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Sandy Giffin, Director of the Poison Center for Oregon, Alaska and Guam

Sandy Giffin, Director of the Poison Center, had a recent opportunity to travel to Guam to speak about the services of the Poison Center.  The Guam Poison Control Conference was hosted by the Guam Emergency Medical Services for Children Program of the Department of Public Health and Social Services.  An article about the event was published in the Variety News.

A document created by the poison center describing the brown tree snake in Guam was distributed at the conference and is posted here: FF Brown Tree Snake 

Brown Tree Snake

2013 ANNUAL REPORT FOR THE GUAM POISON CENTER

The Oregon Poison Center (PC) has served as the designated regional poison center for Guam since 2004, when federal grant funds through the Poison Control Centers Enhancement and Stabilization Act to fund services to the U.S. Territories. The PC collaborates with Public Health Officials and Emergency Medical Services personnel in Guam to increase awareness of the resources and service of the poison center for the region. 

In 2013, the poison center received 309 calls from Guam. The majority of calls involved human exposures to potentially toxic and poisonous substances. The remaining calls involved requests for information.  Figure 1 shows a breakdown of call types. Figure 2 details the type of information calls received by PC.  A breakdown of caller sites for human exposure cases is shown in Figure 3.  Fifty six eight percent of calls originated from the public in a residence, seeking initial advice prior to any other contact with health care providers. Forty percent of calls were received from health care providers, seeking assistance from the poison center in managing complex human exposure cases. Pediatric accidental poisoning represents a significant proportion of calls to poison centers throughout the United States and Territories.  In Guam, children less than 6 years of age represented 52% of cases reported last year.  Adults over 19 years of age represented 32% of cases Figure 4. Pharmaceuticals represent the most common category of exposure, resulting in 58% of calls, and represent the most serious poisoning incidents. Among pharmaceuticals, analgesics represent the most frequent substance of exposure throughout the U.S. as well as Guam. The most common substances of exposure for all age groups are shown in Figure 5. Pediatric exposures usually involve substances that are readily accessible and prevalent in the home environment. Personal care products, such as cosmetics, dental products, shampoo and perfume represent one of the most frequent sources of exposure for children.  Analgesics also represent a significant risk for pediatric poisoning Figure 6.

Figure 7 shows the treatment site of Guam poisoning cases managed by the poison center last year. Many pediatric exposures require decontamination and observation in an emergency department. More serious poisoning incidents require hospital admission for longer observation, stabilization and treatment. The most serious poisonings and most fatalities occur in adults.  Prescription drug abuse is a rapidly growing national concern, effecting not only adults, but also teenagers.  Between 2000 and 2009, death rates from unintentional poisoning increased, with a 91 percent increase among teens aged 15-19, largely due to prescription drug overdose according to a recent CDC report. Poisoning deaths exceed the number of motor vehicle-related deaths in the United States.

Substances that result in the greatest number of calls to the poison center do not always represent the most serious poisoning incidents. Figure 8 shows substances resulting in hospital visits for all ages. Figure 9 indicates substances involved in pediatric hospital visits.

Many cases handled by poison centers can be effectively managed at home, with careful ongoing follow-up calls by the poison center nursing staff.  In these cases, the poison center nurses provide home treatment advice and instruction regarding symptoms of concern. Safe and effective management of these cases at home saves significant health care costs, and is one of the reasons that poison centers are such an important health care resource.  If a poisoning has potential serious complications and cannot be safely treated at home, referral arrangements are made with the nearest emergency department for evaluation and treatment. The poison center staff continues to monitor the patient condition and provide ongoing treatment advice in collaboration with the hospital staff throughout the patient's hospital stay.  As we begin to examine

Examination of poison center cases in Guam and from various regions provides an opportunity to identify unique hazards, service utilization and resources.  A larger proportion of calls to the poison center in Guam are initiated by health care providers (40% versus 17%) and a larger percentage of cases are treated in a health care facility (43% versus 22%) when compared to poison center cases from other regions.  Since the initiation of poison center service in Guam, significant efforts have resulted in close collaboration with health care providers in the region, which may be reflected in these statistics.  Future efforts will be made to increase awareness and access to poison center services by the public, to assist in management of patients who with careful follow-up by the poison center staff, may not need treatment in a health care facility.  The poison center has additional resources to assist in poison prevention education as well as health care provider education regarding treatment approaches in case of poisoning and toxic exposures.  The nurses and physicians at the poison center welcome suggestions and opportunities to increase visibility and awareness in our Guam region, and encourage callers who may have questions and concerns regarding poisonings and toxic exposures.