8401 West Dodge Road, Suite 115 Omaha, NE (Nebraska & Wyoming) (402) (Omaha) 2005 Annual Report

Transcription

1 8401 West Dodge Road, Suite (Nebraska & Wyoming) (402) (Omaha) 2005 Annual Report Nebraska Regional Poison Center is sponsored by: The Nebraska Medical Center, Creighton University Medical Center, and University of Nebraska Medical Center

2 Table of Contents 2005 Staff Hour Emergency Telephone Service... 3 Toxicologist Consultations... 3 Public Education... 4 Media Interviews... 5 Professional Education 9 Research...11 Professional Staff Development 12 Poisoning Data Collection...12 Hazardous Materials Incidents/Terrorism.12 Medical Cost Savings. 13 Call Volume By Month 14 Calls By Day of the Week.. 15 Call Type Call Site By Call Type. 17 Exposure Site Reason.. 18 Acute/Chronic Route of Exposure Decontamination and Therapeutic Intervention. 19 Management Site By Referral Pattern. 20 Medical Outcome. 20 Poisoning Fatalities. 21 Top Ten Substances: Non-Drug Top Ten Substances: Drug 23 Exposures By Substance Age By Gender 25 Calls By State.. 26 Calls By County Top Calls From Health Care Facilities Top Patient Referrals to Health Care Facilities Top

3 2005 Staff Medical Director Steven Seifert, MD, FACMT, FACEP Assistant Medical Director Jennifer Audi, MD Managing Director Kathy Jacobitz, RN, CSPI Staff Toxicologist David Tolo, MD Specialists in Poison Information Kathy Besancon, RN, BSN Karla Finnigan, RN, CSPI* Chris Fladby, RN, CSPI* Luis Gonzalez, RN, BSN Teresa Heeney, RN, BSN, CSPI* Marlys Horky, RN, CSPI* Julia Kimble, RN, BSN, CSPI* Jean Lubbert, RN, CSPI* Sandra Lurry, RN, CSPI* Kristyn McEachen, RN, BSN Joan McVoy, RN, CSPI* Marcia Rasmussen, RN, CSPI* Gail Shannon, RN, BA Karen Smith, RN, BSN, CSPI* Julie Tomoser, RN, CSPI* Connie Tschetter, RN, BSN, CSPI* *AAPCC Certified Specialist in Poison Information Nebraska Regional Poison Center 2

4 The Nebraska Regional Poison Center (NRPC) is certified as a regional poison center by the American Association of Poison Control Centers. It is designated by state health departments to serve Nebraska, Wyoming, American Samoa, and Federated States of Micronesia. NRPC and its programs are sponsored through collaborative community support from The Nebraska Medical Center, Creighton University Medical Center, and University of Nebraska Medical Center. This report highlights services provided throughout the region in Hour Emergency Telephone Service Nebraska Regional Poison Center operates 24 hours a day, seven days per week, and is staffed by a nationally certified team of registered nurses and physicians. Its primary function is to assess and make treatment recommendations during poisonings. The emergency telephone service is available to both health care professionals and the public. The following is a 2005 summary: Handled 36,604 incoming calls in ,952 calls were regarding human poisonings 836 calls were regarding animal poisonings 10,691 calls were for poison or drug information 31,480 follow-up calls were made by NRPC staff 56% of the poisoning exposures involved children less than 6 years of age 85% of poisoning exposures were unintentional; 12% were intentional; 2% were the result of an adverse reaction to a drug or food; 1% were due to substance contamination, tampering or malicious intent Common exposure substances include medications, cosmetics/personal care products, cleaning products, foreign bodies, and pesticides 73% of poisoning exposures were treated safely at home 15% of calls originated from health care professionals requesting treatment advice for poisoned patients Toxicologist Consultations A medical toxicologist is available by telephone 24 hours a day to provide consultations as needed. In 2005, toxicologists provided telephone consultations directly with health care professionals on 248 cases and consulted with Poison Center staff on another 433 cases. In addition, toxicologists treated 19 poisoned patients at The Nebraska Medical Center, Children s Hospital, and Creighton University Medical Center. Public Education Nebraska Regional Poison Center s public education activities are organized by the education coordinator, Joan McVoy, RN, CSPI. She works closely with schools, healthcare organizations, parenting groups, childcare providers and business groups 3

5 throughout the region. Each activity is designed to inform the public about the 24-hour emergency telephone service and to provide education on methods to prevent poisonings. The following is a summary of 2005 activities: Live Presentations by NRPC Staff Seventy-nine live presentations were conducted during 2005 by the education coordinator. A population of 5,710 people heard a variety of presentations. Educational Materials NRPC distributed 219,128 poison prevention brochures, telephone stickers, magnets, and other educational materials throughout its region. Pinky the Elephant, NRPC s mascot costume, was used during 234 presentations. Video Tape Loan Library NRPC maintains a lending library of audio-visual programs available to groups in its service area. The following table represents usage for 2005: Program Number Audience Primary (Preschool-2nd Grade) ,360 Intermediate (3 rd Grade-Jr. High) 66 1,993 Adult (Sr. High & Adults) 46 1,124 Total ,477 Pharmacy Students NRPC partnered with pharmacy students at the University of Nebraska Medical Center (UNMC), Creighton University, and University of Wyoming. This program helps NRPC reach more schools, and it also educates future pharmacists. UNMC pharmacy students provided 6 presentations/health fairs to an audience of 634. Creighton University pharmacy students provided 7 presentations to an audience of 238. University of Wyoming pharmacy students provided 4 presentations to an audience of 64. Casper-Natrona (Wyoming) Health Department Tammy Haines gave 56 poison prevention presentations, serving a total of 3,744 people. Nebraska Injury Prevention Coalition NRPC is a member of the Injury Prevention Coalition, a statewide network of professionals dedicated to reducing the risk of serious injury to Nebraska residents. Safe Kids NRPC is actively involved in the Safe Kids Coalition. Web Site NRPC s web site ( is continuously updated with educational materials. National Poison Prevention Week Congress intended this event as a means for local communities to raise awareness of the dangers of accidental poisoning. In 2005, NRPC participated in the following activities: Proclamations from the Governors of Nebraska and Wyoming and the Omaha City Council Mailed information about public education programs to elementary schools throughout Nebraska and Wyoming Presentations and displays at various sites throughout the service area 4

6 Public service announcements, radio, newspaper, and television interviews Poster contest for Grand Island and Omaha schools with the Tri-Cities Safe Kids, St. Francis Medical Center, and the Omaha Safety and Health Council A Grand Island poster won the national contest and will be the National Poison Prevention Week Poster in 2006! Media Interviews Nebraska Regional Poison Center regularly sends public service announcements on poison topics to the media. This generates radio and television interviews and newspaper and magazine articles. The following table lists the 2005 media interviews and articles generated from the public service announcements. Date Media Type Agency Topic 1/1/05 Newsletter New Horizons ENOA Carbon Monoxide 1/4/05 Newspaper Guernsey Gazette Carbon Monoxide Guernsey, WY 1/19/05 Newspaper Burt County Plaindealer Health Fair With Pinky Tekamah, NE 1/21/05 Television KETV Channel 7 News Methamphetamine 1/24/05 Magazine Weekly Reader Methamphetamine 1/25/05 Newspaper Pilot Tribune Carbon Monoxide Blair, NE 2/14/05 Newspaper Lincoln Star Journal Spider Bite Lincoln, NE 3/14/05 Television WOWT Channel 6 News Poison Prevention 3/21/05 Television KM3 News Lawn Care Safety 3/24/05 Radio KWYO Radio Gasoline Sheridan, WY 3/24/05 Newspaper Sun Poison Prevention Schuyler, NE 3/25/05 Newspaper Grand Island Independent Poison Prevention Grand Island, NE 3/25/05 Newspaper Wyoming Tribune Eagle Poison Prevention Cheyenne, WY 3/29/05 Newspaper Omaha World Herald Dextromethorphan 3/31/05 Newspaper Criterion Poison Prevention Dodge, NE 4/24/05 Newspaper Omaha World Herald Mercury 5/2/05 Television KHAS TV Tilmicosin Hastings, NE 5/10/05 Newspaper Journal Poison Prevention Falls City, NE Date Media Type Agency Topic 5/11/05 Newsletter Kids Safety Chronicle Spring Outdoor Hazards National Safety Council 5/19/05 Newspaper Omaha World Herald Acetaminophen 5

7 5/27/05 Newspaper Omaha World Herald Tilmicosin 6/7/05 Newspaper Lincoln Journal Star Tilmicosin Lincoln, NE 6/13/05 Newsletter The Label Poison Center Annual Report Lincoln, NE 6/27/05 Television WOWT Channel 6 News Insect Repellents 7/7/05 Newspaper Omaha World Herald Chlorine Gas 7/8/05 Television WOWT Channel 6 News Chlorine Gas 7/11/05 Radio KRVN Chlorine Gas Lexington, NE 7/15/05 Television KETV 7 News Methamphetamine 7/19/05 Newspaper Omaha World Herald Poison Prevention 7/20/05 Television KPTM Fox 42 News Chlorine Gas 7/25/05 Television KETV 7 News Insect Repellents 7/26/05 Newspaper Star Mail Chlorine Gas Madison, NE 7/26/05 Newspaper Falls City Journal Chlorine Gas Falls City, NE 7/27/05 Newspaper Journal Register Toxic Algae Hebron, NE 7/27/05 Newspaper Grand Island Independent Chlorine Gas Grand Island, NE 7/28/05 Newspaper Grand Island Independent Poison Prevention Grand Island, NE 8/11/05 Newspaper Plattsmouth Weekly Chlorine Gas Plattsmouth, NE 8/16/05 Television KETV 7 News Inhalant Use 8/31/05 Newspaper Times Herald Hot Peppers Alliance, NE 9/1/05 Newspaper Omaha World Herald Hot Peppers 9/2/05 Newspaper Falls City Journal Hot Peppers Falls City, NE 9/6/05 Newspaper Northern Wyoming Daily News Poison Prevention Worland, WY 9/8/05 Newspaper Pierce Leader Hot Peppers Pierce, NE 9/18/05 Television KTWO Television Poison Prevention Casper, WY 9/21/05 Television KCWY Poison Prevention Casper, WY Date Media Type Agency Topic 10/10/05 Television WOWT Channel 6 News Halloween Safety 10/10/05 Television WOWT Channel 6 News Beestings 6

8 10/13/05 Radio KFAB Beestings 10/14/05 Newspaper Falls City Journal Beestings Falls City, NE 10/15/05 Radio KFAB Halloween Safety 10/17/05 Radio KGBI Halloween Safety 10/18/05 Radio KQSW Halloween Safety Rock Springs, WY 10/22/05 Newspaper Beatrice Daily Sun Snakebite Symposium Beatrice, NE 10/22/05 Newspaper Omaha World Herald Snakebite Symposium 10/24/05 Newspaper Norfolk Daily News Snakebite Symposium Norfolk, NE 10/24/05 Newspaper Lincoln Star Journal Snakebite Symposium Lincoln, NE 10/24/05 Television KPTM Fox 42 News Snakebite Symposium 10/24/05 Television WOWT Channel 6 News Snakebite Symposium 10/24/05 Newspaper Yankton Daily Press Snakebite Symposium Yankton, SD 10/24/05 Television KPTM Fox 42 News Halloween Safety 10/26/05 Radio KTWO Radio Halloween Safety Casper, WY 10/28/05 Radio Radio Station Halloween Safety Gillette, WY 11/2/05 Newspaper Red Cloud Chief Hot Peppers Red Cloud, NE 11/8/05 Television KPTM Fox 42 News Arsenic in Yards 11/8/05 Television WOWT Channel 6 News Arsenic in Yards 11/8/05 Newspaper Northern Wyoming Daily News Turkey Safety Worland, WY 11/9/05 Radio KQSW Turkey Safety Rock Springs, WY 11/10/05 Newspaper Crete News Turkey Safety Crete, NE 11/17/05 Newspaper Thomas County Herald Turkey Safety Thedford, NE 11/17/05 Newspaper Journal Turkey Safety Crofton, NE 11/17/05 Newspaper Tribune Turkey Safety Niobrara, NE 11/17/05 Newspaper Southwest Nebraska News Turkey Safety Indianola, NE Date Media Type Agency Topic 11/17/05 Newspaper Enterprise Stapleton, NE Turkey Safety 7

9 11/17/05 Newspaper Pierce County Leader Turkey Safety Pierce, NE 11/17/05 Newspaper Journal Turkey Safety Plattsmouth, NE 11/18/05 Newspaper The Index Turkey Safety Mitchell, NE 11/21/05 Newspaper Omaha World Herald Turkey Safety 11/23/05 Newspaper Creighton News Turkey Safety Creighton, NE 11/24/05 Newspaper Journal Turkey Safety Palmer, NE 11/26/05 Radio KFAB Carbon Monoxide 11/26/05 Television KPTM Fox 42 News Carbon Monoxide 11/28/05 Radio KZWY Carbon Monoxide Sheridan, WY 11/28/05 Radio KROE Radio Carbon Monoxide Sheridan, WY 11/28/05 Radio KYTI Carbon Monoxide Sheridan, WY 11/29/05 Radio KQSW Carbon Monoxide Rock Springs, WY 11/30/05 Newspaper Weekly Carbon Monoxide Valentine, NE 11/30/05 Newspaper Herald Carbon Monoxide Springview, NE 11/30/05 Newspaper Times Carbon Monoxide Milford, NE 11/30/05 Newspaper Weekly Carbon Monoxide Creighton, NE 12/1/05 Newspaper Harlan County Journal Carbon Monoxide Alma, NE 12/1/05 Newspaper Messenger Carbon Monoxide Wolbach, NE 12/1/05 Newspaper News Chronicle Carbon Monoxide Wisner, NE 12/1/05 Newspaper Index Carbon Monoxide Mitchell, NE 12/1/05 Newspaper Thomas County Herald Carbon Monoxide Thedford, NE 12/1/05 Newspaper Thursday Weekly Carbon Monoxide Schuyler, NE 12/1/05 Newspaper Journal Carbon Monoxide Palmer, NE 12/1/05 Newsletter Kids Safety Chronicle Poison Prevention National Safety Council 12/1/05 Newspaper Mirror Sun Carbon Monoxide Lyons, NE 12/1/05 Newspaper Enterprise Carbon Monoxide Stapleton, NE Date Media Type Agency Topic 12/1/05 Newspaper Pierce County Leader Carbon Monoxide 8

10 Pierce, NE 12/5/05 Radio KRVN Lexington, NE 12/7/05 Newspaper News Blade Bridgeport, NE 12/8/05 Newspaper News Times York, NE 12/13/05 Radio KQSW Rock Springs, WY 12/14/05 Radio KFAB 12/14/05 Newspaper Republican Osmond, NE 12/15/05 Newspaper Monitor Bloomfield, NE 12/15/05 Radio KGMT Fairbury, NE Carbon Monoxide Carbon Monoxide Carbon Monoxide Holiday Hazards Holiday Hazards Carbon Monoxide Holiday Hazards Holiday Hazards Professional Education Nebraska Regional Poison Center contributes regularly to health care professionals knowledge in the area of clinical toxicology. Dr. Steven Seifert, NRPC's medical director, writes periodic clinical toxicology updates for emergency department physicians, physician assistants, and nurses. These are faxed to all Nebraska and Wyoming hospital emergency departments. NRPC is a clerkship site for UNMC and Creighton pharmacy students. Eleven students completed month-long rotations in In July, NRPC also became a rotation site for UNMC Emergency Medicine residents. Five residents completed month-long rotations in NRPC staff gave the following professional education presentations to health care professionals and students: Date Topic Presenter Location Attendees # 1/05- Approach to the Steven A. Seifert, MD Nebraska Regional Physician 46 12/05 Poisoned Patient Poison Center Residents; Pharmacy Students 1/05- Monthly Toxicology Steven A. Seifert, MD UNMC UNMC & Creighton 35 12/05 Lectures Pediatric Residents 7/05- Monthly Toxicology Steven A. Seifert, MD UNMC UNMC Emergency 6 12/05 Lectures Medicine Residents 1/05, 4/05, Toxicology Lectures Steven A. Seifert, MD Emergency Medicine Physicians; 20 7/05,10/05 Conferences, UNMC Residents 1/05, 7/05 Toxicology Lectures Steven A. Seifert, MD UNMC Internal Medicine 25 Residents 1/05 Rattlesnake Bite Steven A. Seifert, MD Loma Linda, CA Various Health Care 175 Recurrence Professionals 2/21/05 Pharmaceutical Kathy Jacobitz, RN OMMRS Committee Mtg Various Health Care 80 Disaster Planning Professionals 3/05 Anticholinesterases Steven A. Seifert, MD Creighton University Pathology Residents 25 Medical Center & Staff Date Topic Presenter Location Attendees # 9

11 4/05 Pharmacotherapy I Steven A. Seifert, MD UNMC 5/05 Poison Ctr Medical Steven A. Seifert, MD Pediatric Research Error Reduction Forum 5/05 Chemical & Biologic Steven A. Seifert, MD CDC Emergency Contamination of Preparedness Conf. Food and Water Atlantic, IA 6/05 Toxicology Review Steven A. Seifert, MD UNMC 8/05 Toxicology Update Steven A. Seifert, MD Wyoming Med Center Casper, WY 8/05 Pesticides in Steven A. Seifert, MD Ojibwe Tribe Conference Museum Artifacts Madison, WI 9/05 Unmasking Comm. Steven A. Seifert, MD Nebraska Nurses Risks to Youth Association Conference 9/05 Envenomation Steven A. Seifert, MD Henry Doorly Zoo, Management 9/05 Toxicology 888 Steven A. Seifert, MD UNMC 9/7 & General Management Kathy Jacobitz, RN Paramedic Course 9/8/05 of Poisonings Omaha Fire Department 10/05 Snake Steven A. Seifert, MD UNMC Envenomations 10/05 Naja Envenomation Steven A. Seifert, MD Snakebite Symposium 10/05 Characterization of Non-Native Envenomations 10/05 Quality of Literature on Non-Native Envenomations 10/05 Rattlesnake Envenomation Case Report Steven A. Seifert, MD Steven A. Seifert, MD Jennifer Audi, MD UNMC Snakebite Symposium UNMC Snakebite Symposium UNMC Snakebite Symposium UNMC 11/05 Toxicology Update Steven A. Seifert, MD The Nebraska Medical Center 11/05 Toxicology Update Steven A. Seifert, MD Creighton University Medical Center 11/05 Toxicology Update Steven A. Seifert, MD Alegent Bergan Mercy 11/05 Toxicology Update Steven A. Seifert, MD Alegent Immanuel Medical Center 11/05 Toxicology Update Steven A. Seifert, MD Alegent Midlands Papillion, NE 11/05 Toxicology Update Steven A. Seifert, MD Methodist Hospital 11/17/05 OMMRS Overview Kathy Jacobitz, RN Disaster Response Conf., 12/05 Methamphetamine Steven A. Seifert, MD Creighton University Conference 12/05 Pesticides & Plants Steven A. Seifert, MD Region VII PEHSU Conference Health Care 35 Students Physicians 50 Various Health Care Professionals 100 Pediatric Medicine 25 Residents Physicians, Nurses 50 Various 75 Nurses 24 Paramedic Trainees 50 Toxicology Students 20 EMTs, Paramedics 35 Second-year medical students Various Health Care Professionals Various Health Care Professionals Various Health Care Professionals Various Health Care Professionals ED Medical and Nursing Staff ED Medical and Nursing Staff ED Medical and Nursing Staff ED Medical and Nursing Staff ED Medical and Nursing Staff ED Medical and Nursing Staff Various Health Care Professionals Various Health Care Professionals Various Health Care Professionals

12 Research Published Scientific Journal Articles, Peer Reviewed: Seifert SA, Schwartz MD, Thomas JD. Aripiprazole (Abilify ) overdose in a child. Clinical Toxicology 2005;43(3): Lund B, Seifert SA, Mayersohn M. Efficacy of sustained low-efficiency dialysis in the treatment of salicylate toxicity. Nephrol Dial Transplant Jul;20(7): Epub 2005 Mar 29. Published Scientific Abstracts, Peer Reviewed: Seifert SA, Odegaard N, Smith DR, Smith DL. Pesticide contamination of repatriated objects under the Native American Graves Protection and Repatriation Act: A multidisciplinary approach. Clinical Toxicology, 2005; 43(6): Lubbert J, McVoy J, Seifert SA, Jacobitz K. Accuracy and completeness of initial substance identification. Is what you hear, what they got? Clinical Toxicology, 2005; 43(6):764. Lubbert J, Jacobitz K, Suhr D, Weber AT, Seifert SA. Home observation of tendedyard mushroom ingestions in Nebraska, Wyoming, and Western Iowa. Clinical Toxicology, 2005; 43(6):762. Seifert SA, Jacobitz K. TESS-based characterization of human tilmicosin exposures and the dose-response relationship in parenteral exposures. Clinical Toxicology, 2005; 43(6): Seifert SA, Boyer, LV, Bronstein AC, Jacobitz K, McNally J, Meza JL. Reduction of Medical Error by Introduction of a New Protocol in a Poison Center. Clinical Toxicology, 2005; 43(6): Seifert SA, Boyer LV, Bronstein AC, Jacobitz K, McNally J, Meza J. Medical Error Detection, Characterization and Reduction. Clinical Toxicology, 2005; 43(6):686. Book Chapters: Boyer LV, Seifert SA, Odegaard N. Understanding the Hazards: Toxicity and safety. In Old Poisons, New Problems: A museum resource for managing contaminated cultural materials. Odegaard N, Sadongei, and Associates, Eds. AltaMira Press, Walnut Creek, Professional Staff Development 11

13 Clinical presentations are regularly provided to NRPC staff by the medical directors, specialists in poison information, residents, students, and guest speakers. Date Topic Presenter 2/24/05 Ciguatera, Scrombroid, and Paralytic Shellfish Sandy Lurry, RN Poisoning 2/24/05 Pesticides Larry Schulze, PhD 3/24/05 Drugs of Abuse and Digoxin Immune Fab Steve Seifert, MD 3/24/05 Trileptal Toxicity Connie Tschetter, RN 4/26/05 Uncommon Rodenticides and Heavy Metals Steven Seifert, MD 4/26/05 Ziconotide Toxicity Chris Fladby, RN 5/19/05 Radiation Emergencies Steven Seifert, M.D. 5/19/05 Lunesta Toxicity Marcia Rasmussen, RN 6/16/05 Toxicity of Fireworks Karen Smith, RN 6/16/05 Non-Native Snake Envenomations Steve Seifert, MD 8/11/05 Poisoning Fatalities Case Review Steve Seifert, MD 8/11/05 Nicotine Toxicity Jean Lubbert, RN 9/6/05 Bactrim Toxicity Marlys Horky, RN 9/6/05 Electrophysiologic Antiarrhythmic Medications R. Srinivasan, MD 10/4/05 Highlights of the 2005 North American Congress of Clinical Toxicology Jean Lubbert, RN Kathy Jacobitz, RN Steve Seifert, MD 11/29/05 Inhalant Abuse Joan McVoy, RN 11/29/05 Carbon Monoxide Poisoning Ben Fagot, MD Poisoning Data Collection NRPC maintains an electronic database that captures poisoning case information, which is then uploaded to the American Association of Poison Control Centers Toxic Exposure Surveillance System on a real-time basis. This data is used both nationally and locally for surveillance, to target poison prevention efforts, and to improve poisoning treatment. Hazardous Material Incidents/Terrorism Nebraska Regional Poison Center assists first responders, hospitals, and the public during hazardous material incidents such as chemical spills. NRPC participates in a hazardous materials notification system for area hospitals. NRPC s role in planning and response for nuclear, biological and chemical (NBC) terrorism includes: Provides immediate NBC treatment information to health care professionals and the public on a 24-hour basis Provides educational presentations to health care professionals on recognition and management of NBC agents Assists state and local health departments with surveillance Assists with monitoring the Nebraska Health Alert Network 12

14 Tracks pharmaceutical capabilities in the region and assists in the transfer of antidotes between hospitals Is actively involved with community NBC preparedness planning: Omaha Metropolitan Medical Response System (OMMRS) Steering Committee (Kathy Jacobitz) OMMRS Pharmacy Subcommittee (Kathy Jacobitz, co-chairperson) OMMRS Emergency Operations Center Subcommittee (Kathy Jacobitz) Nebraska Bioterrorism Education Consortium (Kathy Jacobitz and Steve Seifert) Nebraska CHEMPAK Advisory Task Force (Kathy Jacobitz) Estimate of Medical Cost Savings From Nebraska Regional Poison Center s Services Nebraska Regional Poison Center (NRPC) curbs medical costs associated with treatment of poisoning by reducing inappropriate use of emergency departments and by preventing poisoning case progression through early intervention. In addition, NRPC reduces costs by preventing poisonings from occurring. The following shows how NRPC reduced the cost of poisonings in If NRPC was not in operation, theoretically, all callers in 2005 would need to visit an emergency department: Average charge for emergency department evaluation of poisonings = $1,245 Human poison exposures in 2005 = 24,944 Total cost of emergency department visits = $31,055,280 Because NRPC was in operation, certain exposures could be managed safely at home. In 2005, 18,130 poisoning exposures were managed by NRPC without the need for a visit to a health care facility. The cost savings from NRPC s prevention of unnecessary emergency room visits is: 18,130 x $1,245 = $22,571,850 In 2005, NRPC reduced the cost of poisonings by 73%, resulting in savings of over 22.5 million dollars. This estimate does not incorporate savings resulting from poison prevention efforts, increased efficiency in medical management of poisonings, and reductions in ambulance and inpatient care utilization. 13

15 2005 Call Volume By Month 3,300 3,200 3,100 3,000 Number of Calls 2,900 2,800 2,700 2,600 2,500 Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. Series1 3,158 2,792 3,072 3,103 3,147 3,174 3,178 3,202 2,993 3,053 2,885 2,847 Month 14

16 2005 Calls By Day Of The Week 5,800 5,600 5,400 5,200 Number of Calls 5,000 4,800 4,600 4,400 4,200 Sunday Monday Tuesday Wed. Thursday Friday Sat. Series1 4,721 5,615 5,410 5,427 5,218 5,275 4,938 Day of Week 15

17 2005 Call Type Call Type Number % of Total Exposures Human 24, Animal Subtotal 25, Confirmed Nonexposure Human Animal Subtotal Information Drug information 1, Drug identification information 6, Environmental information Medical information Occupational information Poison information Prevention/Safety/Education 1, Teratogenicity information Substance Abuse Administrative Caller Referred Other information Subtotal 10, Total 36,

18 2005 Call Site by Call Type Human Exposures Animal Exposures Confirmed Non-Exp Information Total No No Col % No Col % No Col % No Col% Own residence 18, , ,127 Other residence ,122 Workplace ,173 Health care facility 3, ,657 School Restaurant / food service Public area Other 1, , ,668 Unknown Total 24, , , Human Poisoning Exposures Exposure Site Number Col % Own residence 20, Other residence 1, Workplace Health care facility School Restaurant / food service Public area Other Unknown Total 24,

19 2005 Call Site by Call Type 17

20 2005 Human Exposures By Substance Other Non-Drug Substances 18.3% Plants 2.4% Gases 2.8% Alcohols 3.1% Medications 50.1% Pesticides 3.6% Foreign Bodies 4.2% Cleaning Products 7.4% Personal Care Products 8.1% 24

21 Reason Reason Number Col % Unintentional General 15, Environmental 1, Occupational Therapeutic error 2, Misuse Bite / sting Food poisoning Unknown Total: Unintentional 21, Intentional Suspected suicide 1, Misuse Abuse Unknown Total: Intentional 2, Other Contamination / tampering Malicious Withdrawal Total: Other Adverse reaction Drug Food Other Total: Adverse reaction Unknown Unknown reason Total: Unknown Total 24,

22 Reason 18

23 Management Site by Referral Pattern Patient Already in HCF Patient Referred by Poison Center Total Number Row % Col % Number Row % Col % Number Col % Treated/evaluated and released 1, , , Admitted to critical care unit Admitted to noncritical care unit Admitted to psychiatric facility Patient lost to follow-up/left AMA Refused referral Unspecified level of care Total 3, , , Human Poisoning Exposures Medical Outcome Number Col % No effect 2, Minor effect 4, Moderate effect 1, Major effect Death Death, indirect report No follow-up, nontoxic 2, No follow-up, minimal toxicity 11, No follow-up, potentially toxic Unrelated effect Subtotal for exposures 24, Confirmed nonexposure Total 24,

24 Management Site by Referral Pattern 20

25 Acute/Chronic Number Col % Acute 21, Acute-on-chronic 2, Chronic Unknown Total 24, Human Poisoning Exposures Route of Exposure Route Number Col % Ingestion 19, Inhalation/nasal 2, Aspiration Ocular 1, Dermal 2, Bite/sting Parenteral Rectal Otic Vaginal Other Unknown Total 26,

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55 2005 Poisoning Fatalities Reason Age Gender Substances Unknown 69 years Female Avandamet Intentional Abuse Intentional Suspected Suicide Intentional Suspected Suicide Unintentional Therapeutic Error Unintentional Therapeutic Error 24 years Male Codeine, Hydrocodone, Propoxyphene, Acetaminophen 46 years Female Methadone, Diazepam 34 years Female Tylenol PM 13 years Female Acetaminophen 45 years Female Propafenone 21

56 2005 Top Ten Substances: Non-Drug Human Exposures Substance Number % Of Total Cosmetics & Personal Care Products % Nail Care Products 293 Dental Care Products 291 Creams, Lotions, & Make-up 290 Deodorant 216 Hair Care Products 184 Perfume, Cologne, & Aftershave 174 Mouthwash 180 Household Cleaning Products % Bleaches 449 Miscellaneous Cleaners 298 Wall/Tile/Floor Cleaners 278 Laundry Products 255 Automatic Dishwasher Detergents 203 Glass Cleaners 136 Foreign Bodies % Desiccants 401 Toys 182 Glow Products 123 Pesticides % Insecticides 434 Rodenticides 258 Repellents 172 Herbicides 172 Fungicides 16 Alcohols % Ethanol 741 Isopropanol 134 Gases % Carbon Monoxide 372 Chlorine/Chloramine Gas 190 Hydrogen Sulfide 87 Food Products/Poisoning % Hydrocarbons % Gasoline 286 Freon & Other Propellants 123 Plants % Non-toxic 143 Oxylate Containing 162 Dermatitis Producing 115 Gastrointestinal Irritant 74 Chemicals % Acids 74 Alkali 47 Ammonia 44 22

57 2005 Top Ten Substances: Drug Human Exposures Substance Number % Of Total Analgesics % Acetaminophen (Alone & Combined With Other Drugs) 1503 Ibuprofen 834 Opioids 224 Aspirin (Alone & Combined With Other Drugs) 185 Cold & Cough Preparations % Dextromethorphan (Alone & Combined With Other Drugs) 793 Antihistamine/Decongestant (Combined With Other Drugs) 653 Sedative/Hypnotics/Antipsychotics % Benzodiazepines 548 Atypical Antipsychotics 407 Topical Preparations % Diaper Care/Rash Products 534 Camphor 123 Steroids 106 Methyl Salicylate 100 Antidepressants % SSRIs (Selective Serotonin Reuptake Inhibitors) 442 Cyclic 94 Vitamins % Multiple Vitamins 626 B Vitamins 76 Vitamin C 24 Vitamin E 23 Antimicrobials % Antibiotics 591 Antifungals 103 Anthelmintics 22 Antihistamines % Diphenhydramine 271 Cardiovascular Drugs % Beta Blockers 158 Antihyperlipidemics 98 ACE Inhibitors 94 Calcium Antagonists 64 Clonidine 44 Gastrointestinal Preparations % Antacids 242 Laxatives 161 Other 104 Antidiarrheals 19 23

58 2005 Age By Gender Number of Exposures < y >90 Male Female Age 25

59 2005 Calls By State State Human Animal Information Total Percent Exposures Exposures Only Calls Nebraska 18, ,131 25, % Wyoming 5, ,654 7, % Unknown ,465 1, % Iowa , % Other States (combined) % Missouri % Kansas % Colorado % South Dakota % Total 24, ,816 36, % 2005 Calls By County Top 10 County State Douglas County Nebraska Lancaster County Nebraska Sarpy County Nebraska Laramie County Wyoming Natrona County Wyoming Hall County Nebraska Pottawattamie County Iowa Sweetwater County Wyoming Fremont County Wyoming Dodge County Nebraska Human Animal Information Total Percent Exposures Exposures Only Calls 7, ,684 10, % 2, ,112 3, % , % , % % % % % % % 26

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61 2005 Calls From Health Care Facilities Top 25 (Patient was already in HCF when the Poison Center was contacted) Site of Caller Number Percent of Total # The Nebraska Medical Center % Bryan-Lincoln General Hospital West % Lincoln, NE Children s Hospital % Good Samaritan Hospital % Kearney, NE Regional West Medical Center % Scottsbluff, NE Alegent Midlands Hospital % Papillion, NE United Medical Center % Cheyenne, WY Memorial Hospital of Dodge County % Fremont, NE St. Elizabeth Community Health Center % Lincoln, NE Creighton University Medical Center % St. Francis Medical Center % Grand Island, NE Faith Regional West Hospital % Norfolk, NE Wyoming Medical Center % Casper, WY Mary Lanning Memorial Hospital % Hastings, NE Memorial Hospital of Sweetwater County % Rock Springs, WY Alegent Immanuel Hospital % Great Plains Regional Medical Center % North Platte, NE Nebraska Methodist Hospital % Campbell County Memorial Hospital % Gillette, WY Lander Valley Medical Center % Lander, WY Columbus Community Hospital % Columbus, NE Alegent Bergan Mercy Hospital % Alegent Lakeside Hospital % Ivinson Memorial Hospital % Laramie, WY Beatrice Community Hospital % Beatrice, NE Total Calls From Health Care Facilities 2, % 27

62 2005 Patient Referrals To Health Care Facilities Top 25 (Patients were referred by the Poison Center or were transferred to the HCF) Site of Caller Number Percent of Total # Children s Hospital % Alegent Midlands Hospital % Papillion, NE The Nebraska Medical Center % Bryan-Lincoln General Hospital West % Lincoln, NE St. Elizabeth Community Health Center % Lincoln, NE Wyoming Medical Center % Casper, WY United Medical Center % Cheyenne, WY Alegent Immanual Hospital % Bryan-Lincoln General Hospital East % Lincoln, NE Alegent Lakeside Hospital % Alegent Bergan Mercy Hospital % St. Francis Medical Center % Grand Island, NE Nebraska Methodist Hospital % Regional West Medical Center % Scottsbluff, NE Memorial Hospital of Sweetwater County % Rock Springs, WY Creighton University Medical Center % Great Plains Regional Medical Center % North Platte, NE Mary Lanning Memorial Hospital % Hastings, NE Memorial Hospital of Dodge County % Fremont, NE Campbell County Hospital % Gillette, WY Memorial Hospital % Sheridan, WY Riverton Memorial Hospital % Riverton, WY Ivinson Memoral Hospital % Laramie, WY Good Samaritan Hospital % Kearney, NE Faith Regional West Hospital % Norfolk, NE Total Referrals to Health Care Facilities 1, % 28