Toxicology development in Hong Kong: 5 years onwards

香港毒理學五年間的發展

FL Lau劉飛龍

Guest Editorial

Hong Kong Journal of Emergency Medicine

In the editorial of the October 2005 issue of this journal,namely 'Hong Kong Poison Information Centre: a newchapter in the development of clinical toxicology in HongKong ', the initial development of clinical toxicology inHong Kong was described.

1It gave a summary of how

clinical toxicology, started in the Drug and PoisonInformation Bureau in Prince of Wales Hospital (PWH),extended to analytical toxicology in Princess MargaretHospital (PMH) and popularised by emergencyphysicians in United Christian Hospital (UCH) and theHong Kong College of Emergency Medicine (HKCEM).The formation of the Hong Kong Society of ClinicalToxicology (HKSCT) in January 2005 represented acooperation of all the stake-holders to push for furtherdevelopment in this neglected area, while the commitmentof the Hong Kong Government in funding theestablishment of the Hong Kong Poison InformationCentre (HKPIC) in July 2005 started a new chapter inthe development of clinical toxicology in Hong Kong.Now five years had passed since the last article and muchchange has happened. It is high time to review what wehave achieved and to look our way forwards.

For the development of toxicology service in Hong Kong,the Government of HKSAR continues to give thenecessary financial support to extend the poisoninformation service to 24 hours for the HKPIC, toenhence analytical toxicology service in the Toxicology

Correspondence to:Lau Fei Lung, FHKAM(Emergency Medcinine), FRCP

Director, Hong Kong Poison Information Centre and Chief ofService, Clinical Toxicology Department, United ChristianHospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong KongEmail: fllau@ha.org.hk

Reference Laboratory (TRL) and to establish the PoisonTreatment Centre (PTC) in PWH.

Furthermore, for better coordination of these centres, theHong Kong Poison Control Network was established on21 April 2007 which is consisted of the above three centresplus the toxico-vigilence section of the Department ofHealth (DH). These four units, representing the fourpillars in toxicology service in Hong Kong, are structuredunder a central coordination committee chaired by thedeputy director of DH.

2

To improve the internal coordination among the threemajor toxicology centres within the Hospital Authority,a Central Committee on Toxicology Service (CC Tox)was set up involving HKPIC, PTC, TRL, Chief PharmacyOffice and representatives from related specialties. Withthe management support from Infection, Emergency andContingency section of the Head Office, the committeeholds regular meetings to report, plan and coordinate themajor activities of the relevant parties.

3

As for the development of clinical toxicology inEmergency Medicine, HKPIC was expanded to have1 full time consultant, 2 associate consultants and6 specialists and trainees to provide 24 hours poisoninformation service starting in July 2007. As the HKPICin UCH is specialised in providing toxicology training,the UCH toxicology training centre was established in1 April 2010 to cater for the ever expanding trainingneeds of the health care professionals and the public. Toimprove managerial accountability, the toxicologytraining centre, together with the HKPIC was groupedunder the newly created the UCH Clinical ToxicologyDepartment (CTD). As the only clinical toxicologydepartment in Hong Kong, the CTD would provide

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24 hours onsite clinical support to UCH Accident &Emergency Department (AED) and inpatient to see theirpoisoned patients. The department is also providing twiceweekly toxicology outpatient clinic which is now themajor referral centre for substance abusers for theirphysical illness.

In cooperation with the HKCEM, the HKPIC / UCHtoxicology training centre had, in the past 5 years,trained 765 health care professionals for the 2 daysclinical toxicology course , 136 doctors for the 80 hourscertificate course in clinical toxicology. Furthermore,a diploma course in clinical toxicology was developedin 2007 and had trained 27 doctors. The diplomacourse was so well organised that it is now a quotablequalification as granted by the Hong Kong MedicalCouncil in April 2011.

On the other hand, development in clinical toxicology isalso enhanced by the formation of toxicology trainingunits in the AEDs of Queen Mary Hospital and PamelaYoude Nethersole Eastern Hospital. These units, withtheir respective team of toxicology trained emergencyphysicians, are recognised by the HKCEM for the 6month toxicology training required for the diplomacourse. The formation of these toxicology teams in thetoxicology training units were proven to reduce admissionand believed to improve the care and outcome of theirpoisoned patients. At the time of writing this article,Caritas Medical Centre, Tuen Mun Hospital and QueenElizabeth Hospital are also applying for the training unitstatus and are likely to be successful within 2011.

With more doctors trained and sub-specialised in clinicaltoxicology in Hong Kong, we see a substantial increasein the toxicology research and publication in local andoverseas journals. As there are so many papers onpoisoning submitted to HKJEM that this issue is fullydedicated to toxicology papers.

For the future development of clinical toxicology in HongKong, we would very much like to see closer ties with thenearby cities and area. It is important as many of thepoisoning outbreaks and emerging toxins were importedfrom the neighbouring area. Since July 2010, HospitalAuthority Toxicology Service (HATS) was funded for the

provision of toxico-intelligence service to Hong Kong.The essential role of the service is to provide early warningof potential poisoning outbreaks and emerging toxins sothat Hong Kong can be more prepared.

On the other hand, as we are more developed in clinicaltoxicology, we would very much like to establish morecooperation with other poison centres or toxicologyassociations in Asia and beyond. We have established aclose relationship with toxicology experts in MainlandChina with established exchange training program andinformation sharing channel. We were also activelyengaged in the Asia Pacific Association of MedicalToxicology (APAMT) annual congress in the past fewyears. Currently, the HKCEM in conjunction withHKSCT and HATS are bidding for the hosting APAMT2012 congress in Hong Kong. If the congress is heldsuccessfully in Hong Kong, it would represent anotherimportant step for Hong Kong for the recognition as oneof the major stake-holders for the regional poisoningcontrol and toxicology development.

Finally, although Hong Kong had gone a long way in thedevelopment in toxicology service with both HKPCNand CC Tox are doing the coordinating work for thepoison control in Hong Kong, the arrangement is stillfar from the ideal. Most of the major stakeholders stillhope that Hong Kong can have an all embracing PoisonControl Centre like some of the other cities. Theestablishment of the Hong Kong Poison Control Centre,aggregating all the toxicology experts under one roof,would generate the maximal efficiency and teamwork inpoison control and provide the optimal protection ofHong Kong citizen from poisoning outbreak andmorbidity.

References

1. Lau FL. Hong Kong Poison Information Centre: a newchapter in the development of clinical toxicology in HongKong. [Editorial]. Hong Kong J Emerg Med 2005;12(4):195-7.

2. Hong Kong Poison Control Network. [cited 15 June 2011].Available from: http://hkpcn.org.hk/eng/Index2.html.

3. Hospital Authority Toxicology Service. [cited 15 June2011]. Available from HA Intranet: http://toxicology.home/index.asp.

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