1. society
2. welfare
3. healthcare
4. hospital

2004
Regional Center for Poison
Control and Prevention
serving Massachusetts and Rhode Island • ANNUAL REPORT
Table of Contents
E x e c u t i v e R e p o r t a n d M i s s i o n 2
Financial Report
4
P u b l i c E d u c at i o n 6
P r o f e s s i o n a l E d u c at i o n 7
S TAT I S T I C S
Whom do we serve and why do they call?
P e n e t r a n c e r at e s 8
9
Where do poisonings happen?
11
Where do the calls come from?
11
Where are poisonings managed?
11
Who are the poisoned?
12
w h at a r e t h e M o s t c o mm o n a g e n t s ? 13
W h at w a s t h e r e a s o n f o r t h e p o i s o n i n g ? 14
W h at w a s t h e r e s u lt o f t h e p o i s o n i n g ? 15
S u mm a r y o f d e at h c a s e s 16
APPENDIX
A . C e n t e r S ta ff 17
B . A d v i s o r y C o mm i t t e e 18
C . m o s t c o mm o n s u b s ta n c e s b y c at e g o r i e s 19
D . H o s p i ta l C a l l e r s a n d F u n d i n g Pa r t n e r s 20
E . P u b l i c at i o n s 22
Executive Report
The Regional Center for Poison Control and Prevention serving Massachusetts and Rhode Island (the
Center) has served both states since January 2000. To this the Center adds an additional 45 years of experience
in providing information on the evaluation and treatment of poisonings as the Massachusetts Poison Control
System, and 19 years experience as the Rhode Island Poison Center. This report provides information on
the demographics and substances involved in poisonings reported to the Center during 2004, as well as the
treatments and outcomes of these cases, in addition to the Center’s poisoning prevention efforts.
In March 2004, Massachusetts Governor Mitt Romney met with representatives of the Center, to follow up on the
Center’s extensive legislative outreach across both Massachusetts and Rhode Island in 2003. Governor Romney
signed a proclamation acknowledging Poison Prevention Week and appeared with the Center’s staff at the State
House in demonstration of the state’s commitment to this vital service. Other media events included television
interviews with Channel 10 of Providence and Channel 5 of Boston, public service announcements on several
Massachusetts radio stations, and an interview on a Spanish language call in show on Providence’s 990 AM.
2004 also saw the publication of the Institute of Medicine’s report on Poison Control Centers in the United States,
Forging a Poison Prevention and Control System (http://www.iom.edu/report.asp?id=19901), and the Northeast
Injury Prevention Network’s Poison Data Book (available at http://www.edc.org). Both reports speak to the need
for increased attention to poisoning injuries on a national and regional level, and suggest that poison control
services should be better integrated in the federal and state health public infrastructure.
The original Health Resources and Services Administration (HRSA) incentive grant that ended in 2003 was renewed
for another two years. The New England Consortium of Poison Control Centers continued its collaboration with a
series of regional toxicology meetings, online professional training modules and quarterly newsletters.
What is a poisoning?
A poisoning is caused by any substance that has a toxic, or damaging effect, to the tissues and/or
systems of the body upon exposure. Exposures can occur through ingestion, inhalation or through dermal
and ocular contact.
Any substance may become a poison if it used incorrectly, in the wrong amount, or by a person with a particular
sensitivity to the product. Common poisons include household products, industrial and environmental
chemicals, medications (prescription, over the counter, veterinary and herbal), illicit drugs, and venom. In June, the New Hampshire Poison Control Center closed and the Northern New England Poison Control
Center took over services for that state. Although this brought an end to the Center’s contract to cover New Hampshire’s overnight calls, the Center continues to coordinate with New Hampshire physicians through the ongoing New England Regional Toxicology Conferences.
The Center remains an important component in protecting public health. In October 2004, the Center worked
closely with the Rhode Island Department of Public Health’s Division of Environmental Health to manage a
mass residential exposure to elemental mercury in Pawtucket. The Center advised individuals and health care
professionals in the evaluation and management of these cases, in order to most effectively reduce the long-term
health risks associated with the exposure.
As national security continues to be of foremost concern, poison control center resources remain a vital part of
the public health response to chemical/biological terrorism threats. Accordingly, all segments of the population,
including the general public, law enforcement, legislative bodies, first responders, health care providers, and
public health specialists have utilized poison control center resources as an emergency preparedness resource.
The Center participates in two national surveillance systems, Epi-X and the national Toxic Exposure Surveillance
System, both of which are monitored by the Centers for Disease Control and Prevention (CDC) for potential
early detection of a mass toxic exposure or bioterrorism response.
Locally, the Center also provides its resources for regional exercises that test emergency protocols and identify
gaps in preparedness. As part of the security measures around the 2004 Democratic National Convention, in
Boston, the center provided live toxic surveillance data directly to the Boston Public Health Commission. The
Center remains committed to maintaining a level of excellence in emergency preparedness so that both health
care professionals and the public that it serves will have access to state-of-the-art resources in a time of need.
Mission
The mission of Regional Center for Poison Control and Prevention is to provide assistance and expertise in the medical diagnosis, management and prevention of poisonings involving the people of
Massachusetts and Rhode Island. The Center seeks to improve the quality of medical care given to
patients by maintaining a standard of excellence in both clinical research and professional development.
In addition, the Center develops and implements public education and information campaigns to prevent injuries due to intentional and unintentional poisonings.
Financials
In fiscal year 2004, the annual operating budget for the Regional Center for Poison Control and Prevention
was over $2 million. The majority of the funding for Center operations is provided by the Massachusetts
Department of Public Health and Rhode Island Department of Health, with additional funding from hospital
partners and pharmacy training programs. The Center continues to receive federal funds appropriated from
the Poison Control Center Enhancement and Awareness Act of 2000. The following table highlights revenue
and expenditures for fiscal year 2004. The balance reflects funding reserved to offset the continuing decline
of member hospital donations and the anticipated loss of revenue from the completion of both the New
Hampshire Poison Control Center night contract and the HRSA New England consortium grant.
F isca l Y ea r 2 0 0 4 ( J u ly 2 0 0 3 t o J u ne 2 0 0 4 ) O p e r at i n g R e v e n u e D e pa r t m e n t o f P u b l i c H e a lt h , M a s s a c h u s e t t s $520,440
Sources
M at e r n a l a n d c h i l d h e a lt h b l o c k g r a n t $328,256
HR S A H o s p i ta l Em e r g e n c y P r e pa r e d n e ss $177,184
S u b s ta n c e a b u s e p r e v e n t i o n D e pa r t m e n t o f H e a lt h , R h o d e I s l a n d $15,000
$300,000
S o u r c e s HR S A H o s p i ta l Em e r g e n c y P r e pa r e d n e ss $150,000
CDC $100,000
S tat e o f R h o d e Is l a n d F e d e r a l S ta b i l i z at i o n G r a n t $374,951
Federal New England Consortium Grant
$36,976
F u n d i n g Pa r t n e r s $110,271
$50,000
N e w H a m p s h i r e C o n t r a c t $34,286
P h a r m a c y T r a i n i n g P r o g r a m s $4,500
S u b t o ta l $ 1 , 3 8 1 , 424
C h i l d r en ’ s H o spita l I n - K ind $ 7 1 8 , 34 0
T O TA L $2,099,764
D i r e c t E x p e n s e s S a l a r i e s a n d B e n e f i t s $1,070,749
T e l e p h o n e $38,535
P r i n t i n g a n d P o s ta g e $35,811
T o x i c a l l S o f t w a r e L i c e n s i n g F e e $25,865
T r av e l $16,600
E d u c at i o n a l M at e r i a l s $1,031
S u p p l i e s $15,845
D u e s / M e m b e r s h i p s $8,675
O t h e r $865
S u b t o ta l $ 1 , 213 , 9 7 6
C h i l d r en ’ s H o spita l I n - K ind $ 7 1 8 , 34 0
T O TA L $ 1 , 9 32 , 31 7
BALANCE:
$ 1 6 7 , 44 7
Public Education
The goal of the Poison Control Center’s public education program is to reduce both intentional and
unintentional poisonings through poisoning prevention education and promotion of the Center’s services. In 2004, the Center’s Health Education sub-committee continued to convene to advise the Poison Control
Center’s staff on effective strategies for the implementation of the Strategic Plan created in the year 2000, and revised in 2003; a list of committee members is included in Appendix B. Activities in Massachusetts were
restricted in 2004 as budget limitations required a scaling back of the educational program. A greater emphasis
was turned to development of the web page, www.maripoisoncenter.com, as a means of communicating with
the public. The site subsequently re-launched in 2005.
C u r r ent E d u cati o na l M ate r ia l s , 2 0 0 4
2004 Accomplishments:
P o i s o n C e n t e r B r o c h u r e ( E n g l i s h & S pa n i s h )
» Added the national poison help logo to all new printings of
T e l e p h o n e S t i c k e r s ( E n g l i s h & S pa n i s h )
educational materials and handouts where size allows, in continuing
R e f r i g e r at o r M a g n e t s
efforts to promote the nation-wide hotline number, 1-800-222-1222.
P o s t e r s
» Performed outreach in classrooms, health centers, and health fairs,
including Spanish language outreach to Rhode Island.
» Participated in Rhode Island Department of Health’s mercury
thermometer exchange.
M e d i c i n e Pa s s p o r t f o r S e n i o r s
C l i n i c a l T o x i c o l o g y R e v i e w
Fact S h eets
C a n d y o r M e d i c i n e ( E n g l i s h & S pa n i s h )
C a r b o n M o n o x i d e
» Continued to contribute to and develop the New England Consortium
of Poison Centers newsletter, Poison Control News, supported by
HRSA and focusing on environmental toxins and poison issues. The Center provided articles on pool safety and spiders bites, and
Spanish translations of articles on pesticides, mercury and lead.
» Updated current inventory of educational fact sheets and created
new sheets about common poisoning risks, including presentation
materials on candy and medicine look-alikes, the top ten most
common exposures and poison prevention tips for seniors.
» Updated Spanish language handout inventory, including new
translations of candy and medicine look-alikes and the ipecac alert.
» Added Spanish language telephone stickers to education material inventory.
» Distributed Northeast Injury Prevention Poison Data Book in
Massachusetts and Rhode Island.
C h i l d r e n A c t Fa s t ( E n g l i s h & S pa n i s h )
Fa l l P o i s o n S a f e t y T i p s
H a l l o w e e n S a f e t y
I p e c a c A l e r t ( S pa n i s h )
P o i s o n P r e v e n t i o n T i p s
P o i s o n o u s P l a n t s ( E n g l i s h & S pa n i s h )
P r e v e n t i n g P o i s o n i n g i n Y o u r H o m e
( E n g l i s h & S pa n i s h )
S a f e P l a n t s ( E n g l i s h & S pa n i s h )
S a f e r A lt e r n at i v e s
T o p T e n P o i s o n E x p o s u r e s i n C h i l d r e n
W i n t e r H o l i d ay S a f e t y
mate r ia l s f o r c h i l d r en
SPIKE T e m p o r a r y Tat t o o s f o r C h i l d r e n
P o i s o n P r e v e n t i o n C o l o r i n g B o o k
P o i s o n W o r d S e a r c h
P i l l s a n d P o i s o n s Q u i z ( E n g l i s h & S pa n i s h )
Additional articles covering a wide array of poisoning concerns are available in both English and Spanish at www.maripoisoncenter.com
Professional Education
The Professional Education program at the Regional Center for Poison Control and Prevention is
comprised of three components: continuing education for center staff, education for health professionals,
and extramural education for health professionals. The Center has continued to provide the highest quality
professional development to its staff, as well as the professional community outside the Center.
Continuing Education for Center Staff
» Presented fourteen in-service programs to the staff, on such topics as Alcohols/Glycols, Biologicals, GHB,
Pesticides, Acetaminophen Overdose Management and Weapons of Mass Destruction.
» Instituted monthly reading list of current medical toxicology literature.
» Implemented peer review quality assurance program.
» Participated in New England Regional Toxicology Conference and New England Consortium seminars.
Education for Health Professionals
» Fellowship Program in Medical Toxicology: The Center maintained an active two-year postgraduate
fellowship in medical toxicology. In recognition of its unique service within the Harvard-affiliated hospital
system, the program also received the official designation as the Harvard Medical Toxicology Fellowship.
» Doctor of Pharmacy Clerkship: Several students from the Massachusetts College of Pharmacy and Health
Sciences and the University of Rhode Island College of Pharmacy participated in a six-week rotation
through the Regional Poison Center.
» Emergency Medicine Resident Rotation: Thirty-two third-year residents from Boston Medical Center,
Brigham and Women’s Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center,
the Harvard University-affiliated hospitals, and Rhode Island Hospital participated in a one-month rotation
through the center. The Center was also the site of fourteen Pediatric Emergency Medicine fellows from
Children’s hospital Boston, Boston Medical Center and Hasbro Children’s Hospital.
» Medical Student Clerkship: The Center hosted medical students from Harvard and the University of Glasgow.
Education for Health Professionals—Extramural
» Conducted lectures on clinical toxicology at the Massachusetts College of Pharmacy and Health Sciences
and University of Rhode Island College of Pharamacy, as well as lectured at various teaching hospitals,
community hospitals and continuing education courses for health professionals.
» Authored books and chapters along with contributing articles to various professional journals. A complete
list of these publications is included in Appendix E.
Whom do we serve
and why do
they call?
In 2004, the Center managed a total of 66,585 incoming calls,
including 53,880 exposure calls and 12,705 information calls.
The Center continued to experience a decrease in information
calls in 2004 as a result of the 2003 policy change which
prioritizes drug identification calls to health care and law
enforcement professionals.
2003
T ype o f C a l l 2004
2001
2002
I n f o r m at i o n 15,785
25,209
15,859
12,705
A l l E x p o s u r e s 45,193
52,181
52,739
53,880
T o ta l 60,978
77,390
68,598
66,585
The total population for the area served by the Center is 7,361,057 residents. Massachusetts’ population
is 6,349,097 (86%) and Rhode Island’s population is 1,011,960 (13%). The number of calls received annually
from each state continues to be proportional to the state population.
2001
2002
2003
2004
I n f o r m at i o n 1,713
2,768
2,954
2,159
E x p o s u r e 6,093
8,335
7,415
7,703
T o ta l 7,806
11,103
10,369
9,862
I n f o r m at i o n 13,724
22,020
12,653
10,301
E x p o s u r e 38,387
42,340
43,874
45,106
T o ta l 52,111
64,360
56,526
55,407
T ype o f C a l l R h o de I s l and T ype o f C a l l M assac h u setts
Penetrance
In order to keep trend data consistant, the definition of penetrance will only include the number of human
exposure calls handled per 1,000 population. In 2001, the American Association of Poison Control Centers changed
the definition of penetrance to include information calls; however, we are not using that definition in this report.
The tables below highlight penetrance rates by county in Massachusetts and by core city in Rhode Island. This analysis will help the Center target and evaluate the effectiveness of its outreach and education efforts.
C a l l P enet r ance b y C o u nty: M assac h u setts Cou nty Popul atio n
2002
E xpo su res
2003
P enetr ence E xpos u res 2004
Penetr ence Exp o su res P enetr ence
B a r n s ta b l e 222,230
1,450
6.5
1,428
6.4
1,472
B e r k s h i r e 134,953
821
6.1
757
5.6
794
B r i s t o l 534,678
3,101
5.8
2,797
5.2
3,144
5.7
D u k e s 14,987
124
8.3
126
8.4
148
9.4
E s s e x 723,419
4,327
6.0
4,024
5.6
4,671
6.3
Franklin
71,535
371
5.2
553
7.7
551
7.6
H a m p d e n 456,228
2,411
5.3
2,230
4.9
2,583
5.6
H a m p s h i r e 152,251
828
5.4
779
5.1
905
5.9
1,465,396
9,443
6.4
8,361
5.7
8,688
5.9
9,520
103
10.8
69
7.2
102
10.1
N o r f o l k 650,308
4,451
6.8
4,073
6.3
4,354
6.7
P ly m o u t h 472,822
3,547
7.6
3,270
6.9
3,639
7.4
S u ff o l k 689,807
3,856
5.6
2,929
4.2
3,452
5.2
750,963
4,546
6.1
4,610
6.1
5,013
6.4
6.9
44 , 9 9 2 7.0
Middlesex
N a n t u c k e t Worcester
N o t s p e c i f i e d M A S tate 6 , 34 9 , 0 9 7 C a l l P enet r ance b y C o r e C ity: R h o de I s l and Cor e city 42 , 34 0 6.7
6.4
6
7,826
43 , 8 31 2002
2003
Popul atio n
E xpo su res
C e n t r a l Fa l l s 17,197
152
8.8
74
4.3
67
3.5
N e w p o r t 28,184
273
9.7
235
8.3
241
9.3
Pa w t u c k e t 71,784
647
9.0
616
8.6
412
5.5
156,727
1,340
8.5
1,922
12.3
1,469
8.2
43,377
312
7.2
398
9.2
391
8.8
694,691
5,611
8.1
4,163
6.0
5,040
6.8
1 , 0 11 , 9 6 0 8 , 33 5 8.2
7,408
7.3
7,620
7.1
P r o v i d e n c e Woonsocket
A l l O t h e r s R I S tate P o p u l at i o n d ata s o u r c e : U S Ce n s u s B u r ea u , 2 0 0 0
P enetr ence E xpos u res 2004
Penetr ence Exp o su res P enetr ence
10
Where do
poisonings happen?
Of the 53,731 exposure calls managed by the Center in 2004, about 93% (50,227) were exposures in a residence
with the remaining 7% (3,504) occurring in other locations such as schools, workplaces and other public areas.
Where do calls come from?
In 2004 more than 79% of the exposure calls came from residences,
16% (8,485) from health care facilities and medical professionals with the
remaining 5.9% (3,110) coming from various sources such as public areas,
schools and workplaces. The caller's location was unknown in less than
Health Care
facility: 16%
Residence: 79%
other: 5%
0.1% (31) of cases.
The graph to the right represents caller location distribution for 2004.
Appendix D contains a breakdown of the number of calls by Hospital across
the two-state region.
Where are
poisonings
managed?
M ana g ement S ite 2004
O n s i t e : 40,870
HC F : 11,321
U n k n o w n : R e f u s e d R e f : 1,226
347
In 2004 the majority of the human exposure calls (76%) were managed on-site at a non health care
facility. This year’s figure represents a slight increase in the number of cases treated at a Health Care Facility.
Of interest are the calls that were managed at a health care facility but were
Lost to
f o l l o w- u p : 2 7 %
treated and released. While it is unclear whether a pre-hospital call could
have prevented a trip to the emergency room, the potential for cost savings
T r e at e d a n d
released: 43%
Admitted
Critical: 14%
exists if the Poison Center is involved prior to the hospital. A graph at left
shows calls managed at health care facilities.
Admitted non-critical: 10%
A d m i t t e d p s y c h i at r i c : 6 %
11
Who are the poisoned?
Of the 53,731 human exposure calls answered in 2004, specific age was captured for 53,698 cases
(99.9%). Almost 54% (28,169) of the exposure calls involved children
5 years and younger. Specifically, the greatest numbers of exposure calls
involved two-year-olds; 10,084 calls for this age group were received,
representing over 19% of the total exposure calls. A combined 21% of
Gende r 2004
Males
26,518
Females
26,773
T o ta l 53,291
all exposure calls involved infants age one and under.
Each year gender remains split equally between males and females. Of the
exposure calls received, gender was recorded for 53,291 calls in 2004.
Overall, the distribution of the age or gender has not changed with an
increase in total calls.
A g e C a l l s C a l l s p e r 1 , 0 0 0
P o p u l at i o n
<5
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-59
60+
25,77455.9
4,830 9.6
5,28110.5
6,26812.8
2,868 6.0
1,920 1.8
2,123 1.7
1,564 1.5
437 1.2
2,144 1.7
C a l l V o l u me b y A g e : 2 0 0 4
12,000
10,000
8,000
6,000
4,000
2,000
0
<1yr
1yr
2yr
3yr
4yr
5yr
6-12yr
13-19yr
20-29yr
30-59yr
60+yr
E x p o s u r e s 3,037
8,230
10,084
4,423
1,919
1,076
3,739
3,925
3,159
6,874
2,144
12
What are the most
common agents of poison?
Products involved in poisonings are regularly divided into
drug and non-drug categories. The percentage of calls and products
Cosmetic/
Personal
C are products:
19.5%
other: 42.8%
cleaning
substances:
12.5%
in each category has remained consistent over the past three years.
In 2004 non-drug products comprised 42% (31,933) of all calls.
Items included in this category are cosmetic/personal care products
and household cleaning products. Pesticides are new to this top five
list, narrowly ranking higher than arts and crafts/office supplies.
pesticides: 6.2%
foreign bodies/
toys/miscellaneous: 9.1%
plants: 5.8%
T o p F i v e S u b sta n c e s M o st F r e q u e n t ly I n v o lv e d i n N o n - D r u g R e l at e d E x p o s u r e s , 2 0 0 4
S u b sta n c e M o st C o mm o n P r o d u c ts
C o s m e t i c s / P e r s o n a l c a r e p r o d u c t s r e a m s / l o t i o n s / f o u n d at i o n , T o o t h pa s t e w i t h f l o u r i d e ,
C
M o u t h w a s h , N a i l p r o d u c t s , H a i r c a r e p r o d u c t s
C l e a n i n g S u b s ta n c e s B l e a c h , H o u s e l h o l d c l e a n e r s , D i s h w a s h e r D e t e r g e n t s ,
D i s i n f e c ta n t s
F o r e i g n B o d i e s / T o y s / M i s c e l l a n e o u s S i l i c a g e l , T h e r m o m e t e r s , G l o w p r o d u c t s , T o y s
Plants
N o n - t o x i c p l a n t s , g a s t r o i n t e s t i n a l i r r i ta n t s
Pesticides
I n s e t i c i d e s , R e p e l l e n t s , R o d e n t i c i d e s , H e r b i c i d e s
Analgesics:
18.9%
In 2004 drugs were the reported agent in 55% (36,744)
of all calls. Analgesics, such as acetaminophen, continue
to be the most commonly reported drug-related exposures.
S e d at i v e s /
Hypnotics/
Antipsychotics:
9.8%
other: 49.2%
Appendix C provides a more detailed analysis of the most
Antidepressants:
7.9%
common substances reported in both drug and non-drug categories.
Topicals: 7.9%
Cough and
Cold Remedies: 6.4%
T o p F ive S u b stances M o st F r e q u ent ly I nv o lved in D r u g Re l ated E xp o s u r es , 2 0 0 4
S u b stance M o st C o mm o n P r o d u cts
A n a l g e s i c s I b u p r o f e n , A c e ta m i n o p h e n , O p i o i d s , A s p i r i n , N a p r o x e n
S e d at i v e s / H y p n o t i c s / A n t i p s y c h o t i c s B e n z o d i a z e p i n e s , At y p i c a l a n t i p s y c h o t i c s
A n t i d e p r e s s a n t s e r o t i n i n R e - U p ta k e I n h i b i t o r s , T r a z o d o n e ,
S
Am i t r i p t y l i n e , L i t h i u m
T o p i c a l s D i a p e r r a s h p r o d u c t s , t o p i c a l s t e r o i d s
C o u g h a n d C o l d R e m e d i e s D e x t r o m e t h o r p h a n , P r o d u c t s w i t h o u t o p i o i d s
13
What was the intent related
to the poisoning?
The majority of the human exposures were unintentional. Of intentional poisonings, suspected suicides
(4,093) were recorded as the largest source of the intentional poisonings managed by the Center in 2004.
These data are consistent with national poisoning statistics reported
by the American Association of Poison Control Centers (AAPCC).
Suspected suicide: 8%
U n k n o w n : 1%
A b u s e : 2%
m i s u s e : 1%
intentional:
12%
other: 2%
Unintentional 86%
14
What was the result
of the poisoning?
Of the outcomes recorded in 2004, 8,754 (82.8%) did not require follow up because the exposure was
judged to cause only minimal effect or to be non-toxic, causing no effect.
In 2004, 8,754 (16.4%) human exposures were followed to determine the medical outcome of the poisoning. Below is a table of cases that were followed:
D efiniti o n o f M edica l O u tc o mes C A S E S N O T F OLLO W E D M i n i m a l e ff e c t N = 44 , 4 9 6
37,144
J u d g e d n o n t o x i c 4,512
U n a b l e t o f o l l o w
2,840
2004
M i n o r e ff e c t: 2,675
The patient exhibited some symptoms as a result of the exposure, but they were minimally bothersome to the patient.
The patient has returned to a pre-exposure state of well being and has no residual disability or disfigurement.
M o d e r at e e ff e c t: 2,293
The patient exhibited symptoms as a result of the exposure that are more pronounced,
more prolonged or more of a systematic nature than minor symptoms.
M a j o r e ff e c t: 846
The patient has exhibited some symptoms as a result of the exposure.
The symptoms were life-threatening or resulted in significant residual disability or disfigurement.
D e at h : 25
The patient died as a result of the exposure or as a direct complication of the exposure which
was unlikely to have occurred had the toxic exposure not preceded the complication.
Only included are those deaths that are probably or undoubtedly related to the exposure.
U n r e l at e d e ff e c t: 444
Based upon all information available, the exposure was probably not responsible for the effect(s).
N o e ff e c t: 2,915
The patient developed no symptoms as a result of the exposure.
15
Summary of death cases
The deaths listed below are those cases reported by health care facilities to the Center for management of
a suspected poisoning where the Center received confirmation of a fatal outcome. In those cases where several
substances were ingested, the cause of death is ascribed exclusively to the substance that was deemed to have
had the most toxic effect.
Age
MALE
fema l e S u b stance
0-5
0
0
6-12
0
0
13-19
2
0 S u d d e n c a r d i a c a r r e s t ( p o i s o n i n g r u l e d o u t ) , C o c a i n e , H e r o i n
20-29
2
0 O p i o i d s , THC , E t h a n o l , A c e ta m i n o p h e n , M u lt i - V i ta m i n w i t h I r o n
30-39
3
6 C o c a i n e , G a b a p e n t i n , R i s p e r i d o n e , E t h y l e n e G ly c o l , E t h e ly n e G ly c o l ,
A c e ta m i n o p h e n , F e n ta n y l pat c h , Am i t r i p t y l i n e , A c e ta m i n o p h e n , U n k n o w n
40-49
2
5 T r i c y c l i c A n t i d e p r e s s a n t s , B u p r o p r i o n , A l p r a z o l a m , L o r a z e pa m , T r a z o d o n e ,
L a m o t r i g i n e , R o f e c o x i b , F e n ta n y l pat c h ; A c e ta m i n o p h e n ; H y d r o c o d o n e ,
C a r i s o p r o d o l , A c e ta m i n o p h e n , D e c o n g e s ta n t, A n t i h i s ta m i n e ; Am i t r i p t y l i n e ,
G a b a p e n t i n , P o ta s s i u m C h l o r i d e , Pa n t o p r a z o l e ; H a l o t h a n e , A c e ta m i n o p h e n ;
Oven Cleaner
50-59
0
2 A c e ta m i n o p h e n ; A c e ta m i n o p h e n
60-69
1
0 D r a i n O p e n e r
70-79
0
0
80-89
0
1 C o l c h i c i n e
90-99
0
1 V e r a pa m i l H y d r o c h l o r i d e , F l u va s tat i n , T o lt e r o d i n e
T o ta l ( 2 5 ) 10
15
The relatively small number of deaths reported to the Center does not accurately represent the true enormity
of poisoning as a cause of acute injury and death in the region. Poisonings are the leading cause of injury
death among Massachusetts residents, surpassing motor vehicle fatalities, and rank as the second leading
cause of injury death in Rhode Island. In 2003, there were 836 poisoning fatalities in Massachusetts and 115
in Rhode Island, as reported upon death certificates. Poisoningethylene
g ly c o l : 8 %
related deaths continue to rise at both the regional and national
Opioids: 12%
cleaning
products: 8%
tcas: 12%
unknown
s u b s ta n c e : 8 %
levels. Between 1990 and 2002 the age adjusted poison death
rate rose 133% in MA, 49% in RI, and 83% nationally (source:
WISQARS).
cocaine: 8%
A c e ta m i n o p h e n : 3 2 %
•— c a l c i u m c h a n n e l
blocker: 4%
•— u n r e l at e d c a u s e : 4 %
•— c o l c h i c i n e : 4 %
16
Serious injuries due to poisonings also remain a concern.
In Massachusetts, there were over 6,600 hospital stays for
non-fatal poisonings reported to the Massachusetts Hospital
Discharge and Observation Stay Databases, and approximately 12,000 emergency department discharges in
2003. In the same year, the Rhode Island Department of Health reported 938 poisoning related hospital stay
discharges in 2003.
There are several reasons that the majority of these cases may go unreported to the Center. Patients that are
found dead on arrival or whose history indicates treatment with a known protocol may not be reported to the
Center by law enforcement, first responders, medical examiners, or other health care professionals. Overdoses
of abused substances may also go unrecognized as a poisoning issue. While the Massachusetts Department of
Public Health reports 17,580 hospital discharges and 574 deaths related to opioid abuse in 2003, the Center
was called regarding only 3% (583) of these cases.
A look to the future...
The majority of poisonings are preventable. The Regional Center for Poison Control and Prevention
works to reduce the number of poisonings that occur through outreach and the dissemination of educational
materials to the public. These programs are a vital component of what must necessarily be a multifaceted
prevention system. Continued efforts in primary prevention are needed in the areas of environmental
modification (e.g. locks on cabinets, safety caps, manufacturing of pills), policy (e.g. monitoring prescription
drug dispensing, and drug enforcement by public safety), and educational initiatives performed by other public health professionals, pharmacists and clinicians.
The Center is unique in the region for its combined participation in the medical management and national
surveillance of potential poisonings, and its professional training and public education programs. As such, it
is a valuable resource that seeks to address such critical issues as potential bioterrorism events, environmental
17
A
Appendix A
2 0 0 4 C ente r S taff : Re g i o na l C ente r f o r P o is o n C o nt r o l and P r eventi o n
Medical Director
Specialists
Michele Burns Ewald, MD
Jeffery Benjamin, PharmD
in
Poison Information
Virginia Fortin, RN, CSPI
Managing Director
Susan Gavin, RN, CSPI
Avery Adam, MS
Cathy Kalayjian, RN, CSPI
Krys Modrzejewski, PharmD, CSPI
Staff Toxicologists
Joel Myers, NP, CSPI
Edward Boyer, MD
Bill Partridge, RN, CSPI
Heikki Nikkanen, MD
Jim Rorick, RPh, CSPI
Stephen Salhanick, MD
Anita Rossiter, RPh, CSPI
Michael Shannon, MD, MPH
Katherine Saunders, RN, CSPI
Robert Wright, MD
Iris Sheinhait, PharmD, CSPI
Toxicology Consultants
Cynthia Aaron, MD
Howard Wine, RPh, CSPI
Doris Wong, PharmD
Mike Burns, MD
Poison Information Providers
Sophia Dyer, MD
Dan Garber, PharmD candidate
Steve Traub, MD
Dennis Wigandt, PharmD candidate
Clinical Fellow
Administrative Associate
Ann-Jeannette Geib, MD
Deborah Haber
Melisa Lai, MD
Health Educator
Jill Griffin, MPH
Vilma Rodriguez
Clinical Manager
Alfred Aleguas, PharmD, CSPI
Assistant Clinical Manager
Adina Sheroff, RN, CSPI
18
B
Appendix B
A dvis o r y C o mmittee
Cynthia Aaron, MD
David Savastano
University of Massachusetts Health Care
Johnston Fire Department
Angela Anderson, MD
Kathy Stimson
Rhode Island Hospital
Springwell
L. Anthony Cirillo, MD
Barbara Tausey, MD
Memorial Hospital of Rhode Island
U.S. Department of Health and Human Services
Andy Erickson
Gayla Waller
AMICA Insurance
CVS
Anara Guard*
Susan Webb
Join Together
Massachusetts Medical Society
Daniel Halpren-Ruder, MD
Hea lt h D epa r tment Rep r esentatives
Emergency Medicine Physician
Massachusetts Department of Public Health
Sally Fogerty
Wendy Krupa, RN
Cindy Rodgers*
Rhode Island School Nurse Teachers Association
Janet Berkenfield
William Lewander, MD
Rhode Island Hospital
Tim Maher, PhD
Rhode Island Department of Health
William H. Hollinshead, MD
Laurie Petrone*
Massachusetts College of Pharmacy and
Dhitinut Ratnapradipa, PhD
Applied Health Sciences
Robert Vanderslice, PhD
Barbara McEachern
Re g i o na l P o is o n C ente r Rep r esentatives
US Consumer Product Safety Commission
Avery Adam*
Michele Burns Ewald, MD
Thomas Needham, PhD
Vilma Rodriguez*
School of Pharmacy, University of Rhode Island
Jill Griffin*
Julie Ross
Education Development Center
19
* Health Education Sub-Committee
C
Appendix C
m o st c o mm o n s u b stances b y cate g o r y
P e r centa g e o f exp o s u r es t o a l l s u b stances T o ta l P e r centa g e
C o s m e t i c s / P e r s o n a l c a r e p r o d u c t s
N a i l p r o d u c t s P e r centa g e o f exp o s u r es t o a l l s u b stances analgesics
2571
3.5
T o ta l P e r centa g e
ibuprofen
1,904
c r e a m s / l o t i o n s / f o u n d at i o n 857
1.2
a c e ta m i n o p h e n 1,712
2.3
t o o t h pa s t e w i t h f l u o r i d e 672
0.9
opiods
836
1.1
m o u t h w a s h 641
0.9
aspirin 380
0.5
hair care products
486
0.7
naproxen
304
0.4
s u b t o ta l 5,227
7.0
s u b t o ta l 5,136
6.9
other 992
1.3
other
1,810
2.4
c at e g o r y t o ta l 6,219
8.4
c at e g o r y t o ta l 6,946
9.3
s e d at i v e s / h y p n o t i c s / a n t i p s y c h o t i c s
1,060
1.5
C l e a n i n g S u b s ta n c e s
2.6
bleach
benzodiazepines
1,920
2.6
household cleaners (Misc)
696
0.9
at y p i c a l a n t i p s y c h o t i c s 1,132
1.5
dishwasher detergents
366
0.5
s u b t o ta l 3,052
4.1
d i s i n f e c ta n t s 278
0.4
other
538
0.7
s u b t o ta l 2,420
3.3
c at e g o r y t o ta l 3,590
4.8
other
2,169
2.9
c at e g o r y t o ta l 4,589
6.2
antidepressants
serotonin re-uptake inhibitors
1,361
1.8
Foreign Bodies/Toys/Miscellaneous
trazodone
465
0.6
silica gel
903
1.2
amitriptyline
196
0.3
thermometers
465
0.6
l i t h i u m
glow products
433
0.6
s u b t o ta l toys
321
0.4
other
s u b t o ta l 2,122
2.9
c at e g o r y t o ta l other
1,219
1.6
c at e g o r y t o ta l 3,341
4.5
topicals
P l a n t s
diaper rash products
topical steroids
194
0.3
2,216
3.0
690
0.9
2,906
3.9
1,537
2.1
285
0.4
non-toxic plants
405
0.5
s u b t o ta l 1,822
2.5
g a s t r o i n t e s t i n a l i r r i ta n t s 377
0.5
other
1,063
1.4
s u b t o ta l 782
1.1
c at e g o r y t o ta l 2,885
3.9
other
1,346
1.8
c at e g o r y t o ta l 2,128
2.9
cough and cold remedies
dextromethorphan
products without opiods
P e s t i c i d e s
insecticides
1,032
1.4
s u b t o ta l repellents
504
0.7
other
rodenticides
324
0.4
c at e g o r y t o ta l herbicides
103
0.1
s u b t o ta l other
c at e g o r y t o ta l 1,963
2.6
25
0.03
1,988
2.7
1,417
1.9
766
1.0
2,183
2.9
161
0.2
2,344
3.2
20
D
Appendix D
H o spita l C a l l e r s
H o spita l s in M assac h u setts C a l l s : 2 0 0 4
H o spita l s in M assac h u setts Heywood Hospital
(funding partners in bold)
C a l l s : 2 0 0 4
167
Anna Jaques Hospital
89
Holy Family Hospital
75
Athol Memorial Hospital
46
Holyoke Hospital
34
Bay State Health System
210
Hubbard Regional Hospital
78
Berkshire Medical Center
63
Jordan Hospital, Inc
92
Beth Israel Deaconess Medical Center
43
Lahey Clinic Hospital, Inc.
Boston Medical Center
345
Lahey Clinic North
19
Boston Medical Center University
14
Lawrence General Hospital
74
Brigham & Womens Hospital
76
Lowell General Hospital
50
240
Martha’s Vineyard Hospital
43
179
Mary Lane Hospital
10
Brockton Hospital
Cambridge Hospital
Cape Cod Hospital
85
Massachusetts Eye and Ear Infirmatory
Caritas Good Samaritan Medical Center
78
Massachusetts General Hospital
6
185
Caritis Norwood Hospital
152
Mercy Hospital
30
Carney Hospital
101
Merrimac Valley (Hale) Hospital
68
Children's Hospital Boston
258
Metrowest Medical Center - Framingham
Cooley Dickinson Hospital
57
Dana Farber Cancer Institute
2
Metrowest Medical Center - Natick
Milford Whitinsville Hospital
157
39
7
Emerson Hospital
15
Milton Hospital
Fairview Hospital
13
Morton Hospital & Medical Center
115
Falmouth Hospital
39
Mount Auburn Hospital
131
Faulkner Hospital
56
Nantucket Cottage Hospital
27
Nashoba Valley Hospital
32
Franciscan Hospital
Franklin Medical Center
2
12
Hallmark Health System
New England Medical Center
and Floating Hospital for Children
53
90
Harrington Memorial Hospital
96
Newton Wellesley Hospital
» Lawrence Memorial Hospital
63
Noble Hospital
» Melrose Wakefield
HealthAlliance - Burbank Campus
HealthAlliance - Leominster Campus
21
1
29
126
38
173
Northeast Hospitals
» Addison Gilbert Hospital
» Beverly Hospital
40
125
H o spita l s in M assac h u setts C a l l s : 2 0 0 4
North Adams Regional Hospital
North Shore Medical Center
26
109
C a l l s : 2 0 0 4
Butler Hospital
Emma Pendleton Bradley Hospital
10
1
Portsmouth Medical Center
1
Kent County Memorial Hospital
270
Providence Hospital
1
Landmark Medical Center
132
Memorial Hospital of Rhoade Island
122
Quincy Hospital
112
Saints Memorial Med Center
33
Miriam Hospital
66
Salem Hospital
27
Newport Hospital
61
Shriner's Burn Center
1
Newport Naval Hospital
Shriner's Hospital for Crippled Children
1
Rhode Island Hospital & Hasbro Children’s Hospital
Somerville Hospital
45
Roger Williams Hosptial
Southcoast Hospitals Group
» St Lukes' Hospital
227
» Tobey Hospital
20
» Charlton Memorial Hospital
63
South Shore Hospital
144
Southwood Community Hospital
St. Annes' Hospital
2
102
St. Elizabeths' Medical Center
83
St. John's Medical Center West
1
South County Hospital
South Shore Hospital
2
407
46
119
1
Our Lady of Fatima Hospital (St. Joseph’s)
31
The Westerly Hospital
58
UMMHC-Memorial
VA RI Hospital
Women and Infants Hospital
1
17
7
Worcester Medical Center - St Vincents' Hospital 113
Sturdy Memorial Hospital
68
U Mass Memorial Medical Center
58
U Mass Memorial Marlborough Hospital
16
UMMHC - Memorial
29
UMMHC - University
13
UMMHC - Hanneham
1
Union Hospital
109
VA Hospitals (Bedford, Brockton, Jamaica Plain, Northampton, West Roxbury)
Waltham (Deaconess) Hospital
32
1
Whidden Memorial Hospital
162
Winchester Hospital
164
Wing Memorial
tt 34
H o spita l s in r h o de is l and 22
E
Appendix E
P UBL I C AT I O N S 2 0 0 4
1. Chung S, Mandl K, Shannon M, Fleisher GR. Efficacy of an Educational Website for Educating Physicians
about Bioterrorism. Acad Emerg Med. 2004; 11:143-148
2. Mannix R, Burns Ewald M. Airway Management in the Poisoned Child. In: Erickson T, Ahrens W, Aks S,
Baum CR and Ling L (eds). Pediatric Toxicology: Diagnosis and Management of the Poisoned Child. New
York: McGraw-Hill, 2004:84-88
3. Brush DE, Boyer EW. Gamma hydroxybutyrate poisoning in the elderly. Annals of Internal Medicine. 2004:
140:W70-2
4. Brush, DE, Boyer EW. Intravenous N-acetylcysteine for children. Pediatric Emergency Care. 2004: 20:649-50
5. Boyer EW. Dextromethophan abuse, Pediatric Emergency Care, 2004:20:858-63
6. Quang LS, Shannon MW, Woolf AD, Maher TJ. 4-methylpyrazole decreases 1,4-butanediol toxicity by
blocking its in vivo biotransformation to gamma-hydroxybutyric acid. Annals of the New York Academy of
Sciences.Oct.2004: 1025: 528-37
7. Saidinejad M, Burns MM, Harper MB. Disseminated histoplasmosis in a nonendemic area. Pediatric Infectious
Disease Journal. 2004: 23 (8): 781-782.
8. Smink DS, Finkelstein JA, Peña BMG, Shannon MW, Taylor GA, Fishman SJ. Diagnosis of Acute
Appendicitis in Children Using a Clinical Practice Guideline. J Pediatric Surgery.2004; 29:458-463
9. Paez A, Shannon M, Maher T, Quang L. Effects of 4-Methylpyrazole on Ethanol Neurobehavioral Toxicity in
CD-1 Mice. Acad Emerg Med.2004
10. Shannon M, Management of Infectious Agents of Bioterrorism. Clin Ped Emerg Med.2004:5; 63-71
11. Weiskopf M. Hu H. White RF, Wright RO. Cognitive Deficits and Magnetic Resonance Spectroscopy in
Adult Monozygotic Twins with Lead Poisoning. Environmental Health Perspectives. 2004:112(5):620-5
23
12. Amato C. Wang RY, Wright RO, Linakis JL. Evaluation Of Promotility Agents To Limit The Gut
Bioavailability Of Extended Release Acetaminophen. Journal Of Toxicology – Clinical Toxicology.
2004:42(1):73-7
13. Wright RO Silverman EK, Schwartz J, Tsaih ST, Senter J, Sparrow D, Weiss ST, Aro A, Hu H. Association
between Hemochromatosis Genotype and Lead Exposure Among Elderly Men: the Normative Aging Study.
Environmental Health Perspectives.2004: 112(6):746-750
14. Wright RJ, Finn P., Contreras JP, Cohen S., Wright RO., Staudenmayer J., Wand M., Perkins D., Weiss ST,
Gold DR. Associations Between Chronic Caregiver Stress and Immunoglobulin E Expression, Allergen-Induced Proliferative Response, and Cytokine Profiles in a Birth-cohort Predisposed to Atopy/Asthma Journal of Allergy & Clinical Immunology. 2004:113(6):1051-7
15. Brush DE, Bird SE, Boyer EW. Monoamine Oxidase Inhibitor Poisoning Resulting from Internet
Misinformation on Illicit Substances. Journal of Toxicology. Clinical Toxicology. 2004: 42(2): 191-5.
16. Nikkanen HE, Burns MM. Severe Hydrogen Sulfide Exposure in a Working Adolescent. Pediatrics. 2004:
113(4): 927-9.
17. Weisskopf MG, Wright RO, Schwartz J, Spiro A, Sparrow D, Aro A, Hu H. Cumulative Lead Exposure and
Prospective Change in Cognition among Elderly Men: the VA Normative Aging Study. American Journal of
Epidemiology. 2004:160(12): 1184-93.
24
F
Appendix F
ackn o w l e g ements
The Regional Center for Poison Control and Prevention serving Massachusetts and Rhode Island wishes to
acknowledge the following people and organizations for their contributions to this report.
Massachusetts Department
of
Public Health
Holly Hackman, Director, Injury Surveillance Program
Cindy Rodgers, Director, Injury Prevention and Control Program
Janet Berkenfield, EMSC Program Manager
Beth Hume, Data Manager/Analyst
Torie Ozonoff, Research Advisor, Injury Surveillance Program
Rhode Island Department
of
Health
Dhitinut Ratnapradipa, PhD, Risk Coordinator, Department of Environmental Health
Robert Vanderslice, PhD, Chief, Office of Health Risk Assessment, Department of Environmental Health
Sam Viner Brown, MS, Division of Family Health
Janice Fontes, Principal System Analyst, Office of Health Statistics
MA/RI Regional Center
for
Poison Control
and
Prevention
Michele Burns Ewald, MD, Medical Director
Deborah Haber*, Operations Manager
Christianne Johnson, Administrative Associate
Vilma Rodriguez, Educator
Design
and
Printing
Deborah Liljegren, Veraqua Branding and Design
Rick Michaud, The Graphic Group
Rebecca Chandler, Chandler Design
*Annual Report Editor
25
25
Historical Timeline
1955Boston Poison Control Center established. First of its kind in the state and third center in the nation.
1955 – 1978Additional poison control centers established in Worcester, Fall River, New Bedford and Springfield.
1973Congress passed the National Emergency Medical Services System Act.
1976
Massachusetts Department of Public Health appointed a Poison Committee to create a statewide poison system.
1978
Massachusetts Poison Control System replaced the local poison centers.
1981Rhode Island Poison Center began operations as a community service funded by Rhode Island Hospital.
January 1999Lifespan, through its affiliate Rhode Island Hospital, announced closing the Rhode Island Poison Center.
March 1999Rhode Island General Assembly allocated state funding for Poison Center Services.
August 1999
Massachusetts and Rhode Island Departments of Health issued joint request for proposals for poison center services.
January 2000 Regional Center for Poison Control and Prevention serving Massachusetts and Rhode Island established at Children’s Hospital.
February 2000President Clinton signed into law the Poison Control Center Enhancement and Awareness Act,
which allocated federal funding to Poison Centers.
March 2000
Massachusetts and Rhode Island Departments of Health convened first meeting of the Regional Poison Center Advisory Committee.
September 2001The Regional Center for Poison Control and Prevention was awarded a three-year stabilization grant and a two-year competitive
grant for the first time through the Poison Control Center Enhancement and Awareness Act
January 2002 The new toll-free phone number (1-800-222-1222) was launched nationwide.
January 2002The Regional Center for Poison Control and Prevention began taking calls from the State of New Hampshire during the overnight hours.
September 2002The 1st New England Regional Toxicology Conference was held in Sturbridge, Massachusetts
March 2003The Regional Center for Poison Control and Prevention held legislative awareness events at the Massachusetts and
Rhode Island State Houses during Poison Prevention Week to draw attention to our funding needs.
June 2003US Food and Drug Administration subcommittee voted, 6 to 4, in favor of removing ipecac from over-the-counter status.
September 2003The Regional Center for Poison Control and Prevention was awarded a two-year competitive grant for the second time through the
Poison Control Center Enhancement and Awareness Act.
September 2003The 2nd Annual New England Regional Toxicology Conference was held in Storrs, CT.
November 2003American Academy of Pediatrics announced its new policy on "Poison Treatment in the Home". It recommends that syrup of ipecac
should no longer be used routinely as a residential poison treatment intervention.
December 2003President Bush signed into law P.L. 108-194, the Poison Control Center Enhancement and Awareness Act Amendments of 2003,
reauthorizing P.L. 106-174.
April 2004The Institute of Medicine publishes its report Forging a Poison Prevention and Control System that encourages integrating poison
control services into the federal and state public health infrastructure.
Re g i o na l C ente r f o r P o is o n C o nt r o l and P r eventi o n
S e r vin g massac h u setts & r h o de is l and
C h i l d r e n ’ s H o s p i ta l B o s t o n , 3 0 0 L o n g w o o d Av e n u e , B o s t o n , M A 0 2 1 1 5 , 8 0 0 - 2 2 2 - 1 2 2 2
www. m a r i p o i s o n c e n t e r . c o m
1-800-222-1222