2013 Poison Center Annual Report

Page 1

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


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