Upstate Poison Center - 2021 Annual Report

UPSTATE NEW YORK POISON CENTER

ANNUAL REPORT

2021

1957

65 YEARS

2022

1957

1

65 YEARS

UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

2022

OUR MISSION

OUR COMMITMENT

The Upstate New York Poison Center assists the

The Upstate New York Poison Center strives to

medical community and the general public with

provide the most current toxicology management

poison emergencies by providing state of the art

and prevention information to both the general

management expertise. Combining compassionate

public and health care community for the purpose

patient care, with education, research and

of reducing the number, the cost, and the severity

community outreach, the staff of the Upstate New

of poison exposures. The Poison Center staff

York Poison Center confirms its commitment to

provides telephone triage/case management

excellence through a dedication to wellness.

for poison exposures, 24 hours, 7 days a week, 365 days a year, to 54 counties, 125 hospitals with a population base of 7.4 million people. The clinical and education staff is committed to being the definitive toxicology resource within this catchment area.

2021 ANNUAL REPORT UPSTATEPOISON.ORG

2

CALL TYPE

Inf ormation Calls: 7 4 4 9

Conf irme d Non-Exposure s: 80 Animal Exposure s: 94

Human Exposure s: 4 2351

Human Exposures Information Calls

Animal Exposures

Confirmed Non-Exposures

MANAGEMENT SITE Unknown: 4 66 Othe r: 17 2 Re f use d: 4 7 2

Health Care Facility : 1254 2

Non-Health Care Facility : 28558

3

Non-Health Care UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

Health Care

Refused

Other

Unknown

ROUTE FOR EXPOSURE Inhalation/Nasal: 24 27 De rmal: 2530 Ocular: 17 80

Inge stion: 3597 5

Ingestion

Ocular

Dermal

Inhalation/Nasal

REASON FOR EXPOSURE Othe r: 153 Unknown: 37 5 Adve rse Re action: 84 0 Inte ntional: 837 2

Uninte ntional: 324 7 0

Unintentional

Intentional

Adverse Reaction

Unknown

Other 2021 ANNUAL REPORT UPSTATEPOISON.ORG

4

REASON FOR EXPOSURE

INTENTIONAL CALL VOLUME

UNINTENTIONAL CALL VOLUME •

•

77% of total call volume •

General

•

Suspected Suicide

•

Therapeutic Error

•

Misuse

•

Environmental

•

Abuse

•

Occupational

•

Unknown

•

Substance Misuse

•

Bite / Sting

•

Food Poisoning

•

Unknown

ADVERSE REACTIONS •

UNKNOWN / OTHER •

20% of total call volume

2% of total call volume •

Drugs

•

Food

•

Other

1% of total call volume

MEDICAL OUTCOME

Medical Outcome 25000

20000

15000

10000

5000

0

5

No Effect

Minor Effect

UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

Moderate Effect

Death

Unrelated

Unknown

CALL VOLUME RANKED BY COUNTY

County 1. Onondaga 2. Erie 3. Monroe 4. Albany 5. Orange 6. Oneida 7. Rockland 8. Broome 9. Dutchess 10. Saratoga 11. Niagara 12. Jefferson 13. Ulster 14. Rensselear 15. Schenectady 16. St Lawrence 17. Cayuga 18. Oswego 19. Tompkins 20. Chautauqua 21. Ontario 22. Otsego 23. Clinton 24. Genesee 25. Steuben 26. Chemung 27. Madison 28. Sullivan 29. Warren 30. Wayne 31. Cortland 32. Cattaraugus 33. Montgomery 34. Columbia 35. Schoharie 36. Chenango 37. Delaware 38. Franklin 39. Wyoming

40. Livingston 41. Herkimer 42. Washington 43. Putnam 44. Fulton 45. Essex 46. Allegany 47. Orleans 48. Greene 49. Tioga 50. Seneca 51. Schuyler 52. Lewis 53. Yates 54. Hamilton

HCF RANK BY TOP TEN MOST FREQUENT CALLERS 1. Upstate University Hospital 2. Erie County Medical Center 3. Rochester General Hospital 4. Garnet Health (Orange Regional Medical Center) 5. St Joseph Hospital Health Care 6. Samaritan Hospital 7. Oishei Children’s Hospital 8. Albany Medical Center 9. Binghamton General 10. Ellis Hospital

2021 ANNUAL REPORT UPSTATEPOISON.ORG

6

CASE ANALYSIS

MANAGEMENT SITE •

68% of the cases were managed at home

•

30% were managed in a health care facility

•

1% were lost to follow-up or refused referral

•

1% are other/unknown

•

Of the calls from 5 years of age and under: •

•

Of the calls from 6-12 years of age: 78% of these calls were managed at home

Of the calls from 13-19 years of age: •

29% of these calls were managed at home

BUSIEST MONTHS •

July

•

May

•

August

OUR CATCHMENT AREA 54 COUNTIES 125 HEALTH CARE FACILITIES 7.4 MILLION NYS CITIZENS

7

Managed on site (non-health care facility)

27 153

Patient was referred by PCC to a HCF

1363

Patient already in (enroute to) HCF when PCC called

4 57

Unknown

356

90% of these calls were managed at home

• •

Calls from own home, another home, public area, restaurant or school

UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

Other

41

0

5000

10000

15000

20000

25000

30000

*Our poison center kept 92.5% of those callers out of a health care setting.

SCOPE OF FUNCTION

PROVIDE TELEPHONE TRIAGE • • • •

Home Health Care Facility Schools Workplace

CASE MANAGEMENT • • •

Follow-up at home and at hospitals Evidenced based Clinical Toxicology consults provided on sick cases or as requested

SITUATIONAL AWARENESS • • • •

Instituted after September 11th Alerts Healthcare Providers, Health Departments, and public of unusual exposures Case information uploaded every 8 min to CDC Provide predictive analysis of data

SAFETY EDUCATION AND AWARENESS • • • •

PROFESSIONAL EDUCATION

Clinical Rotation Site for: • • • • •

Toxicology Teaching Days Toxicology presentations for health care professionals •

Sit on national, state, local committees Participate in local and state planning exercises Provide on-going Toxicology Consults

PUBLIC HEALTH PLANNING, RESPONSE AND MITIGATION • • • •

Medical Students Emergency Medicine Residents PharmD Residents PharmD Students Nursing Students

Webinars

DISASTER PLANNING, RESPONSE, AND MITIGATION • • •

Presentations Newsletters Public Health Collaborative Campaigns Social Media Plan

•

Variety of topics: • Drugs of Abuse • Cardiotoxic Agents • Antidepressants • Analgesic Overdoses • Toxic Alcohols • Deadly in a Single Dose Professional Conferences • ENA • NYS School Nurses

Identify, track and inform on drug trends Participate in ‘Flu on Call’ program Created awareness around COVID-19-related poisons Notify providers and public on product recalls

PUBLIC EDUCATION • • • • • •

Webinars for Health Educators in 54 counties ‘Train the trainer’ area-wide collaborations School Presentations on Drug Trends Law enforcement//Dept. of Corrections/911 Training Supervise/ Mentor MPH & Pharmacy students Collaborate with Health Departments on public forums

2021 ANNUAL REPORT UPSTATEPOISON.ORG

8

WEB SITE & SOCIAL MEDIA ANALYTICS

WEBSITE HIGHLIGHTS •

Pageviews = 26,264

FACEBOOK HIGHLIGHTS •

Total Page Followers = 579

•

Our fans = 79% women, age 35-44

TWITTER HIGHLIGHTS • •

Total Twitter Followers = 578 Best month = March with 34,500 Tweet Impressions

INSTAGRAM HIGHLIGHTS •

9

Total Instagram Followers = 175

UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

MEDIA INTERVIEWS • • • • • • • • • • • • • • • • • • • • • • • • • • •

CNYCentral (Syracuse) WSYR (Syracuse) WAER (CNY NPR) Syracuse.com NewsRadio 570 WSYR (Syracuse) Finger Lakes 1 Spectrum News Cortland Standard WKBW (Buffalo) WBFO (Buffalo NPR) WIVB (Buffalo) WBLK Radio (Buffalo) WKBW (Buffalo) Democrat & Chronicle (Rochester) WUHF (Rochester) WUHF (Rochester) WHEC (Rochester) WROC (Rochester) WRVO (Oswego NPR) Olean Times WTEN (Albany) Epoch Times (NYC) NBC (NYC) New York Times (NYC) Yahoo News Staten Island Advance Putnam County Courier

ORGANIZATIONAL INITIATIVES

PROFESSIONAL EDUCATION:

PUBLIC EDUCATION/AWARENESS:

•

Medical and Clinical Toxicology Fellowships

•

Upstate Public Health Masters Program

•

Toxicology Education

•

Health Links

•

Department of Emergency Medicine

•

OASIS Education Programs

•

School of Medicine

•

Department of Medicine

COMMITTEES:

•

Toxicology Teaching Day

Representation on

•

Grand Rounds

•

SafeKids Upstate NY Coalition

•

Nursing Grand Rounds

•

Emergency Medicine Quality and Patient Safety

•

School of Public Health

•

Substance Abuse Disorder Committee

Clinical Rotation Site for the

•

Shared Governance Committee

•

9

•

Department of Emergency Medicine

•

College of Medicine Students

•

College of Nursing Students •

Upstate

•

Le Moyne College

•

SUNY Delhi

•

PharmD Residents

•

PharmD Students

•

Paramedic Students

LOCAL INITIATIVES • •

• •

Onondaga County Drug Taskforce Combined Toxicology Grand Rounds: Collaboration with Onondaga County Medical Examiners Office and Toxicology Lab Onondaga County Emergency Preparedness Committee SNADD Drug Disposal Program

2021 ANNUAL REPORT UPSTATEPOISON.ORG

10

LOCAL INITIATIVES

• • • •

LOCAL INITIATIVES • •

• •

Onondaga County Drug Taskforce Combined Toxicology Grand Rounds: Collaboration with Onondaga County Medical Examiners Office and Toxicology Lab Onondaga County Emergency Preparedness Committee SNADD Drug Disposal Program

COLLABORATIONS AND PARTNERSHIPS • • • • • • • • • • • • • • • • • •

Mental Health Fire Prevention Employee Assistance Program Parent Teacher Associations Schools of Pharmacy Hospital Pharmacies Chain and Independent Pharmacies Service Organizations Energy Plants Office of the Aging Senior Programs Rural Health Networks Higher Education Treatment Centers Native American Health Centers Community Health Centers Fed. Qualified Health Centers Head Starts/Day Care Centers

SPECIFIC COLLABORATIONS AND PARTNERSHIPS • • •

11

NYS Drug Task Forces NYS School Nurses Association Local and regional school districts • Ballston Spa Central School District • Cato-Meridian Central School District • Skaneateles Central School District • Poland Central School District • Oswego Central School District • Little Falls Central School District • Syracuse City School District

UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Vernon-Verona-Sherrill Central School District Clinton Central School District Whitesboro Central School District OCM BOCES and Cortland BOCES - Pharmacy Tech and Medical Assistant Programs Onondaga County Sheriff’s Department Onondaga County Health Department Syracuse City Police Department Syracuse Fire Department Peace Incorporated Upstate Medical University Department of Pharmacy New York City Poison Control Center SUNY Buffalo School of Pharmacy Central Region Prevention Resource Center Oswego County Prevention Coalition Cayuga County Drug Free Community Coalition Bridges Madison County Conifer Park Central Region Addiction Resource Center Center for Family Life and Recovery VOW Foundation of Oswego County Oswego County 911 Exelon Generation Winds of Agape Central New York Alcohol & Drug Association OASIS Madison County Childcare Arnot Ogden Auxiliary Group Safe Kids Upstate New York Syracuse University Falk College Upstate Medical University MPH Program Kinney Drugs, Inc. Nascentia Health McMahon Ryan Advocacy Center

10

STATEWIDE INITIATIVES

NATIONWIDE INITIATIVES

DATA COLLECTION AND SHARING

TOXICOSURVEILLANCE IN PARTNERSHIP

• • • • • • • • •

Media throughout 54 counties 54 county Departments of Health The United States Drug Enforcement Agency (DEA) The New York State Intelligence Center The Office of the Governor The New York State Department of Health The New York/New Jersey High Intensity Drug Tracking Areas (HIDTA) The New York State Department of Environmental and Occupational Health Local, State & National Policy Makers/Leaders

WITH THE CDC •

REPRESENTATION ON • •

COMMITTEES •

New York State Public Health Association Board of Directors

PUBLIC EDUCATION • • • • • •

Poison Prevention Presentations for 54 County Health Department Educators Poison Prevention Train the Trainer Programs Heath Fairs 15 Heath Fairs Poison Prevention Programs for Seniors Poison Prevention Programs for the Refugee Population

PROFESSIONAL EDUCATION PRESENTATIONS FOR • • • • • • • • • • • •

11

Upstate New York Poison Center Toxicology ECHO series University of Buffalo Department of Emergency Medicine University of Buffalo School of Pharmacy Utica College Hospital In-services Public Health Webinars Nursing Grand Rounds Medical Grand rounds New York State Fire Academy Conference NYS Emergency Nurses Association state and regional conferences Western New York Nursing Symposium Department of Health Presentations

Situational awareness around exposure trends and unusual occurrences to health care providers, law enforcement, policy makers, governmental agencies, public health professionals and the general public

• • • •

American Association/CDC Toxicosurveillance Team American Association of Poison Control Centers • Directors Committee • SPI Committee • Accreditation Committee • Public Health Committee • Public Education Committee • PoisonHelp.org Committee CDC’s Poison Control and Public Health Community of Practice Leadership Committee American College of Medical Toxicology American Board of Applied Toxicology American Academy of Clinical Toxicology

PRESENTATIONS FOR • • • • •

AACT National Webinar Series North American Congress Clinical Toxicology Annual Meeting NACCT Conference, presenter AAPPC Annual Conference American College of Medical Toxicology Annual Scientific Meeting

2021 ANNUAL REPORT UPSTATEPOISON.ORG

12

TOP EXPOSURE AGENTS BY GENERIC CATEGORIES

CHILDREN 5 YEARS OF AGE AND UNDER 1. Personal Care Products 2. Household cleaning substances 3. Analgesics 4. Foreign Bodies including toys 5. Dietary Supplements/Herbals 6. Vitamins 7. Topical Preparations 8. Plants 9. Antihistamines 10. Pesticides

CHILDREN 6 TO 19 YEARS OF AGE 1. Analgesics 2. Antidepressants

EMERGING DRUGS OF ABUSE

3. Antihistamines

Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,277

4. Stimulants and Street Drugs

Opioid Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .787

5. Sedatives

E-cigs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280

6. Personal Care Products 7. Cardiovascular Drugs 8. Household Cleaning Products 9. Foreign Bodies 10. Dietary Supplements/herbal medications

Stimulants and Street Drugs . . . . . . . . . . . . . . . . . . 1,298 Kratom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Methamphetamine . . . . . . . . . . . . . . . . . . . . . . . . . 48 Methylphenidate . . . . . . . . . . . . . . . . . . . . . . . . . . .248 LSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Hallucinogenic Amphetamine . . . . . . . . . . . . . . . . . . 16

ADULTS 20 YEARS OLD AND OVER 1. Analgesics

Cocaine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 Cannabinoids and Analogs . . . . . . . . . . . . . . . . . . . .347

2. Sedative Hypnotics 3. Antidepressants 4. Cardiovascular drugs 5. Cleaning Products 6. Alcohols 7. Anticonvulsants 8. Personal Care Products 9. Stimulants and Street Drugs 10. Antihistimines

13

UPSTATE NEW YORK POISON CENTER UPSTATEPOISON.ORG

12

PUBLICATIONS

Experience with lower dose flumazenil at an academic medical center.

Schult RF, Omar D, Wiegand TJ, Gordetsky RM, Acquisto NM. Am J Emerg Med. 2021 Feb 5:S0735-6757(21)00107-8. doi: 10.1016/j.ajem.2021.02.002.

Online ahead of print. PMID: 33581937 Emergency Medicine Intern Education for Best Practices in Opioid Prescribing. Lowy R, Bodkin RP, Schult R, McCann M, Jones CMC, Acquisto NM. West J Emerg Med. 2020 Dec 16;22(2):297-300. doi: 10.5811/ westjem.2020.9.48808.PMID: 33856315 Pilot RCT of the Attempted Suicide Short Intervention Program (ASSIP) adapted for rapid delivery duringhospitalization to adult suicide attempt patients with substance use problems. Conner KR, Kearns JC, Esposito EC, Pizzarello E, Wiegand TJ, Britton PC, Michel K, Gysin-Maillart AC, Goldston DB.Gen Hosp Psychiatry. 2021 Jul 19;72:66-72. doi: 10.1016/j. genhosppsych.2021.07.002. Online ahead of print. PMID: 34304029 Descriptive Analysis of Inpatient and Outpatient Cohorts Seeking Treatment After Prescription Opioid Misuse and Medical Toxicology Evaluation. Varney SM, Wiegand TJ, Wax PM, Brent J; Toxicology Investigators Consortium. J Med Toxicol. 2021 Aug 16. Doi: 10.1007/s13181021-00850-7. Online ahead of print.PMID: 34402039 The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome. Zekhtser M, Carroll E, Boyd M, Ambati S. Case Rep Crit Care. 2021 Aug 28;2021:7590960. doi: 10.1155/2021/7590960. eCollection 2021. PMID: 34497728 ACMT Position Statement: Allow Optimal Treatment for Healthcare Professionals with Opioid Use Disorder. Marino RT, Spyres M, Wiegand TJ, Babu KM, Stolbach A. J Med Toxicol. 2021 Oct 25. doi: 10.1007/s13181-02100861-4. Online ahead of print. PMID: 34697778 Evaluation of high-dose insulin/euglycemia therapy for suspected β-blocker or calcium channel blocker overdose following guideline implementation. Schult RF, Nacca N, Grannell TL, Jorgensen RM, Acquisto NM. Am J Health Syst Pharm. 2021 Nov 19:zxab439. doi: 10.1093/ajhp/ zxab439. Online ahead of print. PMID: 34957477 Second Degree Burns and Systemic Toxicity After Topical Cantharidin Use. Calleo V, Marraffa JM, Stork CM. JMT 2021 Rare Mushroom Toxicity in Upstate New York: Two Cases of Unintentional Lepiota subincarnata Ingestion. Calleo V, Wang T, Marraffa JM, Hodge K. JMT 2021 Late-onset of ornithine transcarbamylase deficiency: A rare medical examiner case. Journal of forensic sciences. Gitto, L., Fuller, C. E., Calleo, V. J., Tawil, M., Thach, R., & Revercomb, C. (2021)

13

2021 ANNUAL REPORT UPSTATEPOISON.ORG

14

1957

65 YEARS

2022