<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>Association <strong>of</strong> Pharmaceutical Teachers <strong>of</strong> IndiaPoison Information Center-An Overview <strong>of</strong> its Significance, Organization and FunctioningShobha C*, Ramesh M, Parthasarathi G.Department <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>, JSS College <strong>of</strong> <strong>Pharmacy</strong>, JSS University, SS Nagar, Mysore-15A B S T R A C TSubmitted: 2/10/<strong>2011</strong>Accepted: 6/11/<strong>2011</strong>Poisoning is a significant global public health problem. According to world health organization (WHO), in the year 2004, it is estimated that346,000 people died worldwide from unintentional poisoning. Nearly a million people die each year as a result <strong>of</strong> suicide, and chemicals accountfor a significant number <strong>of</strong> these deaths. It is estimated that deliberate ingestion <strong>of</strong> pesticides causes 370,000 deaths each year. In India, thereare higher incidences <strong>of</strong> poisoning and is also one <strong>of</strong> the major causes <strong>of</strong> death. In developing countries, pesticides are frequently used forsuicidal poisoning. Increased mortality and morbidity could have been due to lack <strong>of</strong> access to information to the physician treating the poisonedpatients and awareness about the prevention, first aid measures and management <strong>of</strong> different poisoning cases. Poison information center (PIC)can play a vital role in the prevention and management <strong>of</strong> poisoning cases through provision <strong>of</strong> information to general public and also tohealthcare pr<strong>of</strong>essionals. Poison information center or poison control center (PCC) is a specialised unit that provides information on poisoningmanagement and immediate information on early diagnosis, treatment, management, prevention and hazards management <strong>of</strong> poisoningthrough well trained poison information specialist. Poison information services (PISs) helps in reducing the poisoning treatment cost to thepatients and to public health care facility by preventing the unnecessary visits to the healthcare facilityand prolonged hospitalization. Since therehas been a limited number <strong>of</strong> PIC to provide the vital service <strong>of</strong> poison management in India, there is a need for establishing several such centerswith well equipped and well trained personnel is helpful.Keywords: Poison information center, Poison control center, Incidence, India, Poison information servicesINTRODUCTIONPoison information center (PIC) or poison control center(PCC) is a specialised unit that provides information onpoisoning management and immediate information on earlydiagnosis, treatment, management, prevention and hazardsmanagement <strong>of</strong> poisoning through well trained poison1information specialist. Poison information (PI) is aspecialized area <strong>of</strong> drug information which refers to theinformation about the toxic effects <strong>of</strong> chemicals, hazardousmaterial spills, house hold products, over dose <strong>of</strong> therapeuticmedicines, plants including mushroom, animal toxins bybites <strong>of</strong> snake, spider and other venomous creatures and2stings.PIC provides poison information services for the effectivemanagement <strong>of</strong> poisoning cases. Poison information services(PISs) mainly deals with a timely provision <strong>of</strong> poisoningmanagement information appropriate to the needs <strong>of</strong> the1,3enquirer. Poison information service also deals with the riskassessment, diagnosis, management and prevention <strong>of</strong>Address for Correspondence:Shobha Churi, Assistant Pr<strong>of</strong>essor, Department <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>, JSSCollege <strong>of</strong> <strong>Pharmacy</strong>, JSS University, SS Nagar Mysore-15E-mail: shobha912@yahoo.comexposure to any poison, in patients <strong>of</strong> any age irrespective <strong>of</strong>type (intentional or accidental) and route <strong>of</strong> exposure. Theprimary aim <strong>of</strong> PIC is to reduce the morbidity and mortalitydue to poisoning and improve the patients' health related2,4quality <strong>of</strong> life. PISs helps in reducing the poisoningtreatment cost to the patients and to public health care facilityby preventing the unnecessary visits to the healthcare facility,5hospital admission and prolonged hospitalization.PIC functions 24 hours a day round the year with an objective<strong>of</strong> continually improving the outcome <strong>of</strong> the affected peopleby providing a timely, safe information service appropriate tothe needs <strong>of</strong> the enquirer related to poisoning, suspected6poisoning and prevention <strong>of</strong> poisoning. Poison informationcenter aims to prevent unnecessary visits to doctors andhospitals and to ensure that patients, who are poisoned,receive the most effective treatment promptly. The size <strong>of</strong> thePIC may vary based on call volumes and ideally be locatedadjacent to emergency department. PIC may operate locallyproviding the services to populations <strong>of</strong> specific geographicallocation or may extend its service to regional / national level.Need for Poison Information CenterPoisoning is a significant global public health problem.According to world health organization (WHO) data, in the<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong> Volume 4 Issue 4 <strong>Oct</strong> - <strong>Dec</strong>, <strong>2011</strong> 14
Shobha C - Poison Information Center-An Overview <strong>of</strong> its Significance, Organization and Functioningyear 2004 an estimated 346,000 people died worldwide fromunintentional poisoning. Of these deaths, 91% occurred in7low- and middle-income countries . Nearly a million peopledie each year as a result <strong>of</strong> suicide, and chemicals account fora significant number <strong>of</strong> these deaths. It is estimated thatdeliberate ingestion <strong>of</strong> pesticides causes 370,000 deaths each7year. In developing countries, pesticides are frequently usedfor suicidal poisoning. Snake bite is a largely unrecognizedpublic health problem and it has been estimated that about 2.5million people are envenomed every year. Snake bite was thecause for at least 100,000 deaths and around three times as7many amputations and other permanent disabilities.The incidences <strong>of</strong> poisoning are high and it is one <strong>of</strong> the major8causes <strong>of</strong> death in India. Poisoning cases are treated atdifferent levels <strong>of</strong> health care facility including governmentand private settings. However, owing to lack <strong>of</strong> poisoninformation services, management <strong>of</strong> acute poisoning cases isa difficult task to physicians working in emergency9departments <strong>of</strong> <strong>Indian</strong> hospitals. Increased mortality andmorbidity could be due to lack <strong>of</strong> access to information to thephysician treating the poisoned patients and awareness aboutthe prevention, first aid measures and management <strong>of</strong>different poisoning cases. Poison information centers (PIC)can play a vital role in the prevention and management <strong>of</strong>poisoning cases through provision <strong>of</strong> information to general9-11public and also to healthcare pr<strong>of</strong>essionals. Also there is aincrease in the number <strong>of</strong> chemicals, household products andmedicines <strong>of</strong> different brands in the market day by day.Consequently increase <strong>of</strong> the misuse <strong>of</strong> these products,leading to increased intentional and unintentional poisoning.The impact <strong>of</strong> poison information center and its services onquality <strong>of</strong> health care is very significant and hence there is anincreased need <strong>of</strong> the PIC to control the morbidity and2mortality due to poisoning.Evolution <strong>of</strong> Poison Information CenterIncreased number <strong>of</strong> medicines and chemicals were availablein the market after second world war. Consequent to thishigher incidence <strong>of</strong> intentional and unintentional poisoningwere observed. But health care pr<strong>of</strong>essionals were havinglittle knowledge about the ingredients present in the newproducts. In view <strong>of</strong> the increasing incidence <strong>of</strong> poisoning andlack <strong>of</strong> awareness in public about effect <strong>of</strong> poisoning, thepoison information services were started in 1949 in12,6Netherlands and latter in London. In USA in 1930'spharmacist Louis Gdalman started a poison information6service at St Luke's hospital. Because <strong>of</strong> Gdalman'sspecialisation in pharmacy and chemistry, physicians all overthe country used to call him for assistance. In late 1940's hestarted recording information on small cards and laterdeveloped a data collection form. In 1950's he established anextensive library on the management <strong>of</strong> acute and chronicpoisoning and in 1953 the poison information centre atPresbyterian -St Luke's hospital, Chicago was formally6recognised. Subsequently similar centers started6functioning in different parts <strong>of</strong> the world. All the centers areproviding / have provided invaluable service by creatingpublic awareness on poisoning and providing toxicologicaldiagnostic and therapeutic assistance to health carepr<strong>of</strong>essionals.Poison Information Centers in IndiaIn India, there are only four WHO recognised centersestablished till date. In addition there are few other centersthat <strong>of</strong>fer the poison information through clinical pharmacyservice. First National Poison Information Center wasestablished in February 1995 at the All India Institute <strong>of</strong>1Medical Sciences (AIIMS), New Delhi. The other centerswere subsequently established at the National Institute <strong>of</strong>Occupational Health, Ahmedabad, Government GeneralHospital, Chennai and Amrita Institute <strong>of</strong> Medical Sciencesand Research, Cochin. Considering the incidence rate <strong>of</strong>poisoning cases in India, these centers may not be able to meetthe demand for poison information. Hence there is a need forwell equipped poison information centers with well trainedpersonnel.Significance <strong>of</strong> Poison Information CenterThe ultimate motive <strong>of</strong> PIC is to prevent poisoning deaths dueto accidental, intentional ingestion <strong>of</strong> poison in general9public. Poison information center aims to assist generalpublic and healthcare pr<strong>of</strong>essionals with poison preventionand management (identification / assessing / availability <strong>of</strong>antidote and management) by providing immediate poison9,2information. Poison information center conductseducational programs to healthcare pr<strong>of</strong>essionals and publichighlighting the services <strong>of</strong> poison information centerespecially the identification <strong>of</strong> poisoning substance, first aid2measures, management and prevention <strong>of</strong> poisoning cases.It can involve in developing strategy and responding tochemical disasters in association with other responsibleorganisations. There are benefits to the public and healthcarepr<strong>of</strong>essionals by the services provided by the PIC. It ensuresthe health care benefits by reducing morbidity and mortalityfrom poisoning and cost effective benefit by avoidingunnecessary visits to hospital in mild or less severepoisonings. Healthcare pr<strong>of</strong>essionals get up-to-date andrelevant information about poisoning management. The roles<strong>of</strong> PIC are given in Table1.<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong> Volume 4 Issue 4 <strong>Oct</strong> - <strong>Dec</strong>, <strong>2011</strong> 15