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SPECIAL FEATURE
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Poison Control
Providing a unified, bilingual emergency service to the border
By Lindsay Lewis and Janis Parsley
Director of the West Texas Regional Poison Center at Thomason Hospital (WTRPC) in El Paso, Leo Artalejo III, manages an efficient staff with a significant role in emergency healthcare. Situated just a few miles from the U.S.-Mexico border, the poison center is the nation's first 24-hour bilingual regional poison center certified by the American Association of Poison Control Centers.
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Each health professional undergoes a minimum of twelve months of toxicology education in order to be eligible to take the national certification examination to be a Certified Specialist in Poison Information (CSPI).
WTRPC is also a drug information site for UH College of Pharmacy students. Luis "Carlos" Montenegro, an El Paso native, is completing his rotation at WTRPC under the supervision of Senior CSPI Gilbert Parra. Parra recently received "State Preceptor of the Year" honors from University of Texas College of Pharmacy.
"It is important for the trainee to experience the situation without taking control of the call," says Parra. "We have a discussion after each call to reflect on the decisions that were made during the emergency."
During a call, the CSPI reassures the caller, assesses the patient's poison exposure and instructs the caller about the patient's treatment and management. This could include treatment at home or referral to the closest healthcare facility's emergency room.
The CSPI also monitors all poisoned patients referred to a healthcare facility until discharge. Approximately 80 percent of all human exposure calls received at the poison center are able to be treated at home under the CSPI's close monitoring, direction and follow-up calls - saving patients and taxpayers a considerable amount of money. Poison centers are second only to immunizations in public health cost-effectiveness - saving seven dollars for every one dollar invested.
The WTRPC provides 24-hour bilingual services to its designated 36-county region - over one-fifth the landmass of Texas, with 1.4 million people. The center receives roll-over calls from the other five poison centers within the state and provides Spanish-caller services to the entire state of Texas. Its location in El Paso, which borders Ciudad Juarez, Mexico, creates the world's largest border metroplex with nearly three million residents and supplies the need for a bilingual service to callers. With average household incomes of less than $10,000 a year in the region, the center often prevents the dispatch of an ambulance and associated emergency room costs, saving many families from unnecessary healthcare expenses.
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The poison center also makes follow-up calls within an hour of the initial call to see whether the patient's signs and symptoms have changed and that the treatment management instructions were understood and are being completed.
"Follow-up calls or call-backs by poison center staff are an essential part of providing service. People are listening and trying to act simultaneously," says Artalejo. "During the emergency, they may not understand instructions correctly and are too embarrassed to call back."
State Representative Joe C. Pickett reiterates the importance of the follow-up calls after sharing a personal story. "Not only did we receive good information, but an hour later, we received a call back. I was amazed at the service."
In 2003, the Texas Poison Center Network (TPCN) received 302,309 incoming calls or the TPCN answered a call every 1.7 minutes, 24 hours a day, seven days week. According to Artalejo, less than one percent of the Texas Spanish-speaking population utilizes poison control centers.
Emilio Saenz, WTRPC Community Relations-Education Coordinator, explains the benefits of combining emergency communications with educational opportunities. "Imagine being able to call the poison center to find out more about the medications that you are going to be taking. Poison centers are already doing this 24 hours daily in English and Spanish."
The majority of phone calls received at the WTRPC involve medication cases; the most common are medication overdoses, including over-the-counter meds such as acetaminophen.
"What we experience near the border is that individuals are 'self-prescribing' medications," says Artalejo. "Many prescription medications in America are sold over-the-counter in Mexico. Because the prescribed amounts in the U.S. are different, patients are guessing at the proper dosage and, therefore, overdosing on medications."
With an overwhelming portion of the border population in poverty, many neighboring residents seek medications in Mexico as an affordable, yet risky, alternative. The risk of acquiring medications in Mexico not only includes differences in recommended dosages, but some medications commonly sold over the border have been banned in the U.S. for more than thirty years because of their dramatic adverse effects.
In addition to overmedication, Artalejo expounds on other likely sources of poisoning. "Whenever people think of poisons or try to define a poison, they generally think of rare heavy metals like mercury and arsenic. And they overlook the most common toxins - common household cleaners, prescription medications, automotive products, plants, fertilizers, carbon monoxide and insect bites," he adds.
From drug overdoses to snakebites, accidental poisonings to chemical exposures, one thing is for certain: the dedicated staff of the WTRPC is prepared to help.
The new national emergency number for poison control is 1-800-222-1222, which will route callers to the nearest center. For more information, visit www.poisoncenter.org or www.poisoncontrol.org.
Reprinted from University of Houston College of Pharmacy Interactions