

chemicals,medications(prescription,overthecounter,veterinaryandherbal),illicitdrugs,andvenom.

InJune,theNewHampshirePoisonControlCenterclosedandtheNorthernNewEnglandPoisonControl

Centertookoverservicesforthatstate.AlthoughthisbroughtanendtotheCenter’scontracttocover

NewHampshire’sovernightcalls,theCentercontinuestocoordinatewithNewHampshirephysicians

throughtheongoingNewEnglandRegionalToxicologyConferences.

TheCenterremainsanimportantcomponentinprotectingpublichealth.InOctober2004,theCenterworked

closelywiththeRhodeIslandDepartmentofPublicHealth’sDivisionofEnvironmentalHealthtomanagea

massresidentialexposuretoelementalmercuryinPawtucket.TheCenteradvisedindividualsandhealthcare

professionalsintheevaluationandmanagementofthesecases,inordertomosteffectivelyreducethelong-term

healthrisksassociatedwiththeexposure.

Asnationalsecuritycontinuestobeofforemostconcern,poisoncontrolcenterresourcesremainavitalpartof

thepublichealthresponsetochemical/biologicalterrorismthreats.Accordingly,allsegmentsofthepopulation,

includingthegeneralpublic,lawenforcement,legislativebodies,firstresponders,healthcareproviders,and

publichealthspecialistshaveutilizedpoisoncontrolcenterresourcesasanemergencypreparednessresource.

TheCenterparticipatesintwonationalsurveillancesystems,Epi-XandthenationalToxicExposureSurveillance

System,bothofwhicharemonitoredbytheCentersforDiseaseControlandPrevention(CDC)forpotential

earlydetectionofamasstoxicexposureorbioterrorismresponse.

Locally,theCenteralsoprovidesitsresourcesforregionalexercisesthattestemergencyprotocolsandidentify

gapsinpreparedness.Aspartofthesecuritymeasuresaroundthe2004DemocraticNationalConvention,in

Boston,thecenterprovidedlivetoxicsurveillancedatadirectlytotheBostonPublicHealthCommission.The

Centerremainscommittedtomaintainingalevelofexcellenceinemergencypreparednesssothatbothhealth

careprofessionalsandthepublicthatitserveswillhaveaccesstostate-of-the-artresourcesinatimeofneed.

�

Mission ThemissionofRegionalCenterforPoisonControlandPreventionistoprovideassistanceand

expertiseinthemedicaldiagnosis,managementandpreventionofpoisoningsinvolvingthepeopleof

MassachusettsandRhodeIsland.TheCenterseekstoimprovethequalityofmedicalcaregivento

patientsbymaintainingastandardofexcellenceinbothclinicalresearchandprofessionaldevelopment.

Inaddition,theCenterdevelopsandimplementspubliceducationandinformationcampaignsto

preventinjuriesduetointentionalandunintentionalpoisonings.

Financials Infiscalyear2004,theannualoperatingbudgetfortheRegionalCenterforPoisonControlandPrevention

wasover$2million.ThemajorityofthefundingforCenteroperationsisprovidedbytheMassachusetts

DepartmentofPublicHealthandRhodeIslandDepartmentofHealth,withadditionalfundingfromhospital

partnersandpharmacytrainingprograms.TheCentercontinuestoreceivefederalfundsappropriatedfrom

thePoisonControlCenterEnhancementandAwarenessActof2000.Thefollowingtablehighlightsrevenue

andexpendituresforfiscalyear2004.Thebalancereflectsfundingreservedtooffsetthecontinuingdecline

ofmemberhospitaldonationsandtheanticipatedlossofrevenuefromthecompletionofboththeNew

HampshirePoisonControlCenternightcontractandtheHRSANewEnglandconsortiumgrant.

�

F I S C A l Y E A r � 0 0 � ( J u lY � 0 0 � T o J u N E � 0 0 � )

o p e r at i n g r e v e n u e

d e pa rt M e n t o F p u b l i c h e a lt h , M a s s a c h u s e t t s $ 5 2 0 , 4 4 0

S o u r c e S M at e r n a l a n d c h i l d h e a lt h b l o c k g r a n t $ 3 2 8 , 2 5 6

h r S a h o S p i ta l e M e r g e n c y p r e pa r e d n e S S $ 1 7 7 , 1 8 4

S u b S ta n c e a b u S e p r e v e n t i o n $ 1 5 , 0 0 0

d e pa rt M e n t o F h e a lt h , r h o d e i s l a n d $ 3 0 0 , 0 0 0

S o u r c e S h r S a h o S p i ta l e M e r g e n c y p r e pa r e d n e S S $ 1 5 0 , 0 0 0

c d c $ 1 0 0 , 0 0 0

S tat e o f r h o d e i S l a n d $ 5 0 , 0 0 0

F e d e r a l s ta b i l i z at i o n g r a n t $ 3 7 4 , 9 5 1

F e d e r a l n e W e n g l a n d c o n s o rt i u M g r a n t $ 3 6 , 9 7 6

F u n d i n g pa rt n e r s $ 1 1 0 , 2 7 1

n e W h a M p s h i r e c o n t r a c t $ 3 4 , 2 8 6

p h a r M a c y t r a i n i n g p r o g r a M s $ 4 , 5 0 0

S u b T o TA l $ � , � 8 � , � � �

C h I l D r E N ’ S h o S P I TA l I N - K I N D $ 7 � 8 , � � 0

T o TA l $ � , 0 9 9 , 7 6 �

d i r e c t e x p e n s e s

s a l a r i e s a n d b e n e F i t s $ 1 , 0 7 0 , 7 4 9

t e l e p h o n e $ 3 8 , 5 3 5

p r i n t i n g a n d p o s ta g e $ 3 5 , 8 1 1

t o x i c a l l s o F t Wa r e l i c e n s i n g F e e $ 2 5 , 8 6 5

t r av e l $ 1 6 , 6 0 0

e d u c at i o n a l M at e r i a l s $ 1 , 0 3 1

s u p p l i e s $ 1 5 , 8 4 5

d u e s / M e M b e r s h i p s $ 8 , 6 7 5

o t h e r $ 8 6 5

S u b T o TA l $ � , � � � , 9 7 6

C h I l D r E N ’ S h o S P I TA l I N - K I N D $ 7 � 8 , � � 0

T o TA l $ � , 9 � � , � � 7

b A l A N C E : $ � 6 7 , � � 7

5

6

Public Education ThegoalofthePoisonControlCenter’spubliceducationprogramistoreducebothintentionaland

unintentionalpoisoningsthroughpoisoningpreventioneducationandpromotionoftheCenter’sservices.

In2004,theCenter’sHealthEducationsub-committeecontinuedtoconvenetoadvisethePoisonControl

Center’sstaffoneffectivestrategiesfortheimplementationoftheStrategicPlancreatedintheyear2000,

andrevisedin2003;alistofcommitteemembersisincludedinAppendixB.ActivitiesinMassachusettswere

restrictedin2004asbudgetlimitationsrequiredascalingbackoftheeducationalprogram.Agreateremphasis

wasturnedtodevelopmentofthewebpage,www.maripoisoncenter.com,asameansofcommunicatingwith

thepublic.Thesitesubsequentlyre-launchedin2005.

2004 Accomplishments:

»Addedthenationalpoisonhelplogotoallnewprintingsof

educationalmaterialsandhandoutswheresizeallows,incontinuing

effortstopromotethenation-widehotlinenumber,1-800-222-1222.

»Performedoutreachinclassrooms,healthcenters,andhealthfairs,

includingSpanishlanguageoutreachtoRhodeIsland.

»ParticipatedinRhodeIslandDepartmentofHealth’smercury

thermometerexchange.

»ContinuedtocontributetoanddeveloptheNewEnglandConsortium

ofPoisonCentersnewsletter,PoisonControlNews,supportedby

HRSAandfocusingonenvironmentaltoxinsandpoisonissues.

TheCenterprovidedarticlesonpoolsafetyandspidersbites,and

Spanishtranslationsofarticlesonpesticides,mercuryandlead.

»Updatedcurrentinventoryofeducationalfactsheetsandcreated

newsheetsaboutcommonpoisoningrisks,includingpresentation

materialsoncandyandmedicinelook-alikes,thetoptenmost

commonexposuresandpoisonpreventiontipsforseniors.

»UpdatedSpanishlanguagehandoutinventory,includingnew

translationsofcandyandmedicinelook-alikesandtheipecacalert.

»AddedSpanishlanguagetelephonestickerstoeducation

materialinventory.

»DistributedNortheastInjuryPreventionPoisonDataBookin

MassachusettsandRhodeIsland.

C u r r E N T E D u C AT I o N A l M AT E r I A l S , � 0 0 �

p o i s o n c e n t e r b r o c h u r e ( e n g l i s h & s pa n i s h )

t e l e p h o n e s t i c k e r s ( e n g l i s h & s pa n i s h )

r e F r i g e r at o r M a g n e t s

p o s t e r s

M e d i c i n e pa s s p o rt F o r s e n i o r s

c l i n i c a l t o x i c o l o g y r e v i e W

FA C T S h E E T S

c a n d y o r M e d i c i n e ( e n g l i s h & s pa n i s h )

c a r b o n M o n o x i d e

c h i l d r e n a c t Fa s t ( e n g l i s h & s pa n i s h )

Fa l l p o i s o n s a F e t y t i p s

h a l l o W e e n s a F e t y

i p e c a c a l e rt ( s pa n i s h )

p o i s o n p r e v e n t i o n t i p s

p o i s o n o u s p l a n t s ( e n g l i s h & s pa n i s h )

p r e v e n t i n g p o i s o n i n g i n y o u r h o M e

( e n g l i s h & s pa n i s h )

s a F e p l a n t s ( e n g l i s h & s pa n i s h )

s a F e r a lt e r n at i v e s

t o p t e n p o i s o n e x p o s u r e s i n c h i l d r e n

W i n t e r h o l i d ay s a F e t y

M AT E r I A l S F o r C h I l D r E N

s p i k e t e M p o r a ry tat t o o s F o r c h i l d r e n

p o i s o n p r e v e n t i o n c o l o r i n g b o o k

p o i s o n W o r d s e a r c h

p i l l s a n d p o i s o n s Q u i z ( e n g l i s h & s pa n i s h )

Additionalarticlescoveringawidearrayofpoisoningconcernsare

availableinbothEnglishandSpanishatwww.maripoisoncenter.com

Professional Education TheProfessionalEducationprogramattheRegionalCenterforPoisonControlandPreventionis

comprisedofthreecomponents:continuingeducationforcenterstaff,educationforhealthprofessionals,

andextramuraleducationforhealthprofessionals.TheCenterhascontinuedtoprovidethehighestquality

professionaldevelopmenttoitsstaff,aswellastheprofessionalcommunityoutsidetheCenter.

Continuing Education for Center Staff

»Presentedfourteenin-serviceprogramstothestaff,onsuchtopicsasAlcohols/Glycols,Biologicals,GHB,

Pesticides,AcetaminophenOverdoseManagementandWeaponsofMassDestruction.

»Institutedmonthlyreadinglistofcurrentmedicaltoxicologyliterature.

»Implementedpeerreviewqualityassuranceprogram.

»ParticipatedinNewEnglandRegionalToxicologyConferenceandNewEnglandConsortiumseminars.

Education for Health Professionals

»FellowshipPrograminMedicalToxicology:TheCentermaintainedanactivetwo-yearpostgraduate

fellowshipinmedicaltoxicology.InrecognitionofitsuniqueservicewithintheHarvard-affiliatedhospital

system,theprogramalsoreceivedtheofficialdesignationastheHarvardMedicalToxicologyFellowship.

»DoctorofPharmacyClerkship:SeveralstudentsfromtheMassachusettsCollegeofPharmacyandHealth

SciencesandtheUniversityofRhodeIslandCollegeofPharmacyparticipatedinasix-weekrotation

throughtheRegionalPoisonCenter.

»EmergencyMedicineResidentRotation:Thirty-twothird-yearresidentsfromBostonMedicalCenter,

BrighamandWomen’sHospital,MassachusettsGeneralHospital,BethIsraelDeaconessMedicalCenter,

theHarvardUniversity-affiliatedhospitals,andRhodeIslandHospitalparticipatedinaone-monthrotation

throughthecenter.TheCenterwasalsothesiteoffourteenPediatricEmergencyMedicinefellowsfrom

Children’shospitalBoston,BostonMedicalCenterandHasbroChildren’sHospital.

»MedicalStudentClerkship:TheCenterhostedmedicalstudentsfromHarvardandtheUniversityofGlasgow.

Education for Health Professionals—Extramural

»ConductedlecturesonclinicaltoxicologyattheMassachusettsCollegeofPharmacyandHealthSciences

andUniversityofRhodeIslandCollegeofPharamacy,aswellaslecturedatvariousteachinghospitals,

communityhospitalsandcontinuingeducationcoursesforhealthprofessionals.

»Authoredbooksandchaptersalongwithcontributingarticlestovariousprofessionaljournals.Acomplete

listofthesepublicationsisincludedinAppendixE.

7

8

Whom do we serve and why do they call? In2004,theCentermanagedatotalof66,585incomingcalls,

including53,880exposurecallsand12,705informationcalls.

TheCentercontinuedtoexperienceadecreaseininformation

callsin2004asaresultofthe2003policychangewhich

prioritizesdrugidentificationcallstohealthcareandlaw

enforcementprofessionals.

ThetotalpopulationfortheareaservedbytheCenteris7,361,057residents.Massachusetts’population

is6,349,097(86%)andRhodeIsland’spopulationis1,011,960(13%).Thenumberofcallsreceivedannually

fromeachstatecontinuestobeproportionaltothestatepopulation.

T Y P E o F C A l l � 0 0 � � 0 0 �

� 0 0 � � 0 0 �

i n F o r M at i o n 1 5 , 7 8 5 2 5 , 2 0 9 1 5 , 8 5 9 1 2 , 7 0 5

a l l e x p o s u r e s 4 5 , 1 9 3 5 2 , 1 8 1 5 2 , 7 3 9 5 3 , 8 8 0

t o ta l 6 0 , 9 7 8 7 7 , 3 9 0 6 8 , 5 9 8 6 6 , 5 8 5

T Y P E o F C A l l r h o D E I S l A N D � 0 0 � � 0 0 � � 0 0 � � 0 0 �

i n F o r M at i o n 1 , 7 1 3 2 , 7 6 8 2 , 9 5 4 2 , 1 5 9

e x p o s u r e 6 , 0 9 3 8 , 3 3 5 7 , 4 1 5 7 , 7 0 3

t o ta l 7 , 8 0 6 1 1 , 1 0 3 1 0 , 3 6 9 9 , 8 6 2

T Y P E o F C A l l M A S S A C h u S E T T S

i n F o r M at i o n 1 3 , 7 2 4 2 2 , 0 2 0 1 2 , 6 5 3 1 0 , 3 0 1

e x p o s u r e 3 8 , 3 8 7 4 2 , 3 4 0 4 3 , 8 7 4 4 5 , 1 0 6

t o ta l 5 2 , 1 1 1 6 4 , 3 6 0 5 6 , 5 2 6 5 5 , 4 0 7

9

C A l l P E N E T r A N C E b Y C o u N T Y: M A S S A C h u S E T T S � 0 0 � � 0 0 � � 0 0 �

CouNTY PoPulATIoN EXPoSurES PENETrENCE EXPoSurES PENETrENCE EXPoSurES PENETrENCE

b a r n s ta b l e 2 2 2 , 2 3 0 1 , 4 5 0 6 . 5 1 , 4 2 8 6 . 4 1 , 4 7 2 6 . 4

b e r k s h i r e 1 3 4 , 9 5 3 8 2 1 6 . 1 7 5 7 5 . 6 7 9 4 6

b r i s t o l 5 3 4 , 6 7 8 3 , 1 0 1 5 . 8 2 , 7 9 7 5 . 2 3 , 1 4 4 5 . 7

d u k e s 1 4 , 9 8 7 1 2 4 8 . 3 1 2 6 8 . 4 1 4 8 9 . 4

e s s e x 7 2 3 , 4 1 9 4 , 3 2 7 6 . 0 4 , 0 2 4 5 . 6 4 , 6 7 1 6 . 3

F r a n k l i n 7 1 , 5 3 5 3 7 1 5 . 2 5 5 3 7 . 7 5 5 1 7 . 6

h a M p d e n 4 5 6 , 2 2 8 2 , 4 1 1 5 . 3 2 , 2 3 0 4 . 9 2 , 5 8 3 5 . 6

h a M p s h i r e 1 5 2 , 2 5 1 8 2 8 5 . 4 7 7 9 5 . 1 9 0 5 5 . 9

M i d d l e s e x 1 , 4 6 5 , 3 9 6 9 , 4 4 3 6 . 4 8 , 3 6 1 5 . 7 8 , 6 8 8 5 . 9

n a n t u c k e t 9 , 5 2 0 1 0 3 1 0 . 8 6 9 7 . 2 1 0 2 1 0 . 1

n o r F o l k 6 5 0 , 3 0 8 4 , 4 5 1 6 . 8 4 , 0 7 3 6 . 3 4 , 3 5 4 6 . 7

p ly M o u t h 4 7 2 , 8 2 2 3 , 5 4 7 7 . 6 3 , 2 7 0 6 . 9 3 , 6 3 9 7 . 4

s u F F o l k 6 8 9 , 8 0 7 3 , 8 5 6 5 . 6 2 , 9 2 9 4 . 2 3 , 4 5 2 5 . 2

W o r c e s t e r 7 5 0 , 9 6 3 4 , 5 4 6 6 . 1 4 , 6 1 0 6 . 1 5 , 0 1 3 6 . 4

n o t s p e c i F i e d 7 , 8 2 6

M A S TAT E 6 , � � 9 , 0 9 7 � � , � � 0 6 . 7 � � , 8 � � 6 . 9 � � , 9 9 � 7 . 0

C A l l P E N E T r A N C E b Y C o r E C I T Y: r h o D E I S l A N D � 0 0 � � 0 0 � � 0 0 �

CorECITY PoPulATIoN EXPoSurES PENETrENCE EXPoSurES PENETrENCE EXPoSurES PENETrENCE

c e n t r a l Fa l l s 1 7 , 1 9 7 1 5 2 8 . 8 7 4 4 . 3 6 7 3 . 5

n e W p o rt 2 8 , 1 8 4 2 7 3 9 . 7 2 3 5 8 . 3 2 4 1 9 . 3

paW t u c k e t 7 1 , 7 8 4 6 4 7 9 . 0 6 1 6 8 . 6 4 1 2 5 . 5

p r o v i d e n c e 1 5 6 , 7 2 7 1 , 3 4 0 8 . 5 1 , 9 2 2 1 2 . 3 1 , 4 6 9 8 . 2

W o o n s o c k e t 4 3 , 3 7 7 3 1 2 7 . 2 3 9 8 9 . 2 3 9 1 8 . 8

a l l o t h e r s 6 9 4 , 6 9 1 5 , 6 1 1 8 . 1 4 , 1 6 3 6 . 0 5 , 0 4 0 6 . 8

r I S TAT E � , 0 � � , 9 6 0 8 , � � 5 8 . � 7 , � 0 8 7 . � 7 , 6 � 0 7 . �

P o P u l At i o n d AtA S o u r c E : u S c E n S u S B u r E A u , 2 0 0 0

Penetrance Inordertokeeptrenddataconsistant,thedefinitionofpenetrancewillonlyincludethenumberofhuman

exposurecallshandledper1,000population.In2001,theAmericanAssociationofPoisonControlCenterschanged

thedefinitionofpenetrancetoincludeinformationcalls;however,wearenotusingthatdefinitioninthisreport.

ThetablesbelowhighlightpenetranceratesbycountyinMassachusettsandbycorecityinRhodeIsland.

ThisanalysiswillhelptheCentertargetandevaluatetheeffectivenessofitsoutreachandeducationefforts.

�0

Where do poisonings happen? Ofthe53,731exposurecallsmanagedbytheCenterin2004,about93%(50,227)wereexposuresinaresidence

withtheremaining7%(3,504)occurringinotherlocationssuchasschools,workplacesandotherpublicareas.

Where do calls come from? In2004morethan79%oftheexposurecallscamefromresidences,

16%(8,485)fromhealthcarefacilitiesandmedicalprofessionalswiththe

remaining5.9%(3,110)comingfromvarioussourcessuchaspublicareas,

schoolsandworkplaces.Thecaller'slocationwasunknowninlessthan

0.1%(31)ofcases.

Thegraphtotherightrepresentscallerlocationdistributionfor2004.

AppendixDcontainsabreakdownofthenumberofcallsbyHospitalacross

thetwo-stateregion.

Where are poisonings managed? In2004themajorityofthehumanexposurecalls(76%)weremanagedon-siteatanonhealthcare

facility.Thisyear’sfigurerepresentsaslightincreaseinthenumberofcasestreatedataHealthCareFacility.

Ofinterestarethecallsthatweremanagedatahealthcarefacilitybutwere

treatedandreleased.Whileitisunclearwhetherapre-hospitalcallcould

havepreventedatriptotheemergencyroom,thepotentialforcostsavings

existsifthePoisonCenterisinvolvedpriortothehospital.Agraphatleft

showscallsmanagedathealthcarefacilities.

��

M A N A g E M E N T S I T E � 0 0 �

o n s i t e : 4 0 , 8 7 0

h c F : 1 1 , 3 2 1

u n k n o W n : 1 , 2 2 6

r e F u s e d r e F : 3 4 7

t r e at e d a n d r e l e a s e d : 4 3 %

lost to FolloW-up: 27%

a d M i t t e dcritical: 14%

a d M i t t e d p s y c h i at r i c : 6 %

a d M i t t e d n o n - c r i t i c a l : 1 0 %

r e s i d e n c e : 7 9 %

health care Facility: 16%

o t h e r : 5 %

Who are the poisoned? Ofthe53,731humanexposurecallsansweredin2004,specificagewascapturedfor53,698cases

(99.9%).Almost54%(28,169)oftheexposurecallsinvolvedchildren

5yearsandyounger.Specifically,thegreatestnumbersofexposurecalls

involvedtwo-year-olds;10,084callsforthisagegroupwerereceived,

representingover19%ofthetotalexposurecalls.Acombined21%of

allexposurecallsinvolvedinfantsageoneandunder.

Eachyeargenderremainssplitequallybetweenmalesandfemales.Ofthe

exposurecallsreceived,genderwasrecordedfor53,291callsin2004.

Overall,thedistributionoftheageorgenderhasnotchangedwithan

increaseintotalcalls.

��

g E N D E r � 0 0 �

M a l e s 2 6 , 5 1 8

F e M a l e s 2 6 , 7 7 3

T o TA l 5 � , � 9 �

C A l l V o l u M E b Y A g E : � 0 0 �

1 2 , 0 0 0

1 0 , 0 0 0

8 , 0 0 0

6 , 0 0 0

4 , 0 0 0

2 , 0 0 0

0

< 1 y r 1 y r 2 y r 3 y r 4 y r 5 y r 6 - 1 2 y r 1 3 - 1 9 y r 2 0 - 2 9 y r 3 0 - 5 9 y r 6 0 + y r

e x p o s u r e s 3 , 0 3 7 8 , 2 3 0 1 0 , 0 8 4 4 , 4 2 3 1 , 9 1 9 1 , 0 7 6 3 , 7 3 9 3 , 9 2 5 3 , 1 5 9 6 , 8 7 4 2 , 1 4 4

a g e c a l l s c a l l s p e r 1 , 0 0 0 p o p u l at i o n

<5 25,774 55.9 5-9 4,830 9.6 10-14 5,281 10.5 15-19 6,268 12.8 20-24 2,868 6.0 25-34 1,920 1.8 35-44 2,123 1.7 45-54 1,564 1.5 55-59 437 1.2 60+ 2,144 1.7

What are the most common agents of poison?

Productsinvolvedinpoisoningsareregularlydividedinto

drugandnon-drugcategories.Thepercentageofcallsandproducts

ineachcategoryhasremainedconsistentoverthepastthreeyears.

In2004non-drugproductscomprised42%(31,933)ofallcalls.

Itemsincludedinthiscategoryarecosmetic/personalcareproducts

andhouseholdcleaningproducts.Pesticidesarenewtothistopfive

list,narrowlyrankinghigherthanartsandcrafts/officesupplies.

��

T o p F i v e S u b S Ta n c e S M o S T F r e q u e n T ly i n v o lv e d i n n o n - d r u g r e l aT e d e x p o S u r e S , 2 0 0 4

S u b S Ta n c e M o S T c o M M o n p r o d u c T S

C o s m e t i C s / P e r s o n a l C a r e P r o d u C t s C r e a m s / l o t i o n s / f o u n d at i o n , t o o t h Pa s t e w i t h f l o u r i d e ,m o u t h wa s h , n a i l P r o d u C t s , h a i r C a r e P r o d u C t s

C l e a n i n g s u b s ta n C e s b l e a C h , h o u s e l h o l d C l e a n e r s , d i s h wa s h e r d e t e r g e n t s ,d i s i n f e C ta n t s

f o r e i g n b o d i e s / t o y s / m i s C e l l a n e o u s s i l i C a g e l , t h e r m o m e t e r s , g l o w P r o d u C t s , t o y s

P l a n t s n o n - t o x i C P l a n t s , g a s t r o i n t e s t i n a l i r r i ta n t s

P e s t i C i d e s i n s e t i C i d e s , r e P e l l e n t s , r o d e n t i C i d e s , h e r b i C i d e s

In2004drugswerethereportedagentin55%(36,744)

ofallcalls.Analgesics,suchasacetaminophen,continue

tobethemostcommonlyreporteddrug-relatedexposures.

AppendixCprovidesamoredetailedanalysisofthemost

commonsubstancesreportedinbothdrugand

non-drugcategories.

T o P F I V E S u b S TA N C E S M o S T F r E q u E N T lY I N V o lV E D I N D r u g r E l AT E D E X P o S u r E S , � 0 0 �

S u b S TA N C E M o S T C o M M o N P r o D u C T S

a n a l g e s i c s i b u p r o F e n , a c e ta M i n o p h e n , o p i o i d s , a s p i r i n , n a p r o x e n

s e d at i v e s / h y p n o t i c s / a n t i p s y c h o t i c s b e n z o d i a z e p i n e s , at y p i c a l a n t i p s y c h o t i c s

a n t i d e p r e s s a n t s s e r o t i n i n r e - u p ta k e i n h i b i t o r s , t r a z o d o n e , a M i t r i p t y l i n e , l i t h i u M

t o p i c a l s d i a p e r r a s h p r o d u c t s , t o p i c a l s t e r o i d s

c o u g h a n d c o l d r e M e d i e s d e x t r o M e t h o r p h a n , p r o d u c t s W i t h o u t o p i o i d s

a n a l g e s i c s : 1 8 . 9 %

s e d at i v e s / h y p n o t i c s / a n t i p s y c h o t i c s : 9 .8%

o t h e r : 4 9 . 2 %

a n t i d e p r e s s a n t s : 7 . 9 %

t o p i c a l s : 7 . 9 %

c o u g h a n d c o l d r e M e d i e s : 6 . 4 %

c o s M e t i c / p e r s o n a l care products: 1 9 . 5 %

c l e a n i n gsubstances: 12 .5%

o t h e r : 4 2 . 8 %

F o r e i g n b o d i e s / t o y s / M i s c e l l a n e o u s : 9 . 1 %

p l a n t s : 5 . 8 %

p e s t i c i d e s : 6 . 2 %

What was the intent related to the poisoning? Themajorityofthehumanexposureswereunintentional.Ofintentionalpoisonings,suspectedsuicides

(4,093)wererecordedasthelargestsourceoftheintentionalpoisoningsmanagedbytheCenterin2004.

Thesedataareconsistentwithnationalpoisoningstatisticsreported

bytheAmericanAssociationofPoisonControlCenters(AAPCC).

��

intentional: 1 2 %

unintentional 86%

other: 2%

s u s p e c t e d s u i c i d e : 8 %

u n k n o W n : 1 %

a b u s e : 2 %

M i s u s e : 1 %

What was the result of the poisoning? Oftheoutcomesrecordedin2004,8,754(82.8%)didnotrequirefollowupbecausetheexposurewas

judgedtocauseonlyminimaleffectortobenon-toxic,causingnoeffect.

In2004,8,754(16.4%)humanexposureswerefollowed

todeterminethemedicaloutcomeofthepoisoning.

Belowisatableofcasesthatwerefollowed:

�5

D E F I N I T I o N o F M E D I C A l o u T C o M E S � 0 0 �

M i n o r e F F e c t: 2 , 6 7 5

the patient exhibited some symptoms as a result of the exposure, but they were minimally bothersome to the patient.

the patient has returned to a pre-exposure state of well being and has no residual disability or disfigurement.

M o d e r at e e F F e c t: 2 , 2 9 3

the patient exhibited symptoms as a result of the exposure that are more pronounced,

more prolonged or more of a systematic nature than minor symptoms.

M a j o r e F F e c t: 8 4 6

the patient has exhibited some symptoms as a result of the exposure.

the symptoms were life-threatening or resulted in significant residual disability or disfigurement.

d e at h : 2 5

the patient died as a result of the exposure or as a direct complication of the exposure which

was unlikely to have occurred had the toxic exposure not preceded the complication.

only included are those deaths that are probably or undoubtedly related to the exposure.

u n r e l at e d e F F e c t: 4 4 4

based upon all information available, the exposure was probably not responsible for the effect(s).

n o e F F e c t: 2 , 9 1 5

the patient developed no symptoms as a result of the exposure.

C A S E S N o T F o l l o W E D N = � � , � 9 6

M i n i M a l e F F e c t 3 7 , 1 4 4

j u d g e d n o n t o x i c 4 , 5 1 2

u n a b l e t o F o l l o W 2 , 8 4 0

Summary of death cases ThedeathslistedbelowarethosecasesreportedbyhealthcarefacilitiestotheCenterformanagementof

asuspectedpoisoningwheretheCenterreceivedconfirmationofafataloutcome.Inthosecaseswhereseveral

substanceswereingested,thecauseofdeathisascribedexclusivelytothesubstancethatwasdeemedtohave

hadthemosttoxiceffect.

�6

A g E M A l E F E M A l E S u b S TA N C E

0 - 5 0 0

6 - 1 2 0 0

1 3 - 1 9 2 0 s u d d e n c a r d i a c a r r e s t ( p o i s o n i n g r u l e d o u t ) , c o c a i n e , h e r o i n

2 0 - 2 9 2 0 o p i o i d s , t h c , e t h a n o l , a c e ta M i n o p h e n , M u lt i - v i ta M i n W i t h i r o n

3 0 - 3 9 3 6 c o c a i n e , g a b a p e n t i n , r i s p e r i d o n e , e t h y l e n e g ly c o l , e t h e ly n e g ly c o l ,

a c e ta M i n o p h e n , F e n ta n y l pat c h , a M i t r i p t y l i n e , a c e ta M i n o p h e n , u n k n o W n

4 0 - 4 9 2 5 t r i c y c l i c a n t i d e p r e s s a n t s , b u p r o p r i o n , a l p r a z o l a M , l o r a z e pa M , t r a z o d o n e ,

l a M o t r i g i n e , r o F e c o x i b , F e n ta n y l pat c h ; a c e ta M i n o p h e n ; h y d r o c o d o n e ,

c a r i s o p r o d o l , a c e ta M i n o p h e n , d e c o n g e s ta n t, a n t i h i s ta M i n e ; a M i t r i p t y l i n e ,

g a b a p e n t i n , p o ta s s i u M c h l o r i d e , pa n t o p r a z o l e ; h a l o t h a n e , a c e ta M i n o p h e n ;

o v e n c l e a n e r

5 0 - 5 9 0 2 a c e ta M i n o p h e n ; a c e ta M i n o p h e n

6 0 - 6 9 1 0 d r a i n o p e n e r

7 0 - 7 9 0 0

8 0 - 8 9 0 1 c o l c h i c i n e

9 0 - 9 9 0 1 v e r a pa M i l h y d r o c h l o r i d e , F l u va s tat i n , t o lt e r o d i n e

t o ta l ( 2 5 ) 1 0 1 5

TherelativelysmallnumberofdeathsreportedtotheCenterdoesnotaccuratelyrepresentthetrueenormity

ofpoisoningasacauseofacuteinjuryanddeathintheregion.Poisoningsaretheleadingcauseofinjury

deathamongMassachusettsresidents,surpassingmotorvehiclefatalities,andrankasthesecondleading

causeofinjurydeathinRhodeIsland.In2003,therewere836poisoningfatalitiesinMassachusettsand115

inRhodeIsland,asreportedupondeathcertificates.Poisoning-

relateddeathscontinuetoriseatboththeregionalandnational

levels.Between1990and2002theageadjustedpoisondeath

raterose133%inMA,49%inRI,and83%nationally(source:

WISQARS).

Seriousinjuriesduetopoisoningsalsoremainaconcern.

InMassachusetts,therewereover6,600hospitalstaysfor

non-fatalpoisoningsreportedtotheMassachusettsHospital

a c e ta M i n o p h e n : 3 2 %

opioids: 12%

c o c a i n e : 8 %

tcas: 12%

c l e a n i n g p r o d u c t s : 8 %

u n k n o W n s u b s ta n c e : 8 %

e t h y l e n e g ly c o l : 8 %

•— c o l c h i c i n e : 4 %

•— c a l c i u M c h a n n e l b l o c k e r : 4 %

•— u n r e l at e d c a u s e : 4 %

�7

DischargeandObservationStayDatabases,andapproximately12,000emergencydepartmentdischargesin

2003.Inthesameyear,theRhodeIslandDepartmentofHealthreported938poisoningrelatedhospitalstay

dischargesin2003.

ThereareseveralreasonsthatthemajorityofthesecasesmaygounreportedtotheCenter.Patientsthatare

founddeadonarrivalorwhosehistoryindicatestreatmentwithaknownprotocolmaynotbereportedtothe

Centerbylawenforcement,firstresponders,medicalexaminers,orotherhealthcareprofessionals.Overdoses

ofabusedsubstancesmayalsogounrecognizedasapoisoningissue.WhiletheMassachusettsDepartmentof

PublicHealthreports17,580hospitaldischargesand574deathsrelatedtoopioidabusein2003,theCenter

wascalledregardingonly3%(583)ofthesecases.

A look to the future... Themajorityofpoisoningsarepreventable.TheRegionalCenterforPoisonControlandPrevention

workstoreducethenumberofpoisoningsthatoccurthroughoutreachandthedisseminationofeducational

materialstothepublic.Theseprogramsareavitalcomponentofwhatmustnecessarilybeamultifaceted

preventionsystem.Continuedeffortsinprimarypreventionareneededintheareasofenvironmental

modification(e.g.locksoncabinets,safetycaps,manufacturingofpills),policy(e.g.monitoringprescription

drugdispensing,anddrugenforcementbypublicsafety),andeducationalinitiativesperformedbyother

publichealthprofessionals,pharmacistsandclinicians.

TheCenterisuniqueintheregionforitscombinedparticipationinthemedicalmanagementandnational

surveillanceofpotentialpoisonings,anditsprofessionaltrainingandpubliceducationprograms.Assuch,it

isavaluableresourcethatseekstoaddresssuchcriticalissuesaspotentialbioterrorismevents,environmental

A

�8

Medical director

MicheleBurnsEwald,MD

Managing director

AveryAdam,MS

Staff toxicologiStS

EdwardBoyer,MD

HeikkiNikkanen,MD

StephenSalhanick,MD

MichaelShannon,MD,MPH

RobertWright,MD

toxicology conSultantS

CynthiaAaron,MD

MikeBurns,MD

SophiaDyer,MD

SteveTraub,MD

clinical fellow

Ann-JeannetteGeib,MD

MelisaLai,MD

HealtH educator

JillGriffin,MPH

VilmaRodriguez

clinical Manager

AlfredAleguas,PharmD,CSPI

aSSiStant clinical Manager

AdinaSheroff,RN,CSPI

SpecialiStS in poiSon inforMation

JefferyBenjamin,PharmD

VirginiaFortin,RN,CSPI

SusanGavin,RN,CSPI

CathyKalayjian,RN,CSPI

KrysModrzejewski,PharmD,CSPI

JoelMyers,NP,CSPI

BillPartridge,RN,CSPI

JimRorick,RPh,CSPI

AnitaRossiter,RPh,CSPI

KatherineSaunders,RN,CSPI

IrisSheinhait,PharmD,CSPI

HowardWine,RPh,CSPI

DorisWong,PharmD

poiSon inforMation providerS

DanGarber,PharmDcandidate

DennisWigandt,PharmDcandidate

adMiniStrative aSSociate

DeborahHaber

Appendix A� 0 0 � C E N T E r S TA F F : r E g I o N A l C E N T E r F o r P o I S o N C o N T r o l A N D P r E V E N T I o N

B

�9

Cynthia Aaron, MD

University of Massachusetts Health Care

Angela Anderson, MD

Rhode Island Hospital

L. Anthony Cirillo, MD

Memorial Hospital of Rhode Island

Andy Erickson

AMICA Insurance

Anara Guard*

Join Together

Daniel Halpren-Ruder, MD

Emergency Medicine Physician

Wendy Krupa, RN

Rhode Island School Nurse Teachers Association

William Lewander, MD

Rhode Island Hospital

Tim Maher, PhD

Massachusetts College of Pharmacy and

Applied Health Sciences

Barbara McEachern

US Consumer Product Safety Commission

Thomas Needham, PhD

School of Pharmacy, University of Rhode Island

Julie Ross

Education Development Center

David Savastano

Johnston Fire Department

Kathy Stimson

Springwell

Barbara Tausey, MD

U.S. Department of Health and Human Services

Gayla Waller

CVS

Susan Webb

Massachusetts Medical Society

h E A lT h D E PA rT M E N T r E P r E S E N TAT I V E S

Massachusetts Department of Public Health

SallyFogerty

CindyRodgers*

JanetBerkenfield

Rhode Island Department of Health

WilliamH.Hollinshead,MD

LauriePetrone*

DhitinutRatnapradipa,PhD

RobertVanderslice,PhD

r E g I o N A l P o I S o N C E N T E r r E P r E S E N TAT I V E S

AveryAdam*

MicheleBurnsEwald,MD

VilmaRodriguez*

JillGriffin*

*HealthEducationSub-Committee

Appendix BA D V I S o rY C o M M I T T E E

C

�0

Appendix CM o S T C o M M o N S u b S TA N C E S b Y C AT E g o rY

P E r C E N TA g E o F E X P o S u r E S T o A l l S u b S TA N C E S T o TA l P E r C E N TA g E

c o s M e t i c s / p e r s o n a l c a r e p r o d u c t s

n a i l p r o d u c t s 2 5 7 1 3 . 5

c r e a M s / l o t i o n s / F o u n d at i o n 8 5 7 1 . 2

t o o t h pa s t e W i t h F l u o r i d e 6 7 2 0 . 9

M o u t h Wa s h 6 4 1 0 . 9

h a i r c a r e p r o d u c t s 4 8 6 0 . 7

s u b t o ta l 5 , 2 2 7 7 . 0

o t h e r 9 9 2 1 . 3

c at e g o ry t o ta l 6 , 2 1 9 8 . 4

c l e a n i n g s u b s ta n c e s

b l e a c h 1 , 0 6 0 1 . 5

h o u s e h o l d c l e a n e r s ( M i s c ) 6 9 6 0 . 9

d i s h Wa s h e r d e t e r g e n t s 3 6 6 0 . 5

d i s i n F e c ta n t s 2 7 8 0 . 4

s u b t o ta l 2 , 4 2 0 3 . 3

o t h e r 2 , 1 6 9 2 . 9

c at e g o ry t o ta l 4 , 5 8 9 6 . 2

F o r e i g n b o d i e s / t o y s / M i s c e l l a n e o u s

s i l i c a g e l 9 0 3 1 . 2

t h e r M o M e t e r s 4 6 5 0 . 6

g l o W p r o d u c t s 4 3 3 0 . 6

t o y s 3 2 1 0 . 4

s u b t o ta l 2 , 1 2 2 2 . 9

o t h e r 1 , 2 1 9 1 . 6

c at e g o ry t o ta l 3 , 3 4 1 4 . 5

p l a n t s

n o n - t o x i c p l a n t s 4 0 5 0 . 5

g a s t r o i n t e s t i n a l i r r i ta n t s 3 7 7 0 . 5

s u b t o ta l 7 8 2 1 . 1

o t h e r 1 , 3 4 6 1 . 8

c at e g o ry t o ta l 2 , 1 2 8 2 . 9

p e s t i c i d e s

i n s e c t i c i d e s 1 , 0 3 2 1 . 4

r e p e l l e n t s 5 0 4 0 . 7

r o d e n t i c i d e s 3 2 4 0 . 4

h e r b i c i d e s 1 0 3 0 . 1

s u b t o ta l 1 , 9 6 3 2 . 6

o t h e r 2 5 0 . 0 3

c at e g o ry t o ta l 1 , 9 8 8 2 . 7

P E r C E N TA g E o F E X P o S u r E S T o A l l S u b S TA N C E S T o TA l P E r C E N TA g E

a n a l g e s i c s

i b u p r o F e n 1 , 9 0 4 2 . 6

a c e ta M i n o p h e n 1 , 7 1 2 2 . 3

o p i o d s 8 3 6 1 . 1

a s p i r i n 3 8 0 0 . 5

n a p r o x e n 3 0 4 0 . 4

s u b t o ta l 5 , 1 3 6 6 . 9

o t h e r 1 , 8 1 0 2 . 4

c at e g o ry t o ta l 6 , 9 4 6 9 . 3

s e d at i v e s / h y p n o t i c s / a n t i p s y c h o t i c s

b e n z o d i a z e p i n e s 1 , 9 2 0 2 . 6

at y p i c a l a n t i p s y c h o t i c s 1 , 1 3 2 1 . 5

s u b t o ta l 3 , 0 5 2 4 . 1

o t h e r 5 3 8 0 . 7

c at e g o ry t o ta l 3 , 5 9 0 4 . 8

a n t i d e p r e s s a n t s

serotonin re-uptake inhibitors 1 , 3 6 1 1 . 8

t r a z o d o n e 4 6 5 0 . 6

a M i t r i p t y l i n e 1 9 6 0 . 3

l i t h i u M 1 9 4 0 . 3

s u b t o ta l 2 , 2 1 6 3 . 0

o t h e r 6 9 0 0 . 9

c at e g o ry t o ta l 2 , 9 0 6 3 . 9

t o p i c a l s

d i a p e r r a s h p r o d u c t s 1 , 5 3 7 2 . 1

t o p i c a l s t e r o i d s 2 8 5 0 . 4

s u b t o ta l 1 , 8 2 2 2 . 5

o t h e r 1 , 0 6 3 1 . 4

c at e g o ry t o ta l 2 , 8 8 5 3 . 9

c o u g h a n d c o l d r e M e d i e s

d e x t r o M e t h o r p h a n 1 , 4 1 7 1 . 9

p r o d u c t s W i t h o u t o p i o d s 7 6 6 1 . 0

s u b t o ta l 2 , 1 8 3 2 . 9

o t h e r 1 6 1 0 . 2

c at e g o ry t o ta l 2 , 3 4 4 3 . 2

D

��

Appendix Dh o S P I TA l C A l l E r S

h o S P I TA l S I N M A S S A C h u S E T T S C A l l S : � 0 0 �

(fundingpartnersinbold)

Anna Jaques Hospital 89

Athol Memorial Hospital 46

Bay State Health System 210

Berkshire Medical Center 63

Beth Israel Deaconess Medical Center 43

Boston Medical Center 345

BostonMedicalCenterUniversity 14

Brigham & Womens Hospital 76

Brockton Hospital 240

Cambridge Hospital 179

Cape Cod Hospital 85

CaritasGoodSamaritanMedicalCenter 78

Caritis Norwood Hospital 152

Carney Hospital 101

Children's Hospital Boston 258

Cooley Dickinson Hospital 57

Dana Farber Cancer Institute 2

Emerson Hospital 15

Fairview Hospital 13

Falmouth Hospital 39

Faulkner Hospital 56

Franciscan Hospital 2

Franklin Medical Center 12

Hallmark Health System

Harrington Memorial Hospital 96

» Lawrence Memorial Hospital 63

» Melrose Wakefield 1

HealthAlliance - Burbank Campus 29

HealthAlliance - Leominster Campus 126

h o S P I TA l S I N M A S S A C h u S E T T S C A l l S : � 0 0 �

Heywood Hospital 167

Holy Family Hospital 75

Holyoke Hospital 34

Hubbard Regional Hospital 78

Jordan Hospital, Inc 92

Lahey Clinic Hospital, Inc.

LaheyClinicNorth 19

Lawrence General Hospital 74

Lowell General Hospital 50

Martha’s Vineyard Hospital 43

Mary Lane Hospital 10

Massachusetts Eye and Ear Infirmatory 6

Massachusetts General Hospital 185

Mercy Hospital 30

Merrimac Valley (Hale) Hospital 68

Metrowest Medical Center - Framingham 157

Metrowest Medical Center - Natick 39

Milford Whitinsville Hospital 7

Milton Hospital 38

Morton Hospital & Medical Center 115

Mount Auburn Hospital 131

Nantucket Cottage Hospital 27

Nashoba Valley Hospital 32

New England Medical Center

and Floating Hospital for Children 53

Newton Wellesley Hospital 90

Noble Hospital 173

Northeast Hospitals

»Addison Gilbert Hospital 40

»Beverly Hospital 125

��

h o S P I TA l S I N M A S S A C h u S E T T S C A l l S : � 0 0 �

North Adams Regional Hospital 26

North Shore Medical Center 109

PortsmouthMedicalCenter 1

ProvidenceHospital 1

Quincy Hospital 112

Saints Memorial Med Center 33

Salem Hospital 27

Shriner'sBurnCenter 1

Shriner'sHospitalforCrippledChildren 1

SomervilleHospital 45

Southcoast Hospitals Group

» St Lukes' Hospital 227

» Tobey Hospital 20

» Charlton Memorial Hospital 63

South Shore Hospital 144

Southwood Community Hospital 2

St. Annes' Hospital 102

St. Elizabeths' Medical Center 83

St. John's Medical Center West 1

Worcester Medical Center - St Vincents' Hospital 113

Sturdy Memorial Hospital 68

U Mass Memorial Medical Center 58

U Mass Memorial Marlborough Hospital 16

UMMHC - Memorial 29

UMMHC - University 13

UMMHC-Hanneham 1

UnionHospital 109

VA Hospitals (Bedford, Brockton, Jamaica Plain, Northampton, West Roxbury) 32

Waltham (Deaconess) Hospital 1

WhiddenMemorialHospital 162

Winchester Hospital 164

Wing Memorial 34

T T h o S P I TA l S I N r h o D E I S l A N D

C A l l S : � 0 0 �

ButlerHospital 10

EmmaPendletonBradleyHospital 1

KentCountyMemorialHospital 270

LandmarkMedicalCenter 132

MemorialHospitalofRhoadeIsland 122

MiriamHospital 66

NewportHospital 61

NewportNavalHospital 2

RhodeIslandHospital& HasbroChildren’sHospital 407

RogerWilliamsHosptial 46

SouthCountyHospital 119

SouthShoreHospital 1

OurLadyofFatimaHospital(St.Joseph’s) 31

TheWesterlyHospital 58

UMMHC-Memorial 1

VARIHospital 17

WomenandInfantsHospital 7

E

��

Appendix EP u b l I C AT I o N S � 0 0 �

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aboutBioterrorism.AcadEmergMed.2004;11:143-148

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BaumCRandLingL(eds).PediatricToxicology:DiagnosisandManagementofthePoisonedChild.New

York:McGraw-Hill,2004:84-88

3. BrushDE,BoyerEW.Gammahydroxybutyratepoisoningintheelderly.AnnalsofInternalMedicine.2004:

140:W70-2

4. Brush,DE,BoyerEW.IntravenousN-acetylcysteineforchildren.PediatricEmergencyCare.2004:20:649-50

5. BoyerEW.Dextromethophanabuse,PediatricEmergencyCare,2004:20:858-63

6. QuangLS,ShannonMW,WoolfAD,MaherTJ.4-methylpyrazoledecreases1,4-butanedioltoxicityby

blockingitsinvivobiotransformationtogamma-hydroxybutyricacid.AnnalsoftheNewYorkAcademyof

Sciences.Oct.2004:1025:528-37

7. SaidinejadM,BurnsMM,HarperMB.Disseminatedhistoplasmosisinanonendemicarea.PediatricInfectious

DiseaseJournal.2004:23(8):781-782.

8. SminkDS,FinkelsteinJA,PeñaBMG,ShannonMW,TaylorGA,FishmanSJ.DiagnosisofAcute

AppendicitisinChildrenUsingaClinicalPracticeGuideline.JPediatricSurgery.2004;29:458-463

9. PaezA,ShannonM,MaherT,QuangL.Effectsof4-MethylpyrazoleonEthanolNeurobehavioralToxicityin

CD-1Mice.AcadEmergMed.2004

10. ShannonM,ManagementofInfectiousAgentsofBioterrorism.ClinPedEmergMed.2004:5;63-71

11. WeiskopfM.HuH.WhiteRF,WrightRO.CognitiveDeficitsandMagneticResonanceSpectroscopyin

AdultMonozygoticTwinswithLeadPoisoning.EnvironmentalHealthPerspectives.2004:112(5):620-5

��

12. AmatoC.WangRY,WrightRO,LinakisJL.EvaluationOfPromotilityAgentsToLimitTheGut

BioavailabilityOfExtendedReleaseAcetaminophen.JournalOfToxicology–ClinicalToxicology.

2004:42(1):73-7

13. WrightROSilvermanEK,SchwartzJ,TsaihST,SenterJ,SparrowD,WeissST,AroA,HuH.Association

betweenHemochromatosisGenotypeandLeadExposureAmongElderlyMen:theNormativeAgingStudy.

EnvironmentalHealthPerspectives.2004:112(6):746-750

14. WrightRJ,FinnP.,ContrerasJP,CohenS.,WrightRO.,StaudenmayerJ.,WandM.,PerkinsD.,WeissST,

GoldDR.AssociationsBetweenChronicCaregiverStressandImmunoglobulinEExpression,

Allergen-InducedProliferativeResponse,andCytokineProfilesinaBirth-cohortPredisposedtoAtopy/Asthma

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�5 �5

FAppendix FA C K N o W l E g E M E N T S

TheRegionalCenterforPoisonControlandPreventionservingMassachusettsandRhodeIslandwishesto

acknowledgethefollowingpeopleandorganizationsfortheircontributionstothisreport.

MaSSacHuSettS departMent of public HealtH

HollyHackman,Director, Injury Surveillance Program

CindyRodgers,Director, Injury Prevention and Control Program

JanetBerkenfield,EMSC Program Manager

BethHume,Data Manager/Analyst

TorieOzonoff,Research Advisor, Injury Surveillance Program

rHode iSland departMent of HealtH

DhitinutRatnapradipa,PhD,Risk Coordinator, Department of Environmental Health

RobertVanderslice,PhD,Chief, Office of Health Risk Assessment, Department of Environmental Health

SamVinerBrown,MS,Division of Family Health

JaniceFontes,Principal System Analyst, Office of Health Statistics

Ma/ri regional center for poiSon control and prevention

MicheleBurnsEwald,MD,Medical Director

DeborahHaber*,Operations Manager

ChristianneJohnson,Administrative Associate

VilmaRodriguez,Educator

deSign and printing

DeborahLiljegren,Veraqua Branding and Design

RickMichaud,The Graphic Group

RebeccaChandler,Chandler Design

*Annual Report Editor

1955 boston poison control center established. First of its kind in the state and third center in the nation.

1955 – 1978 additional poison control centers established in Worcester, Fall river, new bedford and springfield.

1973 congress passed the national emergency Medical services system act.

1976 Massachusetts department of public health appointed a poison committee to create a statewide poison system.

1978 Massachusetts poison control system replaced the local poison centers.

1981 rhode island poison center began operations as a community service funded by rhode island hospital.

january 1999 lifespan, through its affiliate rhode island hospital, announced closing the rhode island poison center.

March 1999 rhode island general assembly allocated state funding for poison center services.

august 1999 Massachusetts and rhode island departments of health issued joint request for proposals for poison center services.

january 2000 regional center for poison control and prevention serving Massachusetts and rhode island established at children’s hospital.

February 2000 president clinton signed into law the poison control center enhancement and awareness act,

which allocated federal funding to poison centers.

March 2000 Massachusetts and rhode island departments of health convened first meeting of the regional poison center advisory committee.

september 2001 the regional center for poison control and prevention was awarded a three-year stabilization grant and a two-year competitive

grant for the first time through the poison control center enhancement and awareness act

january 2002 the new toll-free phone number (1-800-222-1222) was launched nationwide.

january 2002 the regional center for poison control and prevention began taking calls from the state of new hampshire during the overnight hours.

september 2002 the 1st new england regional toxicology conference was held in sturbridge, Massachusetts

March 2003 the regional center for poison control and prevention held legislative awareness events at the Massachusetts and

rhode island state houses during poison prevention Week to draw attention to our funding needs.

june 2003 us Food and drug administration subcommittee voted, 6 to 4, in favor of removing ipecac from over-the-counter status.

september 2003 the regional center for poison control and prevention was awarded a two-year competitive grant for the second time through the

poison control center enhancement and awareness act.

september 2003 the 2nd annual new england regional toxicology conference was held in storrs, ct.

november 2003 american academy of pediatrics announced its new policy on "poison treatment in the home". it recommends that syrup of ipecac

should no longer be used routinely as a residential poison treatment intervention.

december 2003 president bush signed into law p.l. 108-194, the poison control center enhancement and awareness act amendments of 2003,

reauthorizing p.l. 106-174.

april 2004 the institute of Medicine publishes its report ForgingaPoisonPreventionandcontrolSystem that encourages integrating poison

control services into the federal and state public health infrastructure.

Historical Timeline

r E g I o N A l C E N T E r F o r P o I S o N C o N T r o l A N D P r E V E N T I o N

S E r V I N g M A S S A C h u S E T T S & r h o D E I S l A N D

c h i l d r e n ’ s h o s p i ta l b o s t o n , 3 0 0 l o n g W o o d av e n u e , b o s t o n , M a 0 2 1 1 5 , 8 0 0 - 2 2 2 - 1 2 2 2

W W W. M a r i p o i s o n c e n t e r . c o M

1-800-222-1222