Alternative models for telephone response to pediatric poisonings

Poison Control Centers (PCCs) provide telephone consultations to manage poisonings. They are threatened with funding loss. Policy decision-makers have requested an evaluation of alternate models for telephone management of poisonings.

We examined the feasibility of alternative models for the telephone management of poisonings from the public.

Alternative models evaluated included emergency medical dispatchers (EMDs), advice nurses (RNs), and poison information providers (PIPs) to manage real and hypothetical poisonings with protocols or computerized references (Poisindex) with and without PCC backup.

EMDs and RNs with a structured protocol and access to a PCC specialist were able to manage a small subset of poisoning calls. EMDs and RNs managed 6% and 12% of poisoning calls respectively. Non-protocol management of hypothetical cases using Poisindex resulted in mismanagement of cases and longer periods of time to manage cases. PIPs within a PCC were able to manage a substantially greater proportion of calls, but had a significant portion of non-productive time waiting for a PCC call.

EMDs, RNs, and technician-level PIPs can manage a subset of poisoning cases using structured protocols. Alternative providers were dependent on PCC staff for consultation of the majority of poisoning calls. There are several obstacles to these models and their cost-effectiveness needs to be determined. These studies were the basis of a new staffing model with the integration of PIPs into the call response system in California.