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					     2009 Service Summary
              for the
Mississippi Poison Control Center




                     Robert D. Cox, M.D.,
                                    Ph.D.
                                                            Medical Director

Introduction

This report contains a summary of the activities for the Mississippi Poison Control Center
(MPCC) for the year 2009. Since 2005, the MPCC has had a steady increase in the year
recall volume up to 2008. In 2009, a call volume decreased 6% from the previous years
high. In 2009, the MPCC handled 37,447 calls. This is the second highest call volume
that the MPCC has experienced in its history.

Nationally, poisonings remain a major source of morbidity and mortality. According to
the Centers for Disease Control and Prevention, poisoning was second only to motor-
vehicle crashes as a cause of death from unintentional injury in the United States.
Among people 35 to 54 years old, unintentional poisoning caused more deaths than motor
vehicle crashes. In 2006, poisonings resulted in 924,626 emergency department visits and
over 325,000 hospitalizations, at a cost over $26 billion (2).

Poison Control Centers provide the first line of defense against poisoning in the United
States. They provide free information concerning the dangers of exposure, initial
treatment, and whether or not to seek emergency medical care. Poison Control Centers
also give advice to hospitals and health care providers on the treatment of poisonings.
All states and territories in the United States are served by a Poison Control Center. All
of the state and regional Poison Control Centers upload their data several times a day to a
national database that is used by the Centers for Disease Control and Prevention and the
Department of Homeland Security for toxicosurveillance. This is currently the only
national system that is monitoring for potential disease outbreaks that might be related to
terrorist activity in the United States.

The Mississippi Poison Control Center fields calls from private citizens, health care
facilities, schools, law enforcement agencies and other entities concerning exposures to
poisons and other toxic substances and envenomations and provides advice on risks and
medical management. All of these calls are entered into a computer database that is
uploaded into the national database and used for toxicosurveillance. The Mississippi
Poison Control Center has served this state since 1978. This document summarizes the
call volume and types of calls received and managed by the Mississippi Poison Control
Center in 2009.


Call Volume

The Mississippi Poison Control Center managed 37,447 calls in 2009. This included
37,362 calls from Mississippi and 85 calls from out of state. The volume of calls
managed by the Mississippi Poison Control Center over the past eight years is shown in
Figure 1. In 2009, the overall call volume decreased by 6% from the previous year.
Exposure calls increased by 4% and information calls decreased by 15%. The decrease in
information calls is primarily due to a change in the way that pill identification calls were
handled by the MPCC. This change was prompted by local and national concerns of


                                                                                            2
prescription drug abuse that was facilitated by free poison center identification of pills.
The call volume in 2009 was the second highest in the history of the MPCC.


                         Mississippi Poison Control Center
                                Yearly Call Volume

                                   Exposures          Information calls


 40000
 35000
 30000
 25000
 20000
 15000
 10000
  5000
      0
             2002        2003    2004          2005       2006      2007         2008     2009

          Figure 1. Yearly call volume managed by the Mississippi Poison Control Center



The number of calls managed by the Mississippi Poison Control Center each month is
shown in Figure 2. In the average month, 3125 calls were managed by the Mississippi
Poison Control Center. This figure demonstrates the decrease that occurred when the new
policy on handling pill identification calls went into effect during the month of April.



Figure 2. Monthly calls managed by the Mississippi Poison Control Center in 2009

  4000


  3500                                            2008 Monthly Average


  3000


  2500


  2000


  1500


  1000


   500


     0
           Ja n   Fe b    Ma r   Apr    Ma y     Jun      Jul    Aug      Se p    O ct   No v    Dec   3
The calls in 2009 included 19,022 cases of human exposures to potentially toxic
substances, 562 cases of animal exposures and 17,859 information calls. Free information
was provided to law enforcement agencies, health care providers, emergency response
teams, schools and private citizens. The toxic exposures that the MPCC assisted in
medical management included the following:

   Table 1. Severity of Poisonings Managed by the Mississippi Poison Control Center
    Severity                Human Exposures       Animal Exposures
    Mild Toxicity                   3322                    36
    Moderate Toxicity                757                    14
    Severe Toxicity                  114                     0
    Death                             14                     0


Caller Location

The location of callers when initial contact was made is shown in Figure 3. Data are
presented for the past two years for comparison. In 2009, 79% of all calls came from
private residences. This is a slight increase over the previous year. Health-care facilities
including hospitals, pharmacies, doctor’s offices and clinics accounted for 14% of calls in
2009. The remainder of the calls came from workplaces - 3.9%, and public locations
including automobiles, schools and day-care centers.

                                              2008   2009
                 79%
           76%
   80%


   70%


   60%


   50%


   40%


   30%

                          18%
   20%
                                14%

   10%                                        3.9%     3.0% 1.7%
                                       1.5%                        0.4% 0.8%   0.4%     0.4%

    0%
          Residence    Health care    Workplace       Other/Unkn   Public      School


Figure 3. Location of caller when the Mississippi Poison Control Center was contact


Service by County
The number of calls the Mississippi Poison Control Center managed for each county in
Mississippi in 2009 is listed in Table 2. This data is shown pictorially along with the
population for each county on the front cover. In general, the call volume for each
county reflected the county’s population
                                                                                               4
.

Table 2. Calls Managed by the MPCC by County in 2009
County            # Calls                   County         # Calls
Adams                 493                   Leflore            288
Alcorn                777                   Lincoln            912
Amite                   44                  Lowndes            521
Attala                304                   Madison            555
Benton                  37                  Marion             568
Bolivar               346                   Marshall           222
Calhoun               101                   Monroe             509
Carroll                 13                  Montgomery           83
Chickasaw             102                   Neshoba            459
Choctaw                 35                  Newton               92
Claiborne               47                  Noxubee              47
Clarke                  51                  Oktibbeha          345
Clay                  184                   Panola             579
Coahoma               188                   Pearl River        950
Copiah                186                   Perry              139
Covington             223                   Pike               525
De Soto               622                   Pontotoc           293
Forrest              2377                   Prentiss           534
Franklin                87                  Quitman              54
George                436                   Rankin             919
Greene                  84                  Scott              262
Grenada               358                   Sharkey              26
Hancock               853                   Simpson            321
Harrison             3804                   Smith                66
Hinds                4747                   Stone              226
Holmes                  60                  Sunflower          132
Humphreys               50                  Tallahatchie         58
Issaquena                 0                 Tate               194
Itawamba              105                   Tippah             236
Jackson              2309                   Tishomingo         276
Jasper                  71                  Tunica               49
Jefferson               31                  Union              389
Jefferson Davis         56                  Walthall           119
Jones                1080                   Warren             756
Kemper                  15                  Washington         485
Lafayette             383                   Wayne              209
Lamar                 207                   Webster            115
Lauderdale           1223                   Wilkinson            47
Lawrence              176                   Winston            142
Leake                 120                   Yalobusha            49
Lee                  1758                   Yazoo              468
Exposures

The Mississippi Poison Control Center assisted in the management of 19,584 cases of
exposure to potentially toxic substances in 2009. The main substances involved in these
toxic exposures are shown in Figure 4. Fifty-five percent of exposures involved
pharmaceutical products. Broken down, 31% of potentially toxic exposures involved
prescription drugs and 24% involved over-the-counter drug products like cough and cold
medications. The next largest category, 26%, involved home products such as hair
products, cosmetics, drain cleaners and cleaning agents. Chemicals accounted for 9.4% of
exposures and pesticides 5.7%. Bites from snakes and spiders and insect stings
accounted for 2.3% of exposure cases.


                    5848
         6000
                                   4858
         5000                                4479

         4000


         3000

                                                          1773
         2000
                                                                      1083
         1000                                                                                418
                                                                                   442                   255         248

            0

                                                                                                                 Beverages
                                          OTC Meds &




                                                                   Pesticides
                Prescription




                                                                                Bites &
                               Products




                                                                                                      Drugs of
                                                                                          Mushrooms
                                                       Chemicals




                                                                                Stings
                                Home




                                                                                                       abuse
                                                                                           Plants &




                                                                                                                  Food &
                                           Vitamins
                   Drugs




Figure 4. Types of substances associated with exposures reported to the Mississippi
          Poison Control Center in 2009.



The age ranges of exposure victims for the past two years are shown in Figure 5. The age
distribution has been very constant compared to previous years. Sixty percent of all
exposures occurred in children less than 6 years old and 71% occurred in children and
adolescents less than 19. Adults accounted for 29 percent of exposures and those over 65
accounted for 3 percent.




                                                                                                                             6
                                                                        2008          2009


   70%
             61% 60%

   60%


   50%


   40%


   30%                                                                                                              26% 26%



   20%


   10%                                                  6%                       5%                                                                6%
                                             3%                                                 5%                                                               3%


    0%
              <6                            6-12                                13-18                              19-64                        >65


Figure 5. Age distribution of human exposures reported to the Mississippi Poison Control
          Center 2008-2009.

The estimated reasons for poison exposures are shown in Figure 6. Accidental exposures
were the most common reason for toxic exposures followed by exposures due to
inappropriate access to toxic substances. Therapeutic errors resulted in 7.8% of
exposures and suicide resulted in 8.5%.



          12000
                   10318
          10000


           8000


           6000


           4000                    3495


                                                1655       1520         1462
           2000
                                                                                      380              222        209        185        126           12
              0
                                                                                   Bite/sting




                                                                                                                                     reaction
                                            Suspected




                                                                                                                                     Adverse
                                                        Therapeutic
                   Accidental


                                Inapprop.




                                                                      Product




                                                                                                                                                Food poisoning
                                                                                                     Abuse



                                                                                                             Environment


                                                                                                                           Unknown
                                                                      misuse




                                                                                                              Occupation
                                  access




                                                                                                                            Other
                                             suicide


                                                           error




Figure 6. Reasons for human and animal exposures to toxic substances reported to the
           Mississippi Poison Control Center in 2009.



                                                                                                                                                                      7
Case Management

Case management recommendations for poisoning exposure cases reported to the
Mississippi Poison Control Center for the past two years are shown in Figure 7. The
proportion of cases managed at home by the MPCC was very constant over the past two
years. In 2009, the Mississippi Poison Control Center managed 67% of potential
poisoning exposures at home (13,076 total cases, 12,648 human cases). The majority of
these cases were children who potentially ingested a medication or a household product.
Home management saves considerable money instead of referring all cases to a health-
care facility. Hospitals, medical clinics and doctor’s offices directly contacted the
Mississippi Poison Control Center on 4,209 exposure cases. Of the remaining cases,
1,857 cases were referred to hospitals by the Mississippi Poison Control Center.

                                               2008    2009


     14000       12749 13076


     12000


     10000


      8000


      6000
                                       4010    4209

      4000
                                                               1723    1857
      2000                                                                               442
                                                                                 375

         0
             Managed at home   In Health-care Facility Referred to Health-care   Other
                                                               Facility


Figure 7. Management of exposure cases by the Mississippi Poison Control Center from
          2008-2009.


Research Activities

Research performed by personnel from the Mississippi Poison Control Center
on the types of poison exposures seen in Mississippi following Hurricane Katrina was
published in the journal Clinical Toxicology. Also several book chapters on management
of Hazardous Chemical Incidents and Chemical Burns were published in a popular on-
line medical reference. Also, a joint project between the Mississippi State Department of
Health and the Mississippi Poison Control Center was undertaken to study the percentage
of children in Mississippi with elevated blood lead levels. This project has been
completed and the results were presented to the CDC. It should be published in 2010.




                                                                                               8
      Cox RD, Amundson, T, Brackin B. Evaluation of the patterns of potentially toxic
       exposures in Mississippi following Hurricane Katrina. Clin Toxicol 2009;46:722-
       727.
      Cox RD. HAZMAT. in Emergency Medicine On-Line. Boston Medical
       Publishing Group, Boston, MA, 2009.
      Cox RD. Chemical Burns. in Emergency Medicine On-Line. Boston Medical
       Publishing Group, Boston, MA, 2009

Educational Activities

In addition to intervening in exposure cases and answering questions for those who call,
the Mississippi Poison Control Center also conducts ongoing poison-prevention
educational programs in an attempt to decrease the exposure of children and adults to
toxic substances. These programs include providing educational materials to hospitals,
county health departments, schools and day-care centers on how to decrease toxic
exposures in the home, information on how to contact the Mississippi Poison Control
Center if an exposure has occurred and direct classroom instruction in schools, hospitals
and day-care centers. In 2009, the Mississippi Poison Control Center provided more than
16,500 stickers and pamphlets to organizations in Mississippi. Presentations were made
by Mississippi Poison Control Center at 3 different health fairs and school functions.

The Mississippi Poison Control Center has maintained its web site, available for public
viewing at http://poisoncontrol.umc.edu/. This contains a variety of educational
information including emergency first aid information for poisoning exposures, the types
of poisonings seen in Mississippi and educational brochures on venomous animals and
poisonous plants in Mississippi, baby-sitting and home safety for children.


Economic Impact

Several studies have demonstrated that Poison Control Centers save money by reducing
unnecessary visits to emergency departments (3-5) and reduce hospital stays in
hospitalized patients (6-7). It has been estimated that every dollar spent on poison
control centers saves $7-13 in health care costs. In 2009, there were 19,022 cases of
human exposures to potentially toxic substances in Mississippi and 12,648 of these were
managed at home by the Mississippi Poison Control Center. Of these, 10,165 were
children and adolescents under 19 years of age and 2483 were adults. Using factors of
51% of children and 17% of adults in Mississippi that are covered by Medicaid, this
results in 5,608 cases of individuals likely covered by Medicaid that were managed at
home by the Mississippi Poison Control Center in 2009. The costs of treating these
patients in an emergency setting are outlined below using Mississippi Medicaid
reimbursement rates.

Table 3. Mississippi Medicaid Savings for Emergency Medical Services by the
Mississippi Poison Control Center
Emergency Service             Medicaid         Patients     Savings


                                                                                          9
                           Reimbursement
Ambulance 50% use              $215              5608 x 0.5     $602,860
Emergency Department,          $101                5608         $566,408
Level 3
Physician, Level 3               $53               5608         $297,224
                                                   Total        $1,466,492

Several studies have demonstrated that when poison centers are consulted on hospitalized
patients the length of stay is reduced by 1.2 to 3 days (6, 7). In 2009, the MPCC was
consulted on 792 patients requiring critical care admission and another 706 patients who
required inpatient hospitalization. Of the total 1498 hospitalized patients the MPCC
assisted on, 469 were children and 1029 were adults. Using Mississippi Medicaid
percentages, it was calculated that there 414 of these patients would be covered by
Medicaid. The savings to Medicaid for reduced hospital stays is calculated below,
assuming that the average admission was reduced by 1.5 hospital days.

Table 4. Mississippi Medicaid Savings for Hospitalizations by the Mississippi Poison
Control Center
Hospital days saved          Medicaid        Admissions        Savings
                         Reimbursement
1.5 days/admission          $1637/day             414          $1,016,577


The total savings to Medicaid by the MPCC is estimated to be $2,483,069 in 2009.

These estimates do not include any laboratory or radiographic studies that might have
been done in hospitals. Adding these in could drive the Medicaid cost savings even
higher. If poisoning exposure occurs at an increased rate for low-income families, then
this number would also be greater.

The cost savings were also calculated for non-Medicaid patients who suffered poison
exposures. Shown below are the calculations for outpatient cases managed at home in
Table 5 and inpatient savings using the estimate of decreasing inpatient stays by 1.5 days
when the MPCC was involved in patient care in Table 6.

Table 5. Mississippi non-Medicaid Savings for Emergency Medical Services by the
Mississippi Poison Control Center
Emergency Service           Typical Cost        Patients   Savings
Ambulance 25% use              $1000          7040 x 0.25  $1,760,000
Emergency Department,           $350             7040      $2,464,000
Level 3
Physician, Level 3              $132             7040        $929,280
                                                 Total     $5,153,280

Table 6. Mississippi non-Medicaid Savings for Hospitalizations by the Mississippi
Poison Control Center


                                                                                          10
Hospital days saved            Typical           Admissions        Savings
                               Cost/day
1.5 days/admission            $3500/day              1084          $5,691,000


The total cost savings for non-Medicaid patients is $10,844,280. Even if only one-half of
the minor poisonings sought emergency care, the total savings would still be over eight
million dollars. For insured patients, this amounts to a savings to insurance companies
and to the patients for co-pays. For uninsured patients, this results in a significant
savings to hospitals and to the debt incurred by the patients and their families. For all
Mississippians, this results in a decrease in emergency department over-crowding.

Combining all of these factors, Medicaid and non-Medicaid cases managed at home,
costs savings to hospitals, cost savings to individuals hospitalized, it is estimated that the
Mississippi Poison Control Center saves the state of Mississippi approximately 10.5 - 13
million dollars a year. Given the operating budget of the MPCC, this works out to a
savings of 7 - 9 dollars saved for every dollar spent. These numbers are on the
conservative side of other national estimates (3-5).


References

   1. CDC. Unintentional Poisoning Deaths – United States, 1999-2004. MMWR 2007;56:93-
      96.
   2. CDC. Poisoning in the United States: Fact sheet. Available at
      http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/poisoning-factsheet.htm.
      Accessed 6/1/2009.
   3. Miller T, Lestina D. Costs of poisoning in the United States and savings from poison
      control centers: A benefit-cost analysis. Ann Emerg Med 1997:29;239–245.
   4. Kelly N, Ellis M, Kirkland R, Holmes S, and Kozinetz C. Effectiveness of a poison
      center: Impact on medical facility visits. Vet. Human Toxicol. 1997:39;44–48.
   5. Chafee-Bahamon C, and Lovejoy F. Effectiveness of regional poison center in reducing
      excess emergency room visits for children’s poisonings. Pediatrics 1983:72;164–169.
   6. Vassilev Z, Marcus SM. The impact of poison control center on the length of stay for
      patients with poisoning. J Toxicol Environ Health 2007:70;107-110.
   7. Bunn, TL, Slavova S, Spiller HA, et al. The Effect of Poison Control Center Consultation
      on Accidental Poisoning Inpatient Hospitalizations with Preexisting Medical Conditions.
      J Toxicol Environ Health Part A 2008:71;283-288.




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