CLINICAL TOXICOLOGY 12(3), pp. 303-307 (1978)
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
National Clearinghouse for Poison Control Centers
JOHN CROTTY, M.D.
* and
GEORGE ARMSTRONG
Department of Health, Education, and Welfare Public Health Service, Food and Drug Administration Bethesda, Maryland 20034
In 1957, the National Clearinghouse f o r Poison Control Centers became operational. This federal program originated aft er a committee recommendation a t the November 1956 American Public Health Association meeting. Upon the advice of the committee and the authority of the S e cr et ar y of the Department of Health, Education, and Welfare, the Surgeon General designated the National Clearinghouse as a functional unit under the U.S. Public Health Service, Accident Prevention P r o g r am, Division of Special Health Services, Bureau of State Services. The need f o r a centralized focal point f o r collecting and disseminating information among the 17 existing Poison Control Centers was exp res s ed by these cent er s and they, along with the American Academy of Pediatrics and others, spearheaded the committee resolution. P r i o r to the inception of the Clearinghouse, the existing Poison Control Centers we r e collecting data and providing information, but in s o doing w er e duplicating efforts and were not getting a collective sharing of case experience o r product information. F o r each center to collect the needed product data was impossible; likewise, human experience *Reprint request to: John J. Crotty, M.D., Director, National Clearinghouse f o r Poison Control Centers, 5401 Westbard Avenue, Bethesda, Maryland 20034. 303
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
304
CROTTY AND ARMSTRONG
data was limited. A Clearinghouse appeared to be the solution and under authority of Section 301 of the Public Health Service Act it became an official entity. The initial arrangement called for the Clearinghouse to s e r v e by coordinating the flow of information among Poison Control Centers. Selection, establishment, and supervision of Poison Control Centers was to be under the jurisdiction of individual State Health Coordinators. Although the initial mandate is officially unchanged, the Clearinghouse h a s been encouraged to take an ever-widening role in poison control activities. A s the number of Centers ballooned from 17 to about 600, coordination of information among cent er s became impossible. It appeared that the solution was f or the Clearinghouse to collect information directly from the manufacturers, texts, and journals and synthesize the information into concise outlines of treatment, ingredient, and toxicity information. The 5 X 8 car d w a s selected as the format to provide an outline to the physician. A s Poison Control Centers became staffed by nonphysicians and m or e and m or e calls came from the general public, Poison Centers needed m or e in-depth data to replace the outline. To facilitate this change, the Clearinghouse has enlisted the support of clinical toxicology consultants to review al l product information in an effort to upgrade the data provided. In addition to the Clearinghouse staff, two clinical toxicologists and a pharmacist are currently reviewing the cards. Most recently a Handbook of Common Poisonings in Children, written by the American Academy of Pediatr i c s , has been published and distributed by the Clearinghouse. The initial concept of sharing human experience burgeoned into attempting to collect and s um m ar i ze data from an ever expanding number of centers and devising a form that would be compatible with a l l reporting centers. The individual case report system f o r m s a data base of over 150,000 incidents annually. Case report form s are submitted to the Clearinghouse by 480 of the 580 Poison Control Cent e r s . These reports are coded and tabulated by computer into categoric and trade name product s um m ar i es f o r national, state, and local poison center reports. The Clearinghouse added to its activities by serving as secret ari at f o r National Poison Prevention Week and other prevention and educational programs; conducting and sponsoring research in treatments and antidotes; and, m or e recently, becoming m ore involved in regionalization of Poison Control Centers, standards f o r Poison Control Cent e r s , and other activities involving staffing and operation of Poison Control Centers. In the 1960s it became obvious that the disciplines of clinical toxicology and poison control w er e rapidly evolving and that the need for mo r e and mo r e data and rapid updating w er e becoming necessities. The Clearinghouse began exploring newer information dissemination systems. Traditional publication of books was much too slow. Cards,
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
POISON CONTROL CLEARINGHOUSE
305
though not quite a s slow, s t i l l could not keep pace with data needs. Microfilm retrieval t i m e was too slow and the s t a t e of the a r t f o r microfiche made i t impractical a t that time. On-line computer s y s t e m s held the p r o m i s e of rapid retrieval, direct input, and other capabilities that made it attractive. The future appeared to be with computers, and an on-line terminal system was envisioned a s a potential f o r c e in regionalization of Poison Control Centers. Computers could, as technology advanced, be used to generate books, c a r d s , microfiche, and microfilm, and to provide on-line s e r v i c e to a number of c e n t e r s and o t h e r s e r v i c e s . The pilot study of on-line terminals clearly indicated that the potential was tremendous, but the problems with computer down time and limited u s e of potential made the existing system impractical. However, a newer s y s t e m with s u p e r i o r up-time (>95%), s e a r c h capabilities, d i r e c t data input, multiple data base availability, and communication and broadcast features has become available through the Consumer Product Safety Commission. Via an interagency a g r e e ment with mutual s h a r i n g of data and costs, the two a r e being combined and is expected to r e s u l t in a s u p e r i o r system. At this writing the new system is in a "one y e a r t r i a l phase," a f t e r which cost/benefit and measure/act/measure analyses will be conducted by the Food and Drug Administration. Closely linked to the computer system is a computer-generated cross-indexed book, forthcoming in the n e a r future. In the l a t e 1960s and early 1970s alternatives to the c a r d file were being explored. Several consultant f i r m s and a n ad hoc committee all examined the various alternatives and solicited input from a number of Poison Control Centers. F o r a variety of r e a s o n s the book f o r m a t was selected as the p r e f e r r e d organ of dissemination. Contractual probl e m s have delayed the production of this book f o r s e v e r a l years. It now a p p e a r s that in l a t e 1977 o r e a r l y 1978 the "end product" will be realized. Computer tapes of the poison control data base a r e made available to the National Technical Institute of Sciences, which provides them to interested p a r t i e s at cost. Several universities and individuals have used these tapes to c r e a t e in-house computer r e t r i e v a l s y s t e m s o r to generate microfilm and microfiche. Since i t s inception, the Clearinghouse has published a bulletin containing a r t i c l e s of i n t e r e s t to those involved in toxicology and poison control. M o r e recently the bulletin added a listing of c u r r e n t l i t e r a t u r e citations on a r t i c l e s relevant to poison control from o v e r 140 journa 1s. Via grants and/or contracts the Clearinghouse h a s supported res e a r c h in s e v e r a l areas including clinical, animal, treatment, antidotal, and information distribution systems. Recently, a Clearinghouse contract led to the first working document concerning Regional Poison Control Centers. Other examples of contract and grant sup-
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
306
CROTTY AND ARMSTRONG
port include charcoal cannister hemoperfusion, o r a l y administered activated charcoal, and analysis of poisonous snake venom. In the late 1960s and ear l y 1970s the Clearinghouse was under the Food and Drug Administration's now defunct Bureau of Product Safety. The Hazardous Substances Act and the Poison Prevention Packaging Act wer e administered by the Bureau until their t ransfer by the Cons u m e r Product Safety Act of 1972 to the Consumer Product Safety Commission. The Clearinghouse remained in the Food and Drug Administration/Bureau of Drugs and is now officially the Division of Poison Control. Educational materials in the form of brochures, booklets, flyers, and radio and T.V. spot announcements have been distributed f o r many years. National Poison Prevention Week activities highlight ongoing prevention and education activities. The overall Clearinghouse plan f o r the future includes testing the on-line system as the potential bas i s f or a national program with direct input of product and free-form case report data. Multiple data b as e s would be available and easily accessible. Recalls and other emergency data could be broadcast instantaneously. However, the implementation of such a system might be delayed until the Regional concept becomes more developed. Linotron books, cards, o r microfiche could be generated from the computer data base for use by a l l Poison Control Centers. In other areas, the Clearinghouse would continue to work with poison control, toxicologic, and pediatric groups to seek resolutions to problems such as standards, competency testing, poison prevention and education, supporting research, and information dissemination. It would al s o seek to encourage close liaison with other important information s our ces , such as the Environmental Protection Agency, Consumer Product Safety Commission, Occupational Safety and Health Administration, Department of Transportation, and others, s o that their data bases may be available through the on-line system, o r other s ys t em s , to Poison Control Centers. Since the Europeans have a very s i m i l a r computer system and are currently sharing data b a s es , the notion of international data base sharing is not an impossibility. SUMMARY The Clearinghouse was originally conceived to coordinate information flow among the then few Poison Control Centers. Services were to be provided through the state health departments where complete control o v e r the individual s t a t e ' s poison centers was to reside. No authority to establish o r regulate cent er s , o r to s e t standards f o r staffing and operation of centers, o r to designate regional cent ers was granted.
POISON CONTROL CLEARINGHOUSE
307
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
However, growth in the numbers of c e n t e r s , m o r e sophistocation in the s t a t e of the a r t , m o r e demands f o r product and human experience data, calls f o r r e s e a r c h support, regionalization, standards setting, competency testing, and o t h e r s h a s led to an i n c r e a s i n g call f o r m o r e and m o r e Clearinghouse involvement i n the e n t i r e poison control program. Though staffing and funding r e m a i n s fairly constant, the Clearinghouse hopes to be as involved and to provide a s great a s e r v i c e a s possible to those involved in clinical toxicology and poison control.
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
National Clearinghouse for Poison Control Centers
JOHN CROTTY, M.D.
* and
GEORGE ARMSTRONG
Department of Health, Education, and Welfare Public Health Service, Food and Drug Administration Bethesda, Maryland 20034
In 1957, the National Clearinghouse f o r Poison Control Centers became operational. This federal program originated aft er a committee recommendation a t the November 1956 American Public Health Association meeting. Upon the advice of the committee and the authority of the S e cr et ar y of the Department of Health, Education, and Welfare, the Surgeon General designated the National Clearinghouse as a functional unit under the U.S. Public Health Service, Accident Prevention P r o g r am, Division of Special Health Services, Bureau of State Services. The need f o r a centralized focal point f o r collecting and disseminating information among the 17 existing Poison Control Centers was exp res s ed by these cent er s and they, along with the American Academy of Pediatrics and others, spearheaded the committee resolution. P r i o r to the inception of the Clearinghouse, the existing Poison Control Centers we r e collecting data and providing information, but in s o doing w er e duplicating efforts and were not getting a collective sharing of case experience o r product information. F o r each center to collect the needed product data was impossible; likewise, human experience *Reprint request to: John J. Crotty, M.D., Director, National Clearinghouse f o r Poison Control Centers, 5401 Westbard Avenue, Bethesda, Maryland 20034. 303
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
304
CROTTY AND ARMSTRONG
data was limited. A Clearinghouse appeared to be the solution and under authority of Section 301 of the Public Health Service Act it became an official entity. The initial arrangement called for the Clearinghouse to s e r v e by coordinating the flow of information among Poison Control Centers. Selection, establishment, and supervision of Poison Control Centers was to be under the jurisdiction of individual State Health Coordinators. Although the initial mandate is officially unchanged, the Clearinghouse h a s been encouraged to take an ever-widening role in poison control activities. A s the number of Centers ballooned from 17 to about 600, coordination of information among cent er s became impossible. It appeared that the solution was f or the Clearinghouse to collect information directly from the manufacturers, texts, and journals and synthesize the information into concise outlines of treatment, ingredient, and toxicity information. The 5 X 8 car d w a s selected as the format to provide an outline to the physician. A s Poison Control Centers became staffed by nonphysicians and m or e and m or e calls came from the general public, Poison Centers needed m or e in-depth data to replace the outline. To facilitate this change, the Clearinghouse has enlisted the support of clinical toxicology consultants to review al l product information in an effort to upgrade the data provided. In addition to the Clearinghouse staff, two clinical toxicologists and a pharmacist are currently reviewing the cards. Most recently a Handbook of Common Poisonings in Children, written by the American Academy of Pediatr i c s , has been published and distributed by the Clearinghouse. The initial concept of sharing human experience burgeoned into attempting to collect and s um m ar i ze data from an ever expanding number of centers and devising a form that would be compatible with a l l reporting centers. The individual case report system f o r m s a data base of over 150,000 incidents annually. Case report form s are submitted to the Clearinghouse by 480 of the 580 Poison Control Cent e r s . These reports are coded and tabulated by computer into categoric and trade name product s um m ar i es f o r national, state, and local poison center reports. The Clearinghouse added to its activities by serving as secret ari at f o r National Poison Prevention Week and other prevention and educational programs; conducting and sponsoring research in treatments and antidotes; and, m or e recently, becoming m ore involved in regionalization of Poison Control Centers, standards f o r Poison Control Cent e r s , and other activities involving staffing and operation of Poison Control Centers. In the 1960s it became obvious that the disciplines of clinical toxicology and poison control w er e rapidly evolving and that the need for mo r e and mo r e data and rapid updating w er e becoming necessities. The Clearinghouse began exploring newer information dissemination systems. Traditional publication of books was much too slow. Cards,
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
POISON CONTROL CLEARINGHOUSE
305
though not quite a s slow, s t i l l could not keep pace with data needs. Microfilm retrieval t i m e was too slow and the s t a t e of the a r t f o r microfiche made i t impractical a t that time. On-line computer s y s t e m s held the p r o m i s e of rapid retrieval, direct input, and other capabilities that made it attractive. The future appeared to be with computers, and an on-line terminal system was envisioned a s a potential f o r c e in regionalization of Poison Control Centers. Computers could, as technology advanced, be used to generate books, c a r d s , microfiche, and microfilm, and to provide on-line s e r v i c e to a number of c e n t e r s and o t h e r s e r v i c e s . The pilot study of on-line terminals clearly indicated that the potential was tremendous, but the problems with computer down time and limited u s e of potential made the existing system impractical. However, a newer s y s t e m with s u p e r i o r up-time (>95%), s e a r c h capabilities, d i r e c t data input, multiple data base availability, and communication and broadcast features has become available through the Consumer Product Safety Commission. Via an interagency a g r e e ment with mutual s h a r i n g of data and costs, the two a r e being combined and is expected to r e s u l t in a s u p e r i o r system. At this writing the new system is in a "one y e a r t r i a l phase," a f t e r which cost/benefit and measure/act/measure analyses will be conducted by the Food and Drug Administration. Closely linked to the computer system is a computer-generated cross-indexed book, forthcoming in the n e a r future. In the l a t e 1960s and early 1970s alternatives to the c a r d file were being explored. Several consultant f i r m s and a n ad hoc committee all examined the various alternatives and solicited input from a number of Poison Control Centers. F o r a variety of r e a s o n s the book f o r m a t was selected as the p r e f e r r e d organ of dissemination. Contractual probl e m s have delayed the production of this book f o r s e v e r a l years. It now a p p e a r s that in l a t e 1977 o r e a r l y 1978 the "end product" will be realized. Computer tapes of the poison control data base a r e made available to the National Technical Institute of Sciences, which provides them to interested p a r t i e s at cost. Several universities and individuals have used these tapes to c r e a t e in-house computer r e t r i e v a l s y s t e m s o r to generate microfilm and microfiche. Since i t s inception, the Clearinghouse has published a bulletin containing a r t i c l e s of i n t e r e s t to those involved in toxicology and poison control. M o r e recently the bulletin added a listing of c u r r e n t l i t e r a t u r e citations on a r t i c l e s relevant to poison control from o v e r 140 journa 1s. Via grants and/or contracts the Clearinghouse h a s supported res e a r c h in s e v e r a l areas including clinical, animal, treatment, antidotal, and information distribution systems. Recently, a Clearinghouse contract led to the first working document concerning Regional Poison Control Centers. Other examples of contract and grant sup-
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
306
CROTTY AND ARMSTRONG
port include charcoal cannister hemoperfusion, o r a l y administered activated charcoal, and analysis of poisonous snake venom. In the late 1960s and ear l y 1970s the Clearinghouse was under the Food and Drug Administration's now defunct Bureau of Product Safety. The Hazardous Substances Act and the Poison Prevention Packaging Act wer e administered by the Bureau until their t ransfer by the Cons u m e r Product Safety Act of 1972 to the Consumer Product Safety Commission. The Clearinghouse remained in the Food and Drug Administration/Bureau of Drugs and is now officially the Division of Poison Control. Educational materials in the form of brochures, booklets, flyers, and radio and T.V. spot announcements have been distributed f o r many years. National Poison Prevention Week activities highlight ongoing prevention and education activities. The overall Clearinghouse plan f o r the future includes testing the on-line system as the potential bas i s f or a national program with direct input of product and free-form case report data. Multiple data b as e s would be available and easily accessible. Recalls and other emergency data could be broadcast instantaneously. However, the implementation of such a system might be delayed until the Regional concept becomes more developed. Linotron books, cards, o r microfiche could be generated from the computer data base for use by a l l Poison Control Centers. In other areas, the Clearinghouse would continue to work with poison control, toxicologic, and pediatric groups to seek resolutions to problems such as standards, competency testing, poison prevention and education, supporting research, and information dissemination. It would al s o seek to encourage close liaison with other important information s our ces , such as the Environmental Protection Agency, Consumer Product Safety Commission, Occupational Safety and Health Administration, Department of Transportation, and others, s o that their data bases may be available through the on-line system, o r other s ys t em s , to Poison Control Centers. Since the Europeans have a very s i m i l a r computer system and are currently sharing data b a s es , the notion of international data base sharing is not an impossibility. SUMMARY The Clearinghouse was originally conceived to coordinate information flow among the then few Poison Control Centers. Services were to be provided through the state health departments where complete control o v e r the individual s t a t e ' s poison centers was to reside. No authority to establish o r regulate cent er s , o r to s e t standards f o r staffing and operation of centers, o r to designate regional cent ers was granted.
POISON CONTROL CLEARINGHOUSE
307
Clinical Toxicology Downloaded from informahealthcare.com by Mcgill University on 10/26/14 For personal use only.
However, growth in the numbers of c e n t e r s , m o r e sophistocation in the s t a t e of the a r t , m o r e demands f o r product and human experience data, calls f o r r e s e a r c h support, regionalization, standards setting, competency testing, and o t h e r s h a s led to an i n c r e a s i n g call f o r m o r e and m o r e Clearinghouse involvement i n the e n t i r e poison control program. Though staffing and funding r e m a i n s fairly constant, the Clearinghouse hopes to be as involved and to provide a s great a s e r v i c e a s possible to those involved in clinical toxicology and poison control.
