Poison Center, sanford Usd MediCal Center

2013 annual report

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.

Poison Centers save americans more than $1.19 billion every year in medical costs and lost productivity.

- American Association of Poison Control

“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.

sdPoison.org

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

in health fairs,

safety camps,

conferences and

mail distribution.

the Center also

utilizes numerous

volunteers in

communities

across the state to

help provide this

poison prevention

information and

education at the

local level.

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.

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.

The Sanford Poison Center works closely with the HRPC to provide the very best Poison Control Service possible for South Dakota.

sdPoison.org

geograPhiC distribUtion of hUMan exPosUres 2013CoUnty total

CallsPoPUlation Per 1,000 CoUnty total

CallsPoPUlation Per 1,000

aurora 15 2742 5.47 hyde 8 1437 5.56

beadle 158 17753 8.9 Jackson 16 3191 5.01

bennett 42 3436 12.22 Jerauld 7 2047 3.41

bon homme 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 14.73 lawrence 194 24397 7.95

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 9.52 Moody 33 6446 5.11

day 31 5613 5.52 Pennington 769 104347 7.36

duel 28 4380 6.39 Perkins 11 3037 3.62

dewey 97 5538 17.51 Potter 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

hutchinson 39 7187 5.42 Ziebach 4 2869 1.39

other/Unknown 230

total 6490 833354 7.79

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

Based on estimated population 2012

exPosUre by 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.

the sanford Poison

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

and other educational

information are

available for

download.

Human exposure calls Information calls

0

2,000

4,000

6,000

8,000

10,000

2012

9%

91%

(6,781)

(634)

2013

7%

92%

(6,720)

(532)

2011

91%

9%

(7,074)

(716)

total Calls by tyPe

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.

524

3,81

1

3361

3,45

6

384

368

392

470

548

2,35

8

2422

2,36

1

51 3346

20122011 2013

0

1,000

2,000

3,000

4,000

5,000

5 years of age or less

6-12 years of age

13-19 years of age

Older than 19 years of age

Unknown

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.

age of Poison exPosed ViCtiMs

0 100 200 300 400 500 600 700

12:00

AM

1:00 A

M

2:00 A

M

3:00 A

M

4:00 A

M

5:00 A

M

6:00 A

M

7:00 A

M

8:00 A

M

9:00 A

M

10:00

AM

11:00

AM

12:00

PM

1:00 P

M

2:00 P

M

3:00 P

M

4:00 P

M

5:00 P

M

6:00 P

M

7:00 P

M

8:00 P

M

9:00 P

M

10:00

PM

11:00

PM #

of C

alls

Time of Day

Exposure by Time of Day

sdPoison.org

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%

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%

Adverse

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%

No Effect 777 12%

Minor 1294 19%

Moderate 494 7%

Major 67 1%

Death 7 0%

Unknown – Non-toxic / Minimal

3693 55%

Unknown -- Potentially Toxic

131 2%

Unrelated Effect 257 4%

Confirmed Nonexposure

12 0%

Missing 0 0%

Total 6732 100%

The most common route of exposure to potentially toxic substances is ingestion (82 percent). Dermal, ocular and inhalation are other

significant routes.

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.

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.

* The number is based on all routes of exposure and any one call may have more than one route.

CirCUMstanCes

MediCal oUtCoMe

roUte of exPosUre

residence4491

(66.71% )other/Unknown

337(5.01%)

Work86

(1.28%)

school22

(0.33%)

healthcare facility/health Professional

1784 (26.5%)

Public area12

(0.18%)

Managed on Site / Non-HCF 4499

Managed In HCF: Admitted 992 Treated and

Released 955

Refused Referral 40AMA/Patient lost to follow-up 180

Other / Unknown 66Total 6732

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.

ManageMent site

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.

Caller loCation and tyPe

sUbstanCes inVolVedThe 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%

Sanford Poison Center Emergency Phone 1-800-222-1222

For education and Non-Emergent Calls(605) 328-6670fax: (605) 328-6671sdpoison.org

1305 W 18th street, Po box 5039sioux falls, sd 57117-5039

Sanford Health USD Medical Center1305 W 18th StreetPO Box 5039Sioux Falls, SD 57117

200-46110-0003 02/14