Poison control centers are a vital component of the United States health care system, providing free 24-hour cost-efficient access to emergency poison information.

As chair of the Committee for Certification for Poison Information Specialists with the AAPCC, Erica Liebelt is responsible for certifying the specialists that work in the 61 poison centers in the United States and Puerto Rico.

But now threats to federal and state funding sources are having a material impact on how the centers deliver and promote these services.

Perhaps no one knows that better than Erica Liebelt, M.D., director of medical toxicology services in UAB’s School of Medicine. She recently was appointed chair of the American Association of Poison Control Center’s (AAPCC) Committee for Certification for Poison Information Specialists and sees the challenges facing her group on a daily basis.

“Many organizations are under attack when it comes to funding these days,” Liebelt says. “That’s why it’s important for the public to know that poison control centers save money in the health care arena. We can prevent unnecessary hospital and emergency department visits. We can help streamline evaluation of patients.”

More than 480 specialists in poison information (SPIs) work in the 61 poison centers in the United States and Puerto Rico. The Committee for Certification for Poison Information Specialists is responsible for certifying the specialists, and Liebelt serves as the editor of the examination. She also oversees the development of the exam and requirements for credentialing.

Liebelt says the examination is extensive, and she expects some revisions in the way it will be developed and administered.

“We go through a rigorous process in developing the yearly examination,” Liebelt says. “I’ve developed a proposal that takes the examination process to a much higher level and brings the examination up to date in terms of credentialing. It’s a new initiative for delivering the examination and how the exam is developed.”

Many of the SPIs are emergency department nurses, critical care nurses or pharmacists.

“Being an SPI is a very unique niche,” Liebelt says. “It’s not like moving to a different floor in a hospital where you can take some of your skills with you. It’s a whole new skill set.”

It also takes intense training, which can last up to six months. An SPI has to demonstrate 2,000 hours of experience and have handled or accumulated 2,000 cases of telephone-poisoning consultation before he or she can take the exam.

“It’s pretty stringent and it’s a big investment to train people,” Liebelt says. “We give an exam every year for recertification.”

Out with the old
Liebelt says poison control is like any other medical field – treatments can change from time to time based on new research information.

One example is in the use of Ipecac syrup – a medicine that causes vomiting. In the past it was used to empty a person’s stomach after a poison was ingested. Now it is rarely recommended.

“We found that it doesn’t change outcome at all,” Liebelt says. “Most poisoning in children doesn’t result in serious outcomes, and the ones we worry about we will refer to the hospital anyway.”

Children who go to the hospital due to poisoning may receive activated charcoal, Liebelt says. The charcoal, which is made of wood pulp, can absorb poison.

“If we feel the ingestion is serious enough, then we will give the charcoal,” Liebelt says. “But it depends on each individual circumstance.”

Exposures increase
According to 2004 poison center survey results, the number of calls placed to poison control centers continues to increase each year, as does the population that each center serves. Human exposure cases increased by 3.7 percent over 2002, and the average population served by all centers increased by almost 300,000.

The reduction of funding for the overwhelming majority of Poison Control Centers threatens the quality of service the centers are able to provide to both the public and other health care professionals, according to the AAPCC.

The average cost expenditure per human exposure declined from $44.91 in 2002 to $40.01 in 2004 – a decrease of 11.1 percent. The percentage of certified call center staff has increased slightly since 2002, however, the same percentage at non-certified centers has dropped by nearly half during the same time. The amount of public education that PCCs are able to conduct is decreasing, dealing a blow to a key service the AAPCC provides.

“We do a lot of outreach and education to the public and provide a much-needed public health service,” Liebelt says. “We aid the public and health-care industry in so many areas. I think we do an incredible service to the public in decreasing emergency department visits, especially when it comes to unintentional exposures in young children.

“We are always trying to push our services and make ourselves available to the public. The parent has to know to call us instead of rushing the child to the emergency department.”

Call 1-800-222-1222 to be connected to your nearest poison control center, which can aid in helping humans and animals. You can also visit www.aapcc.org to learn more.