Another Blow to Preparedness - @

Another Blow to Preparedness



Robin McFee, DO, MPH, FACPM | | Tuesday, July 7, 2009

In a post-9/11 world, terrorism threatens our domestic security as do the more ubiquitous dangers to the health and well being of our families -- poisons, toxins, industrial chemicals and, yes, weapons of mass destruction (WMDs).

To address this wide range of threats, we need specialists who can provide reliable information that can be utilized by health-care professionals and the public. This is where regional poison control centers (PCCs) come in.

So the news that California is likely closing their statewide poison control center system due to dramatic budget cuts to the system is problematic. PCCs are a critical resource; their loss would result in incalculable harm. Our families would be at risk.

A Place to Turn To

As a concentrated body of highly skilled, well-trained specialists in the field of poisons, PCCs provide the expertise, training and guidance to first responders, law enforcement, fire/rescue, hospitals, emergency management and public health on all things poisonous -- biological toxins, chemical weapons, industrial chemicals and radiation. PCCs are one of the few 24-hour-a-day expert resources, providing nearly unlimited, science-based access to best practices in acute medical management related to poisons and things that go bump in the night. When chlorine tankers derail, PCCs are behind the scenes offering guidance. When people come down with strange illnesses, PCCs are called. When anthrax is spread in the U.S. (think 2001) PCCs were hand in glove "go to" people, along with the Centers for Disease Control & Prevention and public health experts.

It's hard to believe, given that California is the most populous state, with high value targets, that the governor/elected officials could consider cutting funding for the PCC system. And against the backdrop of new and more deadly drugs of abuse coming out of Mexico, increased use of questionable psychiatric medication cocktails to teens, an aging population at risk for drug interactions, an overburdened FDA that admittedly cannot handle the volume of new drugs for scrutiny, a decaying transit infrastructure that sets the stage for toxic derailments, and of course the threat of WMD, the implications to the citizens of California and the rest of the U.S. cannot be more obvious.

The folly is more apparent when one considers that these cuts will only save $5.9 million, while the state is in debt $23 billion. With California's population estimated at 36,756,666, the $5.9 million translates to 16 cents per man, woman and child. Eliminating those under 18, the one-time annual cost per person for a year of "free" services, 24/7 access is around 23 cents. It would take less than a one-time cost of a quarter per adult in California to keep the PCC doors open for an entire year.

Let's look at the fiscal situation from a different perspective. According to the American Association of Poison Control Centers (AAPCC) and the Pacific Institute of Research and Evaluation, the average call to a PCC costs about $43 (not to the caller or patient) and saves the health-care system almost $300. How do PCCs do this? Because the staff decides who can be treated at home and who should be sent to the hospital.

One study by the AAPCC showed that 90% of the people who called a PCC had the emergency managed over the phone by center staff (physician, pharmacologist, nurse, pharmacist).

Affect on EMS

Our citizens aren't the only ones who rely upon PCCs and toxicologist guidance. According to AAPCC statistics, Health-care professionals -- from pediatricians and internists to emergency physicians and others -- consult with PCC experts 1,400 times a day, 511,000 times a year.

Besides being a resource for the more than 2.7 million Americans who are poisoned annually (more than 1 million cases involve children under five years of age), PCCs also provide medication safety and WMD education programming to health-care professionals, develop prevention strategies to keep kids safer, conduct research on drug safety after the medications have been approved by FDA (and have resulted in package warnings or products being removed from the market), train first responders, guide health-care facilities on preparedness planning, and are a real time source of human exposure data. PCC also help coordinate care between facilities and can optimize outcomes. It's well recognized that without PCCs, it's likely that 600,000 additional poisoning victims will be sent to a health-care facility annually. And who will those 600,000 people call to get to the hospital? That's rightƒEMS.

And yet California's budget officer was quoted in the L.A. Times stating we should return to the pre-poison control era of do-it-yourself medicine using the rationale "We managed back then."

It's widely recognized in preparedness circles that PCCs are essential for the safety of a community. From a WMD perspective, the regional response is likely to be highly effective if PCCs are critical components of a counterterrorism task/response force. First, there's the expertise concerning the realm of poisons likely to be used by terrorists. Then, there's the ability to teach first responders the critical basics about initial management, personal protection, decontamination and treatment. Add to that toxicosurveillance and interacting with law enforcement, first responders, hazmat and others as a guide with a repository of information and cases -- the value of which has been proven in numerous drills and exercise involving chemicals and biologicals.

Call to Action

PCCs in New York, Michigan, Utah, Texas and Washington are just a few of the states where funding cuts are possible or already occurring. Given the magnitude of public good -- tangible and intangible, it's dangerous for our leaders to even look at PCCs as a source of budget relief.

Let's contact our legislators. The small amount of money initially saved cannot offset the costs of inadequate or inappropriate treatment that will occur without expert guidance. Poison Centers should be one of those "untouchable" public good entities that, barring malfeasance, should remain as perennially supported.

PCCs are one aspect of public preparedness we all have a stake in. We must act quickly and together for the sake of our community and families.

Robin McFee,DO, MPH, FACPM, is the medical director of Threat Science and also a toxicologist and professional education coordinator of the Long Island Regional Poison Information Center, Winthrop University Hospital, Mineola, N.Y. She's also a member of the JEMS editorial board. Contact her

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Related Topics: Medical Emergencies, Operations and Protcols, WMD and Terrorism

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