Expert judgement of poisonings and human biomonitoring--the BfR three-level and matrix model

German physicians are obligated (Para 16e Chemicals Law) to submit essential data on poisonings to the Centre for Documentation and Assessment of Poisonings at the Federal Institute for Risk Assessment (Bundesinstituts für Risikobewertung, BfR). In addition, German poison centres are subjected to compulsory reporting of their findings of general importance gained in the context of their activities. The BfR assessment of poisonings has important significance for human case data collection, risk identification, and German toxicological monitoring. Using more than 60,000 reports on cases of poisoning, the BfR developed a structured expert judgement trial for poisonings. This judgement is based on a three-level model, accompanied by two different matrix procedures for an enhanced and more exact assessment of the exposures and the causality between health impairment and exposure. Particularly for low-dose exposures, human biomonitoring data is extremely valuable for the assessment process. Especially in chronic low-dose level exposures, the scientific assessment of related health impairments is often not possible without existing human biomonitoring data. For the future improvement of public health related to poisonings, ingestions by children, workplace chemical exposures, and incidents, we have to establish a nation-wide programme for monitoring human exposures which keeps pace with the progressive production of new chemicals. This must be done in close co-operation with physicians, poison centres, government safety organisations, and environmental health specialists and must be based on proven expert judgement tools and available human biomonitoring data.