This Podcast Will Kill YouIn last week’s episode/love song to poison control centers, we journeyed through the history of these centers, from idea to institution. This week, we pick up where we left off by taking stock of the incredible impact that poison control centers have had on public health and individual lives. We also get a thrilling behind-the-scenes look at the operational side of things - who is on the other end of the line when you call poison control? How do they know so much and where do they get their information? Dr. Suzanne Doyon, Medical Director at the Connecticut Poison Control Center and Assistant Professor of Emergency Medicine at the University of Connecticut joins us to answer these questions and so many more. If last week’s episode didn’t turn you into a poison center superfan, this one certainly will. Tune in today!
Hi, I'm Aaron Welsh and I'm Aaron Olman up dank and this is this podcast will kill.
You And we're obviously doing things weird because why are you hearing from us? Straight away?
That really felt weird. I was like, there's no first hand to count, so I just how do we begin.
Ease into this?
No?
We eased in last week?
Yeah, yeah, last week.
Did you listen? If you haven't heard last week's episode, I'm not saying like you must pause this and go check it out, but like you probably should because we had so much fun talking and learning about what is poison control and how did poison centers come to be? Like where did they arise from? And how did we even figure out that that needed to happen. It's a great episode. Definitely check it out. And so today we're picking up essentially where that left off.
Right, So we learned all about how they came to be, but we didn't learn what they do, how they work, who works there, all of these questions that are really kind of integral to the existence of poison control centers today. And so that is what we're getting into this week. And we are getting into that with the help of an actual, super duper expert doctor Suzanne Dourion, who is the medical director of the Connecticut Poison Control Center and is an associate professor at the University of Connecticut School of Medicine, and she's a toxicologist. I mean, like, honestly, it's this conversation was so much fun. She knows everything about all the stories she has.
This is why we don't need another first hand account because she's got so many stories for us. It's phenomenal. She sat down with us to answer all of our burning questions about what it is like on the other end of that phone line when we call in to Poison Control, what it took to become a medical director of a poison center, what it takes to be a poison specialist, by the way, best job title I've ever heard of, And there's so much more in this interview. We are thrilled to be able to have had this conversation and to share it with all of you. It's it's going to be a really great episode. We're stoked, it really is.
Before we get into all of that, it is quarantiney time.
It still is. It still is the same drink as last week.
It's just that good.
Name your Poison?
Yeah, I mean, and if you want to stick with last week's like recipe, it is whiskey again of whatever kind, probably not a pede scotch blah blah blah whatever. Do a whiskey and then peaches, lemon juice, simple syrup. It's delicious. But hey, it's called name your poison. If you're like, you know what, I'm going to do a variation on this, I'm going to do something else. I'm going to do nectarine instead of peaches. Wow, go wild, wild, go absolutely wild.
All that to say, the recipe is on our website, it's on our social media. Do you follow us on social media? We're on TikTok, We're on Instagram, we're on Twitter.
Rex.
Is that what they're calling it these days.
I'm not sure.
I think it's it's like Prince the artist formally known as so it's like X formally.
Website formally on Twitter.
Yeah, yeah, okay, anyways, we're there, Aaron, Yeah, do peach pits contain cyanide?
Great?
Just have that realization accroutely question.
I don't know.
Okay, we just confirmed via the search engine that we all use that. Yes, indeed, peaches contain peach pits contain well a compound that gets turned into cyanide when digested. And we didn't realize this. I mean, we should probably have just like delete all this in editing and then claim that we knew it from the beginning, but.
We record our other intro. Yeah it's too late now.
Yeah anyway, Yeah, we totally this did this intentionally. Oh, to enjoy your drink. Back to the other stuff website. This podcast will kill you dot com check it. We got great stuff.
You know.
It's got transcripts, it has got links to merch links to music by Bloodmobile, links to our bookshop, dot org affiliate account, our Goodreads list. It's got to submit your first hand account form. If you all have a Poison Control Center story, send us it. We would love We would love to hear those stories. Use the first hand account form or email us whatever.
We have a.
Contact us form on our website. Things can we get into the episode.
Let's take a quick break and then we'll get to hear from doctor Susanoyan herself.
Let's do it.
We are thrilled to have you here, Doctor Doyon, thank you so much for joining us. If we could start off with you introducing yourself a little bit and telling us how you became interested in the field of toxicology and how you ended up as the medical director of a poison control center.
Thank you, thank you for having me.
This is just for me, a wonderful opportunity to share a little bit about the world of poison centers. So my name is Suzanne Doyon or Duyon, and I'm a physician. I went through medical school, but after finishing medical school, emergency medicine was where I was headed. And so I did a residency in emergency medicine. And during those four years as an emergency physician, you rotate to a number of different places. You do a little bit pediatric work, you do this at the other one of the rotations was a whole month at the New York City Poison Center, and I just, you know, really really enjoyed that work. So upon finishing my four years, I chose to do what they call the fellowship. So that was my entire training. Four years of medical school, four years of emergency medicine, and two years of medical toxicology. What was it about the specialty that attracted you?
Right? And so, of course poisonings are very, very interesting.
But really it's the opportunity to really dig deep into a subject matter, to have an expertise, and to honestly bring that expertise to the bedside, to physicians with a little bit less expertise and guide them, you know, through through the process. Because I always found emergency medicine to be in more of a horizontal specialty, you know, a little bit a lot of different topics. This was an opportunity to know a lot about one small topic and that really attracted me. Now following that, you asked me, how do I become a medical director of a poison center? So once you do all this training, you have a couple of avenues you can go in the industry.
You can do a number of things.
But the two big avenues are are you going to be in a hospital where you consult at the bedside and see poison patients at the bedside and you're responsible for that one patient in front of you and make decisions accordingly. The other avenue, which is the avenue I chose, is to go more into a bit of more of a public health around, so to speak. You become medical director of a poison center, and then yes, you are to some degree involved with the management or the care of a patient at a bedside because you will be on call for the poison center. But also as a medical director, you will make more population based decisions. You will build kind of decision trees. You will have to make big decisions on you know, this antidote for my patient, my entire state patient population versus this antidote. How are we going to kind of deal with this. I found that to be very, very impactful because again, the decisions you may impact the population of your state. So that's millions of people usually. And then, as I said, we're on call, what does that mean. So when a poisoning is that that's severe, we have physicians on call twenty four to seven, three sixty five. So occasionally that's me, but I parachute in and talk to the physician at the bedside. So the physician at bedside sees whatever it is that they see, whatever poisoning that they're seeing, they give me the details. We go back and forth with questions to try to kind of get the stories. Rate I help with the diagnostic testing and any therapy that is administered at the bedside. So just to give you an idea. You know, cyanide poisonings don't occur very often. A given poison center of my size, Connecticut is about three point five million people will get about one sinid overdose per year. So there's no single physician in a hospital out there that has a lot of experience with sinnid overdose. It just doesn't exist. But I get to see about one a year. It's not a whole heck of a lot, but I get to see one a year. So after ten years, I've seen about ten ors roughly.
And so there are.
Antidotes for sinite poisoning, but often the physicians I'm speaking to have never given the antidote before. They're just like, I'm a little bit uncomfortable here. I've never given this before. And I'm like, that's okay. I'll stay on the phone with you. Just stick me on hold. I will not disappear from the phone, administer it. If you run into any problems, I'm right there and we can kind of navigate whatever difficulties you're having.
Now.
In reality, the sin aine antidote is pretty easy to administer, it's pretty safe, but still it's addressing that comfort or that lack of comfort. So sometimes we stay on the phone. We really do stay on the phone with the physician in a critically ill patient to really help them at the bedside. So I find that very rewarding as well. It's not population based medicine, it's a case by case medicine, but it's very, very rewarding.
Of course, you get an incredibly diverse array of phone calls at a poison control center every single day, and I was hoping you could take us through sort of this decision tree for what happens when you get a phone call? What are the first steps, what are the questions asked? What sort of paths can you follow down afterwards?
So first of all, let's talk about the phone and the phone system. We are not like nine to one one. Our phone number is a one eight hundred number. It's quaint, we're working. We would love legislation to have a three digit number, but getting Congress to dergree is a little bit difficult at times hundred number. No matter where dialed from a landline, cell phone, doesn't matter, will be answered twenty four seven three sixty five. And I want to specify here, not by AI, not by artificial intelligent A person will answer it on occasion, there's weight times, but we really strive to keep our weight times extremely short. So one eight hundred number available twenty four hours a day. We never, ever, ever not answer the phone. But what's going to happen? So you're going to get a person who's gonna first ask sort of what's the emergency? Is this really really something extra emergent or is this something I can take my time and get the patient's name and so on and so forth.
But they will ask you your name or the name of the child.
You know, if it's a parent calling, they will ask the age of the person. They will often ask, you know, a gender as well, And then what happened? What's the scenario? Was it ingested? Is this more of a dermal exposure that we're worried about. Is it an ocular exposure that we're worried about. Is it an injection exposure that we're worried about. Is this an acute exposure It just just happened one time right now, just happened or is this something that was every day for the last month or so or something like that. Is this an accidental exposure or is this something intentional? And ultimately, what is this substance. Is it a drug, Is it a chemical that we find in the household. Is it a snake bite, is it a spider bite? Is it something that was breathed in? Is it some kind of smell or some kind of smoke or some kind of gas in your neighborhood. So then once all this information is collected, often the poison they're called poison specialists. The poison specialists right off the top of their head, knows what the ingredients are, knows what are the potential pitfalls, and we'll make recommendations. So the recommendations will vary from stay at home and we don't need to worry about it too too much to you need emergent immediate medical help. How they make these decisions is based on their intrinsic sort of internalized knowledge of things. And then I create for them one hundred to two hundred different complicated algorithms that they can follow as well. The algorithms are available for them twenty four to seven.
It's on a computer platform.
And over time though they internalize again a lot of these algorithms. You use the same algorithm every day for you know, a weeqbe internalized. It usually so that's that's what happens when they call it poison center.
I love it, having called the poison center several times. It's just it's always a phenomenal experience. If that, If that is a thing that you can say about an emergency situation.
I'm happy to hear this.
We strive to be nice, polite on the phone, but we almost we mostly strive to be helpful. Collectively, in the United States, every poison center feels the same way. If we're not helpful, we just get then we have failed terribly at our jobs.
Let's take a quick break.
So speaking of that, of your staff and everyone that you have at your poison center, who are the people the poison specialists who work at the poison center. What kind of training does someone need to have to be able to be a poison center phone operator?
So who are the people answering the phones. They are not operators, they're not volunteers. They're paid. They are usually of two trainings. They are pharmacists or nurses. If they're pharmacists, usually they're licensed in the state in that state, and nurses are licensed as well. If they're nurses, they're usually they usually have one or two years of critical care experience or something like that, and that's to qualify for the job. Now, once they qualify for the job, there's usually about one year of solid training that goes on where they are supervised in real time. We listen to their calls to supervise and make sure that they do the job correctly. And as they get better and better at their jobs, of course, then we don't listen to.
Every single call.
A lot a lot of one on one teaching hours and hours hours of didactic training, all this culminating into a certification exam. Once they become certified, they can really fly solo on the phones. If the case is very, very serious, they will then immediately call the physician on call. The physician on call is someone like me, someone with medical toxic callology training. We can sometimes just speak to the poison specialists to give them some guidance, but sometimes this is just.
Plain so serious.
We must speak to the ED physician, to the intensive care physician whoever is at the bedside of the patient to help with what's going on. So yesterday I was on call. Sometimes the patient had been in the ED, the patient was stable, completely stable, but they had done all the labs, and the labs had been reported back to the poison specialist, and it is at that point that the poison specialists call me to review the labs to see if based on the labs, it was safe to send the patient home from the ED and not admit to patient. So sometimes the questions are those, you know, how can we safely take care of this patient and so on and so forth, And think about that that saves an admission, Yes, it's saves healthcare resources. But think about the patient. The patient is not facing an emission. The patient's family doesn't have to drive back and forth to the hospital to visit the patient, if the patient doesn't get pricked for blood work, and so on and so forth, the patient gets to sleep at home. All these things are good, good things for the patient, for the system in general. So we try as much as possible to keep the patients away from the hospital if we can. So this was a good use of poison centers in terms of health saving healthcare resources and doing right by the patient.
The poison decks. What can you tell us about the poison decks?
So poison index is how some people call it. Other people call it micromedics. We use the terms interchangeably.
But what is this? What is this mammoth that it is?
So I will tell you the poison specialists are probably in micromedics every minute of every shift.
But what is it. It's an online database.
There's an Internet and there's an intranet version there, but it's a huge, huge, huge database. You know, you just put, for example, mister clean whatever, some kind of cleaner you use in the household, but you put the brand name and it will start outlining the ingredients for you. But you say, you can get that from the label. So why do we have microetics Because then micromedics classifies the different individual ingredients into kind of categories or buckets, so to speak, and that helps us kind of understand the product much much, much much better.
So they let me give you an example.
Let's say this cleaning agent used in the household has benzol ammonium chloride.
We and poison centers all know what that is, but you don't. Let's say you're a new poison specialist. You don't know what that is.
Micromedics or Poison Index is going to classify bisol ammonium chloride into cat ionic detergents. Now the poison specialists should know catonic detergents. Of all the detergents out there, those are the ones I need to worry about. So there starts the process. And in caonic detergents, it's only concentrations of the desergents above seven point five percent or so that we worry about. So the next step once the poison specialists recognizes ca ionic detergent is go back what percentage this is this? Two, three percent, five percent, seventeen percent, what is this? And then take it from there. So it's a combination of knowing how to use the database. But that's what micrometics does. You need to be able to read labels as well. There's a so if we're very fortunate in the United States that we have very strong labeling laws. They date back to the nineteen sixties, and so they will list the active ingredients and they will list the inactive ingredients. And then when you see that list of active or inactive ingredients, this it doesn't matter. The most concentrated one will appear first, not the most toxic one. The most concentrated one will appear first, and then the least concentrated ones will appear least and usually if the concentration is less than one percent, mandated to put it on the label at all. Those are the basic basic rules, so that again, if you know these rules, you could start decoding a little bit these labels that we have on all.
The products out there.
But that's what we do with micromedics, that's what we do with labels using brand names. It helps us kind of drove down to what the ingredients are and what the toxicities are.
So how do you analyze the risks of ingestion or exposure when there are multiple substances either the example that you gave of, like a cleaning product that has this long list of ingredients, or someone who either intentionally or accidentally took a mixture of different medications. Like, how do you I assume, with the assistance of micromedics, prioritize these ingredients and what other data do you need to be able to work through that problem?
So I think we probably encounter that, honestly a little bit more when people ingest different medications, and these are called dr drug interactions, and they're getting a lot more common than they used to be. There are not that many honestly computer programs that help you with it. So what it is is, honestly just having a basic knowledge of what gets metabolized, what way, and what medications can interfere with that metabolism, So that's a pharmacokinetic or you know, just knowing intrinsically that, for example, a medication gets primarily eliminated by the kidneys, and then just hearing that either another medication is added, or just hearing that the patient's kidney function, the patient's renal function is a.
Little bit off.
So having a little bit of knowledge of these kinetics is important. So we have to teach the poison specialists. We really kind of just have to teach and teach and teach them. Then we have the other drug drug interactions that we call pharmacodynamics. So a drug binds to a and another drug is added that binds to the exact same receptor. That's basically bottom line, knowing how every drug out there works, and we carry that knowledge. We just have that knowledge, we teach it and so we can often just right off the top of our head say that mix of that drug with that drugs is not going to be a good mix, because they tackle the effect they target the same receptor, and that's going to be a bit of a problem.
We're going to have too.
Much of an effect or not enough an effect, depending on whether they're agonists and antagonists and so on and so forth. When we're talking about all the different chemicals in household cleaners, for example, the cleaners are all there to kind of clean, so they all have they're all there to aim for one given thing, and the active ingredient is the active ingredient for the purpose of that product. So, for example, and insecticide, you look at the active ingredient, the active ingredient is the ingredient to kill insects. So is that going to be an active ingredient in the human Maybe? Maybe not right, So, a lot of insecticides these days contain what we call pyrethrins.
Pyrethrins kill insects, but they're not particularly problematic in humans.
So we're not going to worry too much with the insecticides, or at least the active ingredients. Then we're going to start looking at all the other things they added there. Things to make it more liquid, things to make it smell, god knows what smell. They're searching for, things to make it maybe a bit oily, so when you spray it on your plants, because it's oily, it stays on the leaves. All these things we're going to look at and see if it's particularly problematic for humans. And then so if they patient ingested the insecticide but also then ingested turpentine, so then does the turpentine interact with the insecticides. So that's just a lot of thinking, a lot of thinking, but again we navigate that.
And again try to figure out how to best help the patient at that point in time.
Let's take another quick break. You mentioned how some of the calls that you're getting more of these days involve interactions between different medications. As people are going on more medications, have you noticed any other trends in what calls you're getting more or what types of calls you're getting more today compared to calls in the past, or even just like in the overall number of calls that you're getting.
Absolutely, so we keep abreast of these trends, and so you're going to hear a whole host of things as just a population shifts in what it is that they purchase, what it is that they have in the home, what children have access to. So you're going to hear a lot of noise right now about melatonin, for example. So the melatonin products have been largely manufactured into gummies.
They look like little candies. Some of them are actually shaped like little teddy bears, but they certainly have very beautiful colors. They look like candy.
So not surprisingly, even though they are provided in big jars with child resistant caps, children are just either breaking through the child resistant cap or some way shape or form getting into the gummies. And so there's a lot of you know, melotone gummies. So on the issue of gummies, marijuana gummies, lots of those around. So the states that have legalized marijuana adult use marijuana will have usually a component of the marijuana products that are what we call the edibles. And the edibles can be all kinds of different confections, and so some states have been very strict on this. Connecticut that has been very strict on this are edibles must have uninteresting square shapes, they can't have any interesting colors, they're kind of bland.
Really. They must be in child resistant containers.
A given edible cannot contain more than five milligrams per edible. Five miligrams of THHC the five DELTAHC, the active ingredient in marijuana, and you cannot have more than one hundred milligrams in a bottle, so that if the child gets into the entire bottle, it's still a large amount of five PhD for the child. But we're not talking thousands of milgrams. We're talking one hundred milligrams. And so gummies, you're going to hear a lot about gummies as being a problem. The changes in abortion laws are recent, so we haven't quite quite studied yet or produced the data yet, but we expect an increase in use of herbals dietary supplements to terminate a pregnancy in women who have very few other options that I can't say that we've seen, but we're watching this. We're watching this right now, we're surveilling this. We've definitely seen an uptake in the GLP one receptor agonis, the ozempic go Z. There a couple of others out there, injectables that are used for the management of diabetes, but more recently for weight reduction, and we see all kinds of behavior with that from wellness spas that are dispensing ozempic. We've also had people who if one dose of ozempic is good to lose weight, then doubling the dose is probably better.
You have to be very calpful with these products. The escalation of the dose is very very slow, So if you escalate the dose too quickly, you run into adverse effects and they get a lot of nausea and vomiting and lasts for days and days and days. It's a gesstro paresis type of nausea vomiting, so problematic.
Back to the the ozembic dispensed from non retail pharmacies, one such product was analyzed. It contained insulin. It did not contain any sema glue type, which is the ingredient in ozembic. It contained insulin. So the Wellness Spa sent non diabetic patients who were looking to lose weight. They sent them home with syringes of insulin. Of course, the opioid epidemic, we're seeing a lot a lot of that. The opiod epidemic right now is really a fentinyl epidemic. That is our major major issue in the United States is the fentanyl. It's potency. Everybody is kind of hot under the collar about xylazine. But it's really the fentanyl that is the problem, and we're not out of it. Most of us don't predict we're going to be out of it for a good ten years. It's going to take time to change the tide on that big, big epidemic. So I would say those are the big, big trends we're seeing right now, but of course that will change in six months.
What do you find to be the most rewarding aspect of this work that you do.
I think the times I go yeah, right, usually the appropriate use of an antidote. Appropriate meaning we thought the problem was right, We aim to solve the problem with an antidote, and then the patient did well. A cyanide overdose that gets the appropriate antidote, turns the corner and survives. Because sind is quite toxic, is just a cause for celebration. But they come in all shapes and forms. I remember this. It was very way back, but funny story. The child was bidden by copperhead, had a pretty significant wound to the hand and was seen in the hospital that could not they could not emit pediatric. So this child went from this pripher hospital by helicopter to a what we call tru shree kre Pediatric Center and got the antidote. In the meantime, did very very well, did recovered. I think he was seven or eight and kind of left the hospital and so think about this. He was out there, got bidden by snake, got an antidote, helicopter, ride to the city, all this stuff. He goes, I've got a story for show and tell. I've just got the best story.
That was just like, yeah, you probably do. And that was just it still brings a smile to my face. Just really really funny. Those are yay moments for us in poison center circles, but it's usually saving a life, getting the antidote right, getting it in quickly, and the patient turns the corner, and any physician will tell you that that's just you feel like a thousand bucks, our million bucks. You really really feel like you're superstar at that point in time, and it's so great to turn and turn to the family say yeah, he's going to do okay. So those are there, our great saves and our great great moments. They're few and far between, but they're great.
That was such an amazing conversation, Aaron. We could have talked all day.
I was just gonna say, I could have sat there for so many more hours, just like picking her brain and asking for stories, and no, I know, I would love to sit for a day in a poison center as well, just to like hear it and experience it.
I yeah, well, and it's also I think what's really amazing to me is that, like, this is a hugely impactful area of public health that I didn't really ever think that much about, or know that much about, or know what's an option. And I just think it's really amazing to know that. Okay, let's say that you go into the field of medicine and you're like, I want something that has one foot in public health and one foot in medicine. This is a great opportunity for that. And if you're or if you're just like, hey, you know what I want to keep in my brain an absolute database of compounds and what organ metabolizes them and what receptor they use and blah blah blah, like it's so cool. Yeah.
Also, Aaron, I will I agree one hundred percent that this is like, especially coming from the field of public health, not realizing how amazing and impactful poison control is. That's what we're about to get into is like, ye, what poison control can do for you, what it's already doing that you didn't even know about. I will say that we're going to focus on the US, and this has been a very US centric episode, but we're also going to get into just how much the US doesn't focus enough on poison control hint, hint, funding wise, and I will get a little bit into the global status of poison control centers worldwide. Spoiler there's never enough of them, but they do exist. Nope, and yeah, because there is just there's so much there, Aaron, I can't wait to get into it. So currently, as of twenty twenty four, there are fifty five poison control centers which have recently rebranded into poison Help Center. I think is that they're calling themselves. So not every state has their own poison control center, but every state in the US is served by at least one poison control as are all US territories. But here is a thing that I again thinking back to, like how this started, I just love this about the poison control centers in the US is that all fifty five five of these use a centralized reporting system which is called the National Poison Data System and we heard a little bit about this and the information system that they used in our interview. But this reporting system is the National Poison Data System or the NPDS. This uploads real time data of every single call that is made to all of these poison control centers. This generates so much data that we can use to understand the impact of poison control centers and be able to actively in like real time see trends like we talked about in our interview on like what are people calling poison control center about? Surprise, surprise, it's ozepic these days, right, Yeah. And so from this we also get these incredible annual reports. The most recent annual report that came out was from twenty twenty two that was released in January of this year, and it happened to be the fortieth NPDS report, so happy anniversary. And so this gives us some pretty solid statistics on how many people are calling and for what reasons. So in twenty twenty two in the US, there were over two point four million encounters logged. Of these, over two million of them two million, sixty four thousand, eight hundred and seventy five were human exposures. Fifty thousand of them were animal exposures and three hundred and sixty thousand of them were information requests, which means people contacted poison control even though there wasn't an actual exposure. Okay, And we can see what the top substances were that people called about or that people were exposed to. And these, interestingly, like the top four main categories, haven't changed a ton over the years. And what's interesting is that in this report, because it was the fortieth, they had a data table that was like, compared to nineteen eighty three when this started and twenty twenty two, what are the differences, And there are definitely some. But top of the list for exposures is analgy six and that is things like estatamenifin or titlanol and ibiprofen, which account for eleven percent of all calls. Ok Next on the list is household cleaning substances, followed by antidepressants and then cosmetics or personal care products, which is also interesting, now who is calling in we get that information as well. Unsurprisingly, unfortunately, kids under five account for the majority of exposures, like kind of overall, so kids under age three accounted for twenty eight percent of all exposure calls, and kids under five accounted for forty percent of all human exposures.
Okay, and they are.
Actually more likely to be exposed to cleaning over analgesics, which is like we talked about, because they're easily accessible and a lot of times we might not think about them having as kid proof of access like a lot of our medications do these days. All told, all of these over two million exposures resulted in three thousand, two hundred and fifty five cases of death, two thousand, six hundred and twenty two of which were judged as directly related to the exposure. And what I found really interesting is that out of all of these poison control calls, whenever there is a death that's reported, there's a really complex review process where they go back to that data to try and determine how likely it is that the exposure was related to the death. If that makes sense.
Okay, interesting. Yeah, So that.
Was like a lot of data thrown at us. And there was a really interesting radio Lab episode that I listened to. You listen to it?
I did too.
Yeah, it was so good.
It's really great. Their production value can't be matched but one of the things that they mentioned in that episode is that calls have been on the decline to poison control centers, and it's in this report as well too. Calls have been on the decline. There have been a fairly continuous decline in total calls to poison control centers since about two thousand and eight, which is when it peaked. When it peaked, there were just over four point three million calls to poison control centers in two thousand and eight, which included two point four million exposure calls, human exposure calls, and one point seven million information calls. There was some spikes during the pandemic, especially related to disinfectant use and then COVID vaccines and things like that, which is probably interesting in its own right, very interesting, huh, But I'm not going to get into the detail. But what I think is so interesting about these trends specifically, are a few important detail that are even bigger picture than just a declining calls. What this declining call seems to reflect is a number of different things. The report from twenty twenty two sites that there has been overall declining birth rates, which is important because exposure rates are so much higher in children under age five interesting and an increasing reliance on the Internet because a huge part of what I just said, one point seven million calls were information only calls compared to three hundred and sixty thousand information calls in twenty twenty two. So when someone is looking for just information about a substance without a direct exposure, they're going to go to the internet first. And that makes a lot of sense. Now, as of twenty fifteen, poisonhelp dot org can actually get you really similar information to what you're going to get from a poison control call because you can get in touch with poison Control via their website poisonhelp dot org as of twenty fifteen, So some of these cases might still make it into the poison control database if they're coming from that website, if that makes sense.
Uh huh.
But what we can't necessarily interpret from this reduction in calls is that exposures are decreasing, because what this data from twenty twenty two shows is that exposures with more serious outcomes, including hospital facility calls and calls that result in major harm or death, have actually been on a slight increase across the same time period.
Okay, what are the characteristics of these calls, Like, are there patterns in this?
Not necessarily patterns aside from just that they're more serious calls that have a more serious outcome, whereas information only calls and calls about less serious exposures tend to be have been on the decline around the same period, and it's not a huge increase. I think it was like zero point one point seven percent from last year, for example, and that's about on average. I think it's like one percent ish over the years. But it is really important right that people are still having dangerous exposures and still relying on poison control to call, either from their home or health care facilities are relying on calling poison control for information, and so this is a really important thing that poison control centers are kind of grappling with, is like how to bring themselves into the twenty first century, which is really important because we can look at lots of data and see how important poison controls are in terms of lives saved and in terms of healthcare dollars saved.
Aaron, uh huh, which.
I love to talk about. We don't like to think about healthcare dollars, but we talk about them on this podcast a lot, because, especially in the world of public health, you have to unfortunately justify your existence using dollar signs, and it happens that in the case of poison control, we can absolutely do that. There was a ton of different studies that I saw, but I'm actually going to cite a few that were really old just because they highlighted this point so well. There was a paper from nineteen ninety one when the state of Louisiana closed their poison Control center, and then they were able to compare after this closure in Louisiana, information between Louisiana and Alabama, which is right next door, has very similar demographics and prior to the closure of the Louisiana Poison Control Center had very similar, almost identical triage patterns for exposures of their poison control center. So when they looked at the data, it was like really really similar calls that were coming in, Okay, And what they found is that the rates of people who had to end up going to the emergency room or urgent care or the doctor's office in Louisiana after the close sure of this poison control center, four times as many people sought care for poison exposures in Louisiana compared to Alabama during that time, and the estimated cost of this hospital and outpatient utilization for things that these are low level exposures that did not need to be managed by health care facilities at all, was one point four million dollars.
Oh my gosh.
And you might say, well, that's not that much money when you look at like huge health care spending overall, but it was also three times as much as the poison Control Center cost to run in its entirety.
Oh my gosh. Okay, So I have a question though, just like logistically, when you call poison control, it's eight hundred two two two one two two two. That's the number. So when Louisiana shut down, it's poison control. What did that mean if you were in the state of Louisiana and you call that number. That is such a good question.
I don't know what happened in nineteen ninety one.
Okay, nineteen one, so things might have been organization.
So I don't know if like they just lost access entirely. I know that they had enough data to be able to say there's no access here. Let the parent see what happens. Yeah, because right now, when a poison control center shuts down and we'll get there, then calls are going to be rerouted, and but it could end up then overwhelming another poison control center if you don't have enough people to kind of run it, and that sort of a thing.
Okay, but yeah, that another question following get it to me. After this report came out, did Louisiana immediately go oh wow, whoops.
I don't know the timeframe, but there is one now okay.
Hopefully it was nineteen ninety two or like whenever.
It was three.
I don't know.
But there are a lot of other things that go into how much poison control centers can help. Right There are a lot of other examples like this. There's also some really good ones. There's a paper that details how in El Paso, when they coordinated really well with a poison control center, they have documented that they were able to avert like seventeen hundred ambulance calls in a really short time period. There's a review paper from two thousand and nine, and a lot of these papers were really quite old, but it had a lot more numbers, and that combined with a report that I will say was commissioned by the American Association of Poison Control Centers, so there was some bias for that because it was a consulting firm commission by poison Control But looking at all of this data, the overall cost savings estimate of poison control centers is between seven and fifteen dollars per dollar spent, which accounts for close to a billion dollars in healthcare savings annually. And that's not even counting how many lives are saved, because there are a lot like there is a lot of data that shows that you can reduce hospital length of stay and you can improve health outcomes by having access to poison control center. Despite this, budgets are constantly at risk for poison control centers in the US.
It's the same story for public health in general. And it is infuriating.
It is the most infuriating and just the tail as old as time. Honestly, most of the funding for poison control centers is a mish mash cobbled together budget, right. Some of the funding comes from state budgets, some comes from federal budgets. There's like over twenty nine different agencies which contribute to various poison control centers and I said that there are fifty five poison control centers in the US. If you read some of these papers, they'll tell you that there are sixty one, because there used to be, but in the last few years several of them have closed due to budget cuts. Poison control centers in the US are so vulnerable it is bananas when you look at the data of how much they contribute, how many dollars they save, how much data we are able to generate from this real time reporting system, like the value that they bring is incredible. So that's our rant. I don't know how to fix that, but it's a thing.
I mean invest in public health, yep, yep.
Now, globally, speaking of investing in public health, as of January twenty twenty three, only forty seven percent of World Health Organization member states have poison control centers, so it's a pretty low number. Most of the countries in Europe, Australia, the UK, they all have poison control centers, but especially in low and middle income countries. There's a lot of parts of the world where people just don't have access to this information, which is a huge issue.
Right well, and I think it just sort of shows in general that pattern where it's expensive to invest initially in poison control centers, but over the long run it saves money exactly. But if you don't have that initial investment and it's more like okay, well just triaging right the healthcare situation, then preventative stuff is like down the line, right, Yeah.
If you're so deep in survival mode you can't think, yeah that ony steps ahead. Yeah it's tough, but they're incredibly valuable. I also so that everyone can say they know exactly how to contact if you are exposed to a potential poison, or you're worried you are exposed to something has it is, you too can have the joy of calling your friendly neighborhood poison control center. The phone number is one eight hundred two to two one two two two, or you can go to poisonhelp dot org. And another plug for the incrediblepoisonhelp dot org webs site is that in twenty twenty two they updated this website. So in addition to you, if you don't want to talk on the phone, you are not into talking on the phone, A lot of people aren't into talking on the phone, you don't necessarily have to. You can through their website fill out this information. They ask you very specific questions and you essentially go through the same exact steps as you would talking to someone on the phone, which is great. But as of twenty twenty two, they also have an option where you can say that this is a test or an information call rather than an actual exposure, which I think is just really really helpful. If you're like kind of worried about something but you don't know if anyone is exposed, but you're just worried about bringing something into your house or whatever it is, you can go there and get some information. It's phenomenal.
M That's all I got.
Erin poison controls.
Wow, love them, love them. Are there poison control t shirts that we can.
You know what we should find out?
We should find it, get some but until then, until we can get our hands on a T shirt or make a T shirt or shirt, until then you can read more all about it. Specifically. Let me tell you where I got my information today. Saren already told you last week.
Unsurprisingly, almost entirely, my information was from the twenty twenty two Annual Report of the National Poison Data Systems or NPDS, from America's poison centers it was their fortieth annual report. It was really phenomenal. There is literally so much detail in this report, it's like it just keeps going on and on and on. But I also had a number of really interesting papers about the impact of poison centers, both historically and today. And then a list from the World Health Organization of a directory of poison centers which isn't entirely up to date but is really interesting. You can find the list of these sources from this episode and every single one of our episodes on our website This podcast will Kill You dot Com under the episodes tab.
Thank you again, so so much, doctor Doyon for taking the time to chat with us and sharing those amazing stories. We had the best time, we really really did.
And also thank you for being so enthusiastic and like sending more ideas and things that we have so many more things to cover. I am thrilled about it, yes, totally. Thank you also to Bloodmobile for providing the music for this episode and every one of our episodes.
Thank you to Tom Bryfocal and Leana Scuialacci for the amazing audio mixing.
We love it. Thank you to everyone at Exactly Right Network.
Thank you to you listeners for listening. I we really hope that you enjoyed these last two episodes and learned more and maybe if again. If you have a poison control story that you want to share, please send it our way.
Yeah, love to hear it. Thank you especially to our patrons, Thank you so much for supporting us on Patreon on We really appreciate it. It means the world to us. It really does.
Well. Until next time, wash your hands
You filthy animals.
