SURVEY
OF
POISON
CONTROL
CENTERS
By Howard M. Cann, M.D., Henry L. Verhulst, M.S., and Dorothy S. Neyman
National Clearinghouse for Poison Control Centers, Accident Prevention Program, Public Health Service,
U. S. Department of Health, Education, and Welfare
SPECIAL
ARTICLE
359
T
HE PEDIATRICIAN 15 repeatedlycon-fronted with the problem of accidental
poisoning. The young “mouth-exploring”
child, his careless, unthinking, or uninformed parents, and a seemingly innocent mcdi-cinal or household product are the
prin-cipals involved. In 1956, 1,422 people died
from accidental poisoning by solid or liquid
substances. Of the total deaths 394 (28%)
occurred in children less than 5 years of
age.’ It has been estimated that 150 to
200 nonfatal poisonings occur for every
fatal poisoning. Thus, one can get some
idea of the magnitude of the problem. The American Medical Association has estimated that there are approximately 250,000 toxic or potentially toxic trade-name products on the consumer market. Many of these bear labels containing in-gredient information. Federal law requires that the ingredients of drugs, pesticides, and caustic-containing products be on the label, but cleaning fluid, bleach, soaps,
de-tergents, polishes and a host of other
“labor-saving” household fluids which are
respon-sible for many accidental poisonings are
not required to be labelled with
informa-tion about ingredients except in those few
states with laws requiring labelling.
Obviously the physician cannot be fa-miliar with the composition of all these
unlabelled products, although some idea of the ingredients of the ingested product is
necessary for institution of proper
treat-ment for poisoning. Furthermore, many
substances found in trade-name products
are obscure; pathophysiologic effects are
known td) only those few chemists,
toxicol-ogists, and physicians interested in the
specific substance. The busy practitioner cannot be expected to he cognizant of the
effects of sodium tripolyphosphate,
alumi-num chlorhydrol, ammonium thioglycollate, benzene hexachloride and many other un-familiar, potentially toxic chemical
constitu-cuts found in everyday household products. Local poison control centers have been
established throughout the country to help
physicians with the problem of accidental poisoning. Since 1953, when the first offi-cial poison control center was inaugurated in Chicago,2 the number of centers rapidly increased to 124 by April, 1958. It is the purpose of this paper to review and
dis-cuss the results of a survey of operations
of 102 of these local poison control centers.
To the authors’ knowledge, this is the first
study of such nature since information on
the organization of 18 centers existing in
May, 1956, was obtained.3
METHODS
Special Health Services Consultants, Health
Program Representatives and Records Con-sultants of the eight Public Health Service
Re-gions obtained information by visiting the
poisoll control centers in their respective
re-gions. In a few instances state health officials
obtained the information by visiting poison
control centers within their states.
One of the authors (D.S.N.) developed an
outline as a guide for visiting officials in
re-viewing activities of poison control centers to
promote uniformity of information.
The survey was carried out during the
months of August and September, 1957.
ADDRESS: (H.M.C.) Washington 25, D.C.
RESULTS
As of April, 1958, there were 124 poison control centers in 40 states and territories. Forty per cent of the standard metropolitan areas in this country have operating poison control centers.
Growth of Poison Control Centers
Table I shows the growth of poison con-trol centers since the establishment of the
original Chicago Center. At the end of
1953 there were two centers in existence.
TABLE I
GROWTH OF Poison CONTROL CENTEII.S*
DECEMBER, 1953-MARcH, 1958
Cumulative Number
Date
Centers ‘St at est
1953 l)ccemher
1951 March .Eune
Septeml)er
l)eeember
193.5 March
June September
1)ecemher
1956 March
.JUflC
September
I)eeinher
1957 March**
Juiie
September l)eeemher
19.58 March
* Includes centers known to be in operation on April
1, 1958. Excludes those centers once established but no longer in operation.
t Includes Hawaii, Alaska and District of Columbia.
** Authority to establish a National Clearinghouse
for Poison Control Centers was received from the Sur-geon General on February ‘26, 1957. Operation began in .July, 1957.
Includes three centers which officially opened in Apri’, 1958.
In 1954 six more centers \t’ere formed, anti in 1955 nine additional centers were
crc-ated, bringing the total to 17. Thirty-four
centers came into existence in 1956; 54
were established in 1957 and 19 in the
first quarter of 1958. At present only four States have no centers in operation or tinder development.
Organizational Pattern of Centers
Data were obtained on 102 centers. Eight of these have consolidated with other
cen-ters, and are, therefore, excluded from this
study. Ninety-three of the centers
main-tam 24-hour telephone service, providing
information concerning ingredients and
treatment of various poisonous or
pte11-tially poisonous substances; the remaining
cellter I)rovi(1e5 service 15 hours each day
(
8 A.M. to 11 p.xt.). vIost centers havefacili-ties for emergency treatment, available
‘2 ‘2 either in the center or nearby.
‘I ‘I There are 29 centers tinder tile
supervi-4
:
sion of a state center (or clearinghouse)7 7 (Table II). In addition to these there are S 8 three centers supervising one or more
smaller centers (four in all, usually within
::
a city or county). The majority (58) of1.5 poison control centers operate as
mndepen-17 13 dent units.
Table II shows that some cities have
36 16 two or three poison control centers; 17
cen-::
::
ters are located in seven cities. Some of.51 ‘21 these are smaller centers (2) co-operating
with a supervising center (1) in the city.
61 ‘27 Other cities have two or md)re centers
op-:
:
crating independently (5) or under the105 37 supervision of a State center (9). Thus,
poison control centers give service on a
14 40 city, county, state, or regional basis.
Twenty-nine per cent of the centers serve
an area of several counties, 22% serve the
area within their state, 16% serve only the
city within which they are located, and
hospital 81
()utpatient or
eniergen-cy service 70 714
Other Ii 11.7
health department .5 5 .3
\Iedical school 3 3.‘1
‘e(li(Ill sOciety buil(ling I 1 .1
First aid stHtiOli 1 1.1
Drug store “ ‘2.1
Unknow,i I 1.I
Fotal 94 100.0
---.-86 .I American Academy of Pediatrics
City health department
State health department
Medical society Medical school Othert
81 86.1
59 6.8
50 53.’2
50 53.2
3’i 34.0
cs c29.8
33 35.1
TABLE II
ORGANIZATIONAL PATTERN OF CENTERS
I attern
‘ Ofl!Y (‘enter
zn(zty
Two or More
Cenkrs
.
in Same ( ity
Total
(.\‘o.) (%) (No.) (%) (No.) (%)
State or regional center supervising one or itiore centers i 2.6 1 5.9 3 3.
(enters under supervision of regional center i L6 i 11 .8 4 4.
(‘enters under supervision of state clearinghouse 20 26.0 9 5’2.9 9 ‘30.9
Independent center 53 68 .8 5 929.4 58 61 .7
‘I’otal 77 1(K).0 17* 100.() 94 1()0.0
* Seventeen (18.1%) of (‘enters are loCate(l in cities having two or more poison control centers.
Location and Financial Support
Poison control centers are housed in a
variety of locations (Table III). Nearly 90%
of centers are located in hospitals, usually
in the outpatient departnient or the
emer-gencv room. Other locations are health
dc-1)artilients (state or local), ineclical school
1)uildings, medical society offices, a first aid
station and a blood hank.
\Vho sponsors and supports a poison
con-trol center? Often, more than one agency
or organization furnishes financial aid, per-sound, supplies, office space, and facilities
fur treatment. Eighty-four per cent of the
poison control centers in the country are
affiliated with hospitals, 63% with state
TABLE III
I.O(ATION OF PoIS()N CONTLIOL CENTER
. Number of
JMeatlOfl Per ( eat
Centers
chapters of the American Academy of
Pediatrics, 53% with city health
depart-ments, and 53% with state health
depart-ments (Table IV). Medical schools are
supporting or co-operating with 30% of the
centers; local medical societies are affiliated
with :34% of the centers. Other affiliated
or-ganizations are parent-teacher associations,
local chambers of commerce, local safety
councils, Lions’ Clubs and women’s clubs. The Children’s Bureau provides maternal and child health funds through grants to
state health departments, some of which
may be used to support poison control
ac-tivities.
TABLE IV
(‘0-OPERATING, SPONSORING OR SUPPORTING
AGENCIES*
Number of
Ageneij , Per Cent
. Center8
* Supporting agencies may furnish financial ziid,
per-sonnel, supplie, office space, etc.
t Includes parent-teacher associations, chamber of comnierce, safety council, Lions’ Club, health councils, drug conpa ides, pharmaceutical associa tions, women’s
Number of Place of Treatment Centers
Total 94
Supervision of Centers
Most poison control centers are manned
by physicians. In 88% of the centers
physi-cians routinely answer inquiries concerning the toxic nature of and treatment of poison-ing. In almost all centers medical or para-medical personnel-pharmacists, nurses, or public health sanitarians-are available to give information. Clerks answer inquiries in
only 3% of the centers. All personnel who
give information about toxicity have re-ceived some orientation and training from the director of the center.
In 90% of the centers, the activities are directed by physicians. In those centers
where pharmacists, administrators of hospi-tals, nurses or sanitarians assume
director-ship, physicians serve in advisory or
consult-ant capacity. All the centers, then, are directed or advised by physicians.
Service Provided
The average number of telephone
in-quiries answered by centers is 18 per week, the maximum number, 75. For those centers which treat poisonings in addition to sup-plying information, an average of seven patients per week are treated, with a maxi-mum of 25. These include outpatients and
inpatients.
Most of the centers make treatment available to physicians and the community.
Eighty or 85.1% of the centers have such
facilities at the center (Table V). Nearly
one-half of these centers also offer addi-tional treatment at other participating
hos-TABLE V
AVAILABILITY OF TREATMENT
Treatment and information
centers 80 85 .I
(‘enter 4.5 47.9
Center and
co-operat-inghospitals
Information center only 3.5
14
37.’2
14.9
pitals. The 14 remaining centers furnish
informational services only, but treatment
is available at nearby co-operating hospitals.
Information Available from Center
The information about toxicity, ingredi-ents, and treatment which the poison con-trol centers must have on various products -drugs, detergents, insecticides, polishes, waxes, etc-is derived from a number of sources. Each center has a poison library containing texts on toxicology,
pharmacol-ogy and other related areas.47 Some
cen-ters use only three or four books while others have the facilities of hospital or medical school libraries, containing
periodi-cals.
Most of the centers also use files
contain-ing information about various potentially toxic products or substances,#{176} normally in-dexed by trade name, toxic constituent,
type of product and, in some cases, by
antidote or treatment.
Follow-up Information
Sixty-six per cent (61) of the centers oh-tam follow-up information about patients treated for poisoning at the center or brought to its attention. City health de-partments obtain this information for 51 of the centers; nine do their own follow-up and one center has patients followed by the local visiting nurses association. An av-erage of seven patients per week are fol-lowed, maximum being 25.
Records of poisonings vary from simple report forms on small file cards to several pages of clinical and follow-up data. Fairly detailed coding and mechanical tabulating procedures are used in 54.3% (51) of the centers, usually through the facilities of
Per Cent stateare nowor localutilizinghealth the departments.National Clearing-Thirt’
house for Poison Control Centers for this purpose. Several centers release periodic
bulletins and summaries of cases.
0 Recently the National Clearinghouse for Poison
Control Centers distributed a file containing
in-formation on 500 poisonous or potentially
poison-100.0 products and substances to all operating poison
DISCUSSION
That accidents are the chief cause d)f
death in children is becoming more and
more obvious to the medical profession.
Accidental poisoning, although ranking
eighth as a cause of death among all
acci-dents results in a significant amount of
morbidity. Of all types of accidents,
per-haps poisoning can best be controlled with
our present knowledge. The activity
cx-pended for the control of accidental
poison-ing may seem excessive for the importance
of the problem, but it should be empha-sized that there may be about 700 nonfatal
accidental ingestions for every fatal
poi-soning.8 Furthermore, the lessons and
pre-ventive methods learned from dealing with
accidental poisoning may be used to deal
with other types of accidents.
It is not a coincidence that the growth of control centers has paralleled the rising
interest in accidental poisoning
demon-strated by increased publication and
activ-ity of medical organizations in this field. The current system of poison control centers is serving the needs of the country
well, but there still are some areas in need
of centers. Wherever poison control
cen-ters exist there is a potential for
awaken-ing community interest in educational
cam-paigns on accident prevention.
Ultimately there should be at least one
poison control center in every state and territory. Where more than one poison con-trol center exists, co-operation in the area
should be stressed. It takes time, money and effort to operate a poison control ac-tivity; duplication should be avoided. In some areas excellent well-co-ordinated
programs for several centers are already
in operation, but most centers still operate independently.
The American Academy of Pediatrics has
been a pioneer in the control of accidental
poisoning, influenced by the fact that more preschool children died from this “disease” in 1956 than from scarlet fever, acute
polio-myelitis, diphtheria, infectious hepatitis, and acute infectious encephalitis combined.9 Local and state departments of health are
assuming more and more of a role in this field.
Where medical schools are affiliated with
poison control centers, research in
causa-tion of accidents, methods of treatment, and education of future medical
practi-tioners can be furthered. The hospital of a
medical school is an excellent location for
a control center. Facilities for 24-hour serv-ice in providing information and treatment,
consultants in the various fields related to
poisoning, laboratory and research facili-ties, and the library of the medical school thereby are made available.
To provide a 24-hour information serv-ice by telephone on the toxicity of almost
any product or substance an infant is likely to ingest is no small operation. The in-formation must be at hand or almost im-mediately available, and personnel must be trained to use the informational sources effectively.
The treatment services given by many poison control centers are an important as-pect of their operations, but emergency treatment is not limited to poison control
centers. Every hospital emergency room
should be equipped to give such
emer-gency treatment, and there should be
co-operation with the nearest control center. There is much to be learned about causation of accidents from reporting and follow-up of cases of accidental poisoning. The problem of lead poisoning in children
is being effectively dealt with in some
cities with the aid of these techniques.’#{176}’ ‘
The knowledge we now have about causa-tion of accidental poisoning has been ob-tamed as a result of this epidemiologic
ap-proach,’2 now being used by some com-munities for all types of accidents.13 It is to be hoped that all centers will ultimately institute follow-up, to help define the local problem and improve preventive measures.
given first aid directions and advised to call his family physician at once. The cen-ter may even make an effort to notify the family physician. The effectiveness of the
centers depends on the number of physi-cians in the area who use the services. All physicians should learn the location of the
nearest poison control center, by
contact-ing the local medical society, the local or state department of health, or the U.S. Public Health Service.
SUMMARY
As of April, 1958, there were 124 poison
control centers in 40 states and territories.
The results of a study of the operations of 102 of these centers are presented. Co-ordination of activities of poison control centers is desirable, especially where more than one center serve the same area. The
American Academy of Pediatrics has led
the way in establishing centers all over the country. Increasing numbers of state and local departments of health and medical schools are participating in control of poi-sonings and strengthening the movement for development of poison control centers.
Poison control centers give information
concerning toxicity of a variety of products
and substances. Many also maintain facili-ties for treatment of poisoning, but emer-gency rooms of all hospitals should be equipped to give proper treatment for poisoning.
Prevention of accidental poisoning is the
best “treatment” for this “disease.” Follow-tip studies of patients will uncover sig-nificant causal factors and enable effective preventive measures to be instituted.
All physicians are encouraged to learn the location and utilize the services of the nearest poison control center.
ADDENDUM
Since this paper was written, more poison
control centers have been organized. As of
Oc-tober 1, 1958 there were 193 centers in
opera-tioii iii 4:3 states and territories.
REFERENCES
1. U.S. Public Health Service, National
Of-flee of Vital Statistics: Unpublished data.
2. Press, E. : Public health aspects of
poison-ing. J.A.M.A., 163:1330, 1957.
3. Lindemann, L. C. : Organization of Poison
Information Centers.
J.
Am. M. Women’sA., 12:379, 1957.
4. Gleason, M. N., Gosselin, R. E., and Hodge, H. C. : Clinical Toxicology of Commercial Products. Baltimore, Wil-hams & Wilkins, 1957.
5. Dreisbach, R. H. : Handbook of Poisons.
Los Altos, California, Lange Medical
Pub., 1955.
6. Goodman, L. S., and Gilman, A. : The Pharmacological Basis of Therapeutics,
2nd Ed. New York, Macmillan, 1955.
7. Howard, M. E., ed. : Modern Drug En-cyclopedia, 6th Ed. New York, Drug
Pub., 1955.
8. Cann, H. M., Neyman, D. S., and Ver-hulst, H. L. : The control of accidental
poisoning-a progress report. J.A. M.A.,
to be published.
9. U.S. Public Health Service, National
Of-flee of Vital Statistics: Unpublished data.
10. Williams, H., Kaplan, E., Couchman, C. E., and Sayers, R. R. : Lead poisoning in young children. Pub. Health Rep., 67: 230, 1952.
11. McLaughlin, M. C. : Lead poisoning in
children ill New York Cit’, 1950-1954;
an epidemiologic study. New York
J.
Med., 56:3711, 1956.
12. Jacobziner, H. : Accidental chemical
poi-sonings in children. J.A.M.A., 162:454,
1956.
13. Rice, R. C., Starbuck, C. W., and Reed,
R. B.: Accidental injuries to children.
