2013 Annual Report Poison Center, Sanford USD Medical Center
sdpoison.org “The Sanford Poison Center staff didn’t panic when I called and that immediately calmed me down as a anxious parent. The staff was very knowledgeable and provided wonderful education about the medication that my child had swallowed. Under their guidance I was able to stay home and take care of my child. If the Poison Center was not available I would have definitely taken my child to the Emergency Room which costs money, time and increased anxiety. Thank you Sanford Poison Center.” ~ Parent of Taylor, a two year old, who ingested a prescription medication.
Poison Centers save Americans more than $1.19 billion every year in medical costs and lost productivity. - American Association of Poison Control
Children act fast... So do poisons! Make sure to poison proof your home. The Sanford Poison Center is designated by the South Dakota Department of Health to provide emergency poison management and poison prevention information to the citizens of the State of South Dakota. Funding for the Sanford Poison Center is provided by Sanford USD Medical Center, in addition to funding support received from the South Dakota Department of Health, and from federal funds as a result of the Poison Control Center Awareness and Enhancement Act passed in 2000. These funds have been essential in our efforts to continually advance the level of service provided by the poison center. This report presents an overview of the Sanford Poison Center’s data for 2013. Additional information is available upon request.
sdpoison.org The Sanford Poison Center is dedicated to serving the needs of our State and believes that the needs of residents are best served by a “local” center. However, due to call volume, population base and funding issues it is not possible for us to meet the criteria necessary to be a certified center and handle exposure calls locally. The Sanford Poison Center currently contracts with the Hennepin Regional Poison Center (HRPC) located in Hennepin County Medical Center in Minneapolis to handle all poisoning exposure calls. The HRPC answers calls for the Sanford Poison Center from the public and healthcare professionals 24 hours a day, 365 days a year. Pharmacists certified as Specialists in Poison Information by the American Association of Poison Control Centers (AAPCC) staff the HRPC around the clock. The pharmacists supervise and are assisted by Poison Information Providers who answer calls of a less critical nature. The HRPC has met stringent criteria set forth by the AAPCC, earning the designation of Certified Regional Poison Center. Physicians board certified in toxicology, mycologists, herpetologists, pharmacologists, and other specialists provide emergency consultation to the poison information specialists. These consultants provide their expertise on a volunteer basis and their assistance is gratefully acknowledged.
The Sanford Poison Center provides all of the education and prevention information for the State of South Dakota. Dedicated staff provide poison prevention education and materials to the public through participation
Nearly all of the pharmacists on staff hold teaching appointments with the University of Minnesota’s College of Pharmacy and participate in the education of fourth-year pharmacy students. In addition, the staff assists in providing toxicology instruction to Emergency Medicine, Pediatric and Family Practice residents, medical students, physician assistants, nurses and paramedics.
in health fairs,
The Sanford Poison Center works closely with the HRPC to provide the very best Poison Control Service possible for South Dakota.
The Center also
safety camps, conferences and mail distribution. utilizes numerous volunteers in communities across the state to help provide this poison prevention information and education at the local level.
geographic distribution
The highest percentage of calls come from Minnehaha County (27.02%). The penetrance (exposures per 1,000 population) is highest in Dewey County at 17.51% compared to statewide average of 7.79%
Geographic distribution of Human Exposures 2013 County
Total Calls
Population Per 1,000
Aurora
15
2742
Beadle
158
17753
Bennett
42
Bon Homme
County
5.47 Hyde
Total Calls
Population Per 1,000 8
1437
5.56
8.9 Jackson
16
3191
5.01
3436
12.22 Jerauld
7
2047
3.41
21
7029
2.98 Jones
2
1013
1.97
Brookings
233
32629
7.14 Kingsbury
27
5220
5.17
Brown
298
37331
7.98 Lake
67
11771
5.69
Brule
78
5293
194
24397
7.95
14.73 Lawrence
Buffalo
10
2020
4.95 Lincoln
169
48296
3.49
Butte
59
10228
5.76 Lyman
21
3789
5.54
Campbell
10
1396
7.16 Marshall
23
4671
4.92
Charles Mix
70
9216
7.59 McCook
23
5610
4.09
Clark
21
3585
5.85 McPherson
6
2439
2.46
Clay
107
14131
7.75 Meade
152
26052
5.83
Codington
239
27606
8.65 Mellette
7
2101
3.33
Corson
31
4077
7.60 Miner
11
2326
4.72
Custer
37
8339
4.43 Minnehaha
1816
175037
10.37
Davison
183
19769
33
6446
5.11
Day
31
5613
769
104347
7.36
Duel
28
4380
11
3037
3.62
Dewey
97
5538
11
2359
4.66
Douglas
17
2970
5.72 Roberts
110
10303
10.67
Edmunds
16
4026
3.97 Sanbourn
16
2324
6.88
Fall River
42
6971
6.02 Shannon
166
14059
11.80
Faulk
6
2377
2.52 Spink
38
6611
5.47
Grant
30
7259
4.13 Stanely
8
2969
2.69
Gregory
24
4265
5.62 Sully
6
1427
4.20
Haakon
15
1939
7.73 Todd
169
9942
16.99
Hamlin
50
5981
8.44 Tripp
50
5485
9.11
Hand
18
3388
5.31 Turner
33
8308
3.97
Hanson
12
3377
3.55 Union
49
14855
3.29
Harding
8
1316
6.07 Walworth
52
5459
9.52
Hughes
201
17450
11.51 Yankton
170
22603
7.52
39
7187
5.42 Ziebach
4
2869
1.39
6490
833354
7.79
Hutchinson Other/Unknown
9.52 Moody 5.52 Pennington 6.39 Perkins 17.51 Potter
230 Total
Based on estimated population 2012
sdpoison.org
Total Calls by Type 10,000 Human exposure calls (7,074)
91%
91%
6,000
The Sanford Poison
(6,720)
(6,781)
The majority of calls to the Sanford Poison Center involve an actual exposure to a potentially harmful substance. In addition, the Sanford Poison Center staff provides information pertaining to medications, poisons, poison prevention, medical concerns, and other issues.
92%
8,000
Information calls
4,000
2,000 (716)
(634)
(532)
9%
7%
9%
0
2011
2013
2012
Center website provides information and educational items. It also provides seasonal information. During 2013 the site had 40,000 requests for educational items. All of our brochures
Age of Poison Exposed Victims 5,000
2011
2012
and other educational information are
2013
Children five years of age and younger continue to account for the majority (51 percent) of all the calls managed by the Sanford Poison Control. This age distribution has been consistent in recent years.
4,000
3,000
2,000
6-12 years of age
13-19 years of age
Older than 19 years of age
33
46
51
2422
2,361
2,358
548
524
470
368
384
5 years of age or less
392
3361
0
3,456
3,811
1,000
Unknown
Exposure by Time of Day
PM
PM
00 11 :
PM
00 10 :
PM
9: 00
PM
8: 00
PM
7: 00
PM
6: 00
5: 00
PM
PM
4: 00
3: 00
PM
2: 00
PM
1: 00
PM
12 :
00
AM
AM
00 11 :
10 :
00
AM
AM
00 9:
00
AM
8:
AM
00 7:
AM
00 6:
AM
00
00 4:
5:
AM
3:
00
AM 00
2:
00
00
1:
12 :
AM
700 600 500 400 300 200 100 0 AM
# of Calls
Exposure by Time of Day
Time of Day
This graph shows the time of day that individuals are calling the poison center. Due to the fact a large majority of our calls are for children under 5 years of age, we see an increase in the call volume during lunch and dinner time when young children become hungry and may eat unsafe items when accessible.
available for download.
Route of exposure
Circumstances
The most common route of exposure to potentially toxic substances is ingestion (82 percent). Dermal, ocular and inhalation are other significant routes. Ingestion
5792
82%
Inhalation
378
5%
Aspiration
0
0%
Ocular
323
5%
Dermal
457
6%
Bite / Sting
45
0.63%
Parenteral
66
.93%
Rectal
1
0.01%
Otic
7
0.10%
Vaginal
3
0.04%
Other / Unknown
20
0.28%
Total
7092
100%
* T he number is based on all routes of exposure and any one call may have more than one route.
The majority (75 percent) of exposures are unintentional. Of these, most fall into the “general” category, which is characterized by the classic childhood exposure associated with normal curiosity. Therapeutic errors (11.23 percent) are the second most common cause of unintentional exposures. They usually involve inadvertent misuse of a medication. Intentional exposures account for 19 percent of the total. The majority of those are patients trying to harm themselves. Most of the serious outcomes and deaths arise from this group.
Medical Outcome The medical outcome is a true measure of the effectiveness of the poison control system. In South Dakota 31% had no effect or minor effect and 55% were non-toxic or minimally toxic. The number of moderate to major effects was low. South Dakota reported seven deaths during 2013 associated with a poisoning. The other category contains unrelated effects, patient unable to be followed, and other effects.
Unintentional General
3495
51.92%
Environmental
196
2.91%
Occupational
134
1.99%
Therapeutic Error
756
11.23%
Misuse
430
6.39%
Bite/Sting
45
.067%
Food Poisoning
47
0.70%
Unknown
7
0.10%
Intentional Suspected Suicidal 921
13.86%
Misuse
191
2.84%
Abuse
216
3.21%
Unknown
147
2.18%
Drug Reaction
65
0.97%
Reaction Food
12
0.18%
Reaction Other
13
0.19%
Contamination/ Hampering
20
0.30%
Malicious
14
0.21%
Withdrawl
3
0.04%
Unknown
20
0.30%
Total
6732
100%
Adverse
No Effect
777
Minor
1294 19%
Moderate
494
7%
Major
67
1%
Death
7
0%
12%
Unknown – 3693 55% Non-toxic / Minimal Unknown -Potentially Toxic
131
2%
Unrelated Effect
257
4%
Confirmed Nonexposure
12
0%
Missing
0
0%
Total
6732 100%
Substances involved The table below lists the top ten categories of agents involved in cases reported to the Sanford Poison Center. In a significant number of cases, most notably intentional drug overdoses, more than one substance was involved. * Pharmaceuticals make up over 75 percent of the poison center contacts.
Amount SD% Over-The counter Prescription Drugs
3826
56.8 %
Analgesics
1179
17.5 %
Household/Industrial Cleaning Products/Dyes 609
9%
Personal Care/Cosmetics/Essential Oils
592
8.8 %
Alcohols
365
5.4 %
Foreign Bodies/Toys/Miscellaneous
235
3.5 %
Vitamins
233
3.5 %
Insecticides/Pesticides/Rohenticides/ Herbicides
273
4.1 %
Stimulants/Street Drugs
191
2.8%
Food Poisonings
83
1.2%
Caller Location and Type The primary call site for human exposures is the residence of the caller (66.71%). A significant number of calls (26.5%) originate at healthcare facilities (HCF) and clinics.
Residence 4491
Other/ Unknown 337
(66.71% )
(5.01%)
Work 86 (1.28%)
School 22 (0.33%)
Public Area 12 (0.18%)
Healthcare Facility/ Health Professional 1784 (26.5%)
Management Site In 2013, 67 percent of all poisoning cases were safely managed at home (on site). The table below describes where the cases were managed with HCF denoting a healthcare facility. Safely managing patients at home saves millions of dollars in unnecessary healthcare costs. It also allows more efficient and effective use of limited healthcare resources. By calling the Sanford Poison Center, we can help save lives and save dollars. Managed on Site / Non-HCF Managed In HCF: Admitted Treated and Released Refused Referral AMA/Patient lost to follow-up Other / Unknown Total
4499 992 955 40 180 66 6732
Sanford Health USD Medical Center 1305 W 18th Street PO Box 5039 Sioux Falls, SD 57117
Sanford Poison Center Emergency Phone 1-800-222-1222
For education and Non-Emergent Calls (605) 328-6670 FAX: (605) 328-6671 sdpoison.org
1305 W 18th Street, Po Box 5039 Sioux Falls, SD 57117-5039
200-46110-0003 02/14