Poisoning is a far more serious health problem in the U.S. than has generally been recognized. It is estimated that more than 4 million poisoning episodes occur annually, with approximately 300,000 cases leading to hospitalization. The field of poison prevention provides some of the most celebrated examples of successful public health interventions, yet surprisingly the current poison control “system” is little more than a loose network of poison control centers, poorly integrated into the larger spheres of public health. To increase their effectiveness, efforts to reduce poisoning need to be linked to a national agenda for public health promotion and injury prevention.

Forging a Poison Prevention and Control System recommends a future poison control system with a strong public health infrastructure, a national system of regional poison control centers, federal funding to support core poison control activities, and a national poison information system to track major poisoning epidemics and possible acts of bioterrorism. This framework provides a complete “system” that could offer the best poison prevention and patient care services to meet the needs of the nation in the 21st century.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON POISON PREVENTION AND CONTROL
• BOARD ON HEALTH PROMOTION AND DISEASE PREVENTION
• Reviewers
• Acknowledgments
• Executive Summary
  • THE DEFINITION, SCOPE, AND MAGNITUDE OF POISONING
  • BACKGROUND
  • CONCLUSIONS AND RECOMMENDATIONS
• Part I. Overview
  • 1. Introduction
    • BACKGROUND
    • CHARGE TO THE IOM COMMITTEE
    • POISONING: A MATTER OF DEFINITION
    • MAGNITUDE OF POISONINGS: A PUBLIC HEALTH PROBLEM
    • THE COMMITTEE'S APPROACH TO THE PROBLEM
    • THE COMMITTEE'S METHODS
    • OVERVIEW OF REPORT CHAPTERS
  • 2. Toward a Poison Prevention and Control System
    • THE “SYSTEMS” CHARACTERISTICS OF A POISON PREVENTION AND CONTROL SYSTEM
    • THE ROLE OF POISON CONTROL CENTERS IN A POISON PREVENTION AND CONTROL SYSTEM
    • THE CASE FOR REGIONAL POISON CONTROL CENTERS
    • THE CORE FUNCTIONS OF POISON CONTROL CENTERS
    • CONNECTIONS BETWEEN THE POISON CONTROL CENTERS AND THE BROADER PUBLIC HEALTH SYSTEM
    • FEDERAL FUNDING FOR THE CORE SERVICES OF A POISON PREVENTION AND CONTROL SYSTEM
    • THE RESEARCH NEEDS OF A POISON PREVENTION AND CONTROL SYSTEM
    • SUMMARY
• Part II. Current Status and Opportunities
  • 3. Magnitude of the Problem
    • Defining Poisoning
    • Definitions Used in This Report
    • EPIDEMIOLOGY OF POISONING
    • SYNTHESIS
    • Appendix 3-A Additional Detail on Survey Sources and Frequency Estimations
  • 4. Historical Context of Poison Control
    • BRIEF OVERVIEW
    • POISON CONTROL CENTERS
    • PUBLIC OVERSIGHT
    • PUBLIC HEALTH LINKAGES
    • SUMMARY
    • Appendix 4-A Poison Control Center Enhancement and Awareness Act Amendments of 2003
  • 5. Poison Control Center Activities, Personnel, and Quality Assurance
    • ACTIVITIES
    • HEALTH CARE PROFESSIONALS AND THEIR TRAINING BY POISON CONTROL CENTERS
    • QUALITY ASSURANCE
    • OPPORTUNITIES
    • SUMMARY
    • Appendix 5-A Case Studies of Poison Control Centers in Emerging Health Situations
  • 6. Current Costs, Funding, and Organizational Structures
    • COST-EFFECTIVENESS AND COST-BENEFIT ANALYSES
    • CURRENT COSTS, ORGANIZATION, AND STAFFING
    • SUMMARY
    • Appendix 6-A Poison Control and Prevention Organizational Interview Questions
  • 7. Data and Surveillance
    • THE NEED FOR DATA AND SURVEILLANCE SYSTEMS
    • CURRENTLY AVAILABLE SYSTEMS
    • COMPARISONS AMONG SURVEILLANCE SYSTEMS
  • 8. Prevention and Public Education
    • PROGRAM DEVELOPMENT AND EVALUATION: THEORIES AND MODELS
    • THE CHALLENGE OF ETHNIC DIVERSITY
    • CURRENT PRACTICES IN POISON PREVENTION EDUCATION
    • COLLABORATIONS AND CONTRIBUTIONS BY OTHER ORGANIZATIONS
    • CONCLUSIONS
    • Appendix 8-A Education Materials from AAPCC and Poison Control Center Websites
  • 9. A Public Health System for Poison Prevention and Control
    • CORE PUBLIC HEALTH FUNCTIONS
    • POISON CONTROL SERVICES IN THE CURRENT PUBLIC HEALTH INFRASTRUCTURE
    • SUMMARY AND CONCLUSIONS
    • Appendix 9-A Federal Agencies Involved with Poison Prevention and Control
• Part III. Conclusions and Recommendations
  • 10. Conclusions and Recommendations
    • SCOPE OF CORE POISON PREVENTION AND CONTROL ACTIVITIES
    • COORDINATION OF POISON CONTROL CENTERS WITH OTHER PUBLIC HEALTH ENTITIES
    • STRENGTHS AND WEAKNESSES OF POISON CONTROL CENTER ORGANIZATIONAL STRUCTURES
    • FINANCIAL SUPPORT FOR THE POISON PREVENTION AND CONTROL SYSTEM
    • ASSURE HIGH-QUALITY POISON CONTROL CENTER SERVICE
    • NATIONAL DATA SYSTEM AND SURVEILLANCE NEEDS
• References
• Appendix A Contributors
• Appendix B Committee and Staff Biographies

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. 240-02-0004 between the National Academy of Sciences and the Health Resources and Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.