My Elective Rotation at a Poison Control Center

I just finished a two week elective at a poison control center and it was such a unique experience. I learned SO much – and not just medical management of common poisonings, but also some public health knowledge and that poison control is a fantastic (and underutilized) resource for medical professionals! I’m not sure how common this is as a rotation, but if your school offers it, I would recommend it. I’m lucky that one of the three poison control centers (PCC) in Florida is located on my medical school campus.

There are 55 PCC’s spread around the United States and they pick up the phone 24 hours a day, 7 days a week, 365 days a year to give FREE advice and management direction. And they all use a single national hotline number – 1 (800) 222-1222. The only thing to note is that currently, it will direct you to the PCC that is geographically closely to the area code you are calling from, so if you live in one state but have a cell phone area code from another state, this might be the one time to use a landline!

Before I started this rotation, I had two ideas in mind for when someone would call poison control – when their child drank bleach or if they got bit by a snake.

I’m sure that’s what most people think, if they even know poison control center’s exist in the first place. And yes, those are both reasons to call. But there are so many more! Poison control centers ARE NOT mandatory reporters, they are sources of advice and do not share your information with anyone. They are staffed by specially trained pharmacists, physicians with toxicology training, nurses, and physician assistants.

I’m sure this would vary from PCC to PCC, but my duties were pretty limited as a student. I listened in on calls that came in to the center and learned how the SPI’s (a Specialist in Poison Information) gather information from callers about specific exposures and give advice – should they expect symptoms, when/if to call 911 or go to the hospital, to call back with any questions or changes. I also helped with some of the follow-ups, particularly calling hospitals to get updates on patients who had ingested various substances. The type of substance would direct the information I needed – if it was a Tylenol ingestion, I was interested in liver function labs; if it was a beta-blocker (cardiac/blood pressure medication) ingestion, I was interested in vitals and some specific labs; if it was an anti-depressant overdose, I was interested in signs of serotonin syndrome. It was a really good way to review my pharmaceutical knowledge! I also joined various webinars, didactics with our emergency medicine residents (who rotate through the PCC), and reviewed some common toxicology cases with the director of the PCC.

When should you call poison control? And who can call?

  • First of all, anyone can call! It’s a free service and while it is helpful for them to know your name and contact information to follow-up, even that isn’t required to ask for help.
  • Call if you accidentally took more than one dose of medication, if your child accessed and swallowed some pills or a battery or a magnet (or really anything that isn’t food).
  • You should call if you’re a medical professional taking care of a patient who ingested substances (this includes plants) – known or unknown – or was bit by a potentially poisonous animal, not only will you get management advice but the PCC uses the call data for public health and trend tracking.
  • Law enforcement can call if they needing help identifying substances (this is a particularly important use as some very legal medications, like Tylenol, can look different when made in other countries).
  • Teachers and others in the education field can also call if it seems that there as been an exposure or ingestion among students.

According to data from the American Association of Poison Control Centers, the number one substance exposure they receive calls about are prescription/non-prescription pain relievers, at 11% of all exposures in 2019. In Florida, that number was 10.8%, followed by cleaning substances at 7.4%, and sedative/hypnotics/antipsychotics at 6%. Overall, less than half of all calls in 2019 (43%) were for children under the age of 5, the population we typically think is ingesting toxic substances. In Florida, the number of calls for young kids was even lower, at 38%.

And across the United States in 2019, unintentional injury was the third leading cause of death, following only heart disease and malignant neoplasm (cancer). That data can be broken down even further – for adults aged 25-64, the number one cause of unintentional death was unintentional poisoning, meaning they ingested substances without the intent to harm themselves but it resulted in death.

This should be concerning to everyone who takes medication, knows someone who takes medication, or prescribes medication. One sad but unsurprising contributor to this data are opioids, which is a leading reason for calls for poison control (remember 11% of all calls in 2019 were for ingestion of pain relievers). For kids, who we often think unintentionally ingest poisonous substances, unintentional poisoning is much lower as a cause of death. It is, however, the second leading cause of injury death for adolescents and young adults aged 15-24. The data I shared and linked above is from 2019, but I also think this is a helpful visual representation of the data from 2018. There isn’t a 2019 version of this chart yet but you’ll note that in 2018, unintentional poisoning was 9th on the list for 10-14 year olds…it was 2nd in 2019.

Even for someone like me, who has studied public health and now medicine, I was shocked to learn about unintentional poisoning as the number one cause of unintentional injury death. I never even categorized that as an injury death in my mind – I thought of motor vehicle collisions (of which we have too many in Miami), firearm incidents, and drownings. So now I’m passing on that knowledge to all of you. We all know that heart disease and cancer are leading causes of death. But we rarely stop to think about injury deaths in the same breath and we should.

You can follow the American Association of Poison Control Centers on Facebook and Twitter for excellent educational content. I encourage everyone to put the PCC hotline number, 1 (800) 222-1222, in their phone and use it! You should never be afraid to call, the specialists are there to help YOU.

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