Western Australian Poisons Information Centre

Annual Report 2012

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Table of Contents

1. Introduction ......................................................................................................... 2

2. Visitors and farewells ......................................................................................... 2

3. Talks ..................................................................................................................... 2

4. Radio interviews and other media ..................................................................... 2

5. Training ................................................................................................................ 2

6. Data Provisions ................................................................................................... 3

7. Staff ...................................................................................................................... 4

8. Call recording ...................................................................................................... 5

9. Phone call numbers and characteristics ........................................................... 5

(a) Table 1: Number of incoming phone calls by state of origin .............................. 5

(b) Graph 1: Monthly call volume 2012 ................................................................... 6

(c) Table 2: Incoming phone calls per category of caller ......................................... 7

(d) Table 3: Number of Cases, Incidents and Requests ......................................... 8

10. Case Statistics ................................................................................................... 9

(a) Table 4: Victims of poisoning............................................................................. 9

(b) Table 5: Initial severity – human cases ........................................................... 10

(c) Table 6: Human case numbers by gender ....................................................... 10

(d) Graph 2: Case number by age group .............................................................. 11

(e) Table 7: Routes of Exposure – human cases .................................................. 12

(f) Table 8: Circumstance of Exposure – human cases ........................................ 13

(g) Table 9: Location of exposure – human cases ................................................ 14

(h) Table 10: Number of human cases by location of treatment pre-inquiry ......... 15

(i) Table 11: Recommended treatment location of human cases where treatment pre-inquiry was the location of the poisoning ........................................................ 15

(j) Table 12: Top 20 agents – human cases ......................................................... 16

(k) Comments ....................................................................................................... 17

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1. Introduction

The Western Australian Poisons Information Centre (WAPIC) provides telephone consultation to the general public and medical professionals in cases of poisoning or suspected poisonings. The centre also provides advice on poisoning prevention, drug information, first-aid management of exposures and the identification of toxic agents. The WAPIC is located at Sir Charles Gairdner Hospital in Perth. It is closely associated with the hospital’s Emergency Department and the Western Australian Clinical Toxicology Group that is based at Sir Charles Gairdner and Royal Perth Hospitals. Complex cases (approximately 3 per day) are referred to the Toxicologist-on-call for the Western Australian Clinical Toxicology Group.

The WAPIC serves Western Australia, South Australia and the Northern Territory – a total population of 4.3 million. Operational hours: 08:00 to 22:00 h, seven days per week (WST). Out-of-hours Australia-wide overnight coverage is shared by the four Australian Poisons Information Centres (PICs), with the WAPIC working two overnights per week.

Access to the service is via the 13 11 26 phone number which is charged at the cost of a local call from any landline in Australia.

2. Visitors and farewells

Jennifer Malloy, a Poisons Specialist from the Maryland Poison Center, Baltimore, USA, visited in June and spent three days observing our centre.

In 2012 the WAPIC bid a reluctant farewell to Ray Thomas after nine years in The Centre. His great sense of humor and presence will be very much missed.

3. Talks

A-M Lynch “Unintentional Adult Poisonings” at the Injury Prevention Workshop: Adult Poisonings, June 11, 2012, St Catherine's College, The University of Western Australia.

On November 26, 2012, ICCWA and its partners on the Injury Prevention Summit Working Group hosted the Injury Prevention Summit at “The Rise” in Maylands funded by the WA Department of Health. This was attended by Nick Merwood, Christine Duncan and Ann-Maree Lynch who provided information on poisonings to the participants.

4. Radio interviews and other media

The West Australian Newspaper, Health and Medicine Section: case details of the 108 paediatric cases of ingestion or exploratory "tastes" of automatic dishwasher "tablets" recorded in 2012 provided by A-M Lynch.

5. Training

On-going training and education was provided through attendance of fortnightly case conferences held by the Clinical Toxicologists. In addition, a representative attended the bi-monthly national clinical meetings held at the NSWPIC. At these meetings, case presentations are made and consensual case management guidelines are formulated.

Clinical placement was provided for two, final year Curtin University, Bachelor of Pharmacy students and lectures were given to Curtin University, Post-graduate Diploma of Pharmacy students.

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6. Data Provisions

Public health reporting is a key function of the WAPIC. Over 2012, the WAPIC provided case data as follows:

1. Case details of cases involving prescription opioids (methadone, buprenorphine, oxycodone) and stimulants (methylphenidate, dexamphetamine) for the period November 2011 to October 2012 was provided to the Rocky Mountain Poison and Drug Center, Denver, Colorado, USA, as part of an international study investigating trends in prescription drug abuse.

2. Poisoning due to fungi ingestion: a retrospective study (2007-2012) of cases reported to Australian Poisons Information Centres. WAPIC data was provided to the study co-ordinators at Griffith University, Queensland.

3. Case details of reports made to the WAPIC January to May 2012 involving the agricultural chemical product, Trifluralin, supplied to the Australian Pesticides and Veterinary Medicines Authority, May 2012.

4. Case details of calls involving ingestion of energy drinks combined with alcohol for the period 2004-2010, was provided to WA Department of Health.

5. Cases involving ingestion of decongestant nasal and eye pharmaceuticals provided to the Commonwealth Therapeutic Goods Administration.

6. Case details involving exposures to Lye water in South Australia (January 2012 to December 2012) was provided to the SA Department of Health.

7. Cases details of carbon monoxide poisoning arising from charcoal briquettes (January 2008 to February 2012) provided to the Australian Competition and Consumer Commission.

8. Cases involving liquid laundry capsules provided to the Australian Competition and Consumer Commission, and the NSW Department of Health.

9. Case details of exposures to methanol including those involving home brewing (2007 to October 2012) supplied to SA Department of Health.

10. Cases involving exposures (all routes) to teeth whitening products 2005 to January 2012 supplied to the Australian Competition and Consumer Commission, Canberra.

11. Details of cases (01/01/2010 to 31/12/2012) involving infant colic mixtures prepared by compounding pharmacies supplied to the Victorian Health Department.

12. The most common agents involved in cases reported to the WAPIC in 2010; a report provided to the WA Heath Department.

13. Cases of supratherapeutic errors involving ibuprofen-containing products for the period 2010 to 2011 supplied to the Therapeutic Drugs Administration, Canberra.

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7. Staff

Medical Director

Dr Jason Armstrong, MBChB, FACEM

Administrative Director (Head of Department)

Dr Ann-Maree Lynch, BSc. (Hons) PhD

Specialists-Poison Information

Kasra Ahmadi, BSc., BPharm.

Klaus Auert, BPharm.

Dale Beecham, BPharm.

Tony Coltrona, BPharm.

Christine Duncan, RN MPharm, BSc.(Nursing), PGDip (Clin.Nsg, Crit. Care), Grad Cert. (Infection Control; Crit. Care).

Mechaiel Farag, BPharm., MPS, MSHP.

Teresa DiFranco, BSc., M.Pharm.

Donald Hulme, BSc., B.Pod., M.Pharm.

Bridgett McKay, B.Pharm.

Nick Merwood, BSc., MPharm.

Shirley Murphy, BPharm.

Yumi Tan, BPharm., Grad Dip Pharm.

Ray Thomas, BPharm.

Matt Veale, BPharm.

Medical Consultants

Dr Mark Monaghan, MBBS, FACEM

Dr Jason Armstrong, MBChB, FACEM

Dr Frank Daly, MBBS, FACEM

Dr David McCoubrie, MBBS, FACEM

Dr Ovidiu Pascu, MD, FACEM

Dr Jessamine Soderstrom, MBBS, FACEM, Grad Cert Tox.

Dr Kerry Hoggett, MBBS, FACEM, Grad Cert ClinTox.

Toxicology Fellows

Dr Alan Gault, MBChB, BAO, BA HSc., FACEM

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8. Call recording

Call details are entered directly into a computer database, the INTOX Data Management System which was developed by the International Programme on Chemical Safety and the World Health Organisation, Geneva, Switzerland and is maintained by the Canadian Centre for Occupational Health and Safety, Hamilton, Ontario.

9. Phone call numbers and characteristics

(a) Number of incoming phone calls by state of origin (Table 1)

(b) Monthly call volume (Graph 1)

(c) Incoming phone calls per category of caller (Table 2)

(d) Number of Cases, Incidents and Requests (Table 3)

(a) Table 1: Number of incoming phone calls by state of origin

Incoming phone calls Number %

Western Australia 19,451 51.7

South Australia 13,327 35.5

Northern Territory 1,439 3.8

New South Wales 1,542 4.1

Victoria 792 2.1

Queensland 854 2.3

Australian Capital Territory 67 < 1

Tasmania 71 < 1

Overseas 6 <1

Unknown/not recorded 40 < 1

TOTAL 37,589 100

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(b) Graph 1: Monthly call volume - 2012

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(c) Table 2: Incoming phone calls per category of caller

Caller category Number

Family member (unspecified) 1,912

Family member: Grandparent 424

Family member: Other 536

Family member: Parent 13,715

Family member: Partner/spouse 1,297

Victim/patient 6,651

Health personnel (unspecified) 112

Health personnel: Physician 4,998

Health personnel: Ambulance officer 396

Health personnel: Non-physician, medical 2,807

Health personnel: Veterinary personnel 578

Other personnel (unspecified) 100

Other personnel: Carer 2,304

Other personnel: Armed forces personnel 2

Other personnel: Police 61

Other personnel: Educational worker 151

Other personnel: Other Emergency services personnel 5

Other personnel: Social worker/Psychologist 97

Other 1,390

Unknown 53

37,589

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(d) Table 3: Number of Cases, Incidents and Requests

A total of 37,589 phone calls were handled by the WAPIC in 2012, of which 28,989 were cases of exposure. More than one phone call can be recorded for each Case, Incident and Request.

Call classification Number

Case 28,989

Request 6,713

Incident 11

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10. Case Statistics

(a) Victims of poisoning (Table 4)

(b) Initial severity – human cases (Table 5)

(c) Human case number by gender (Table 6)

(d) Case number by age group (Graph 2)

(e) Routes of exposure – human cases (Table 7)

(f) Circumstance of exposure – human cases (Table 8)

(g) Location of exposure – human cases (Table 9)

(h) Number of human cases by location of treatment pre-inquiry (Table 10)

(i) Recommended treatment location of human cases where treatment pre-inquiry was the location of the poisoning (Table 11)

(j) Top 20 agents – human cases (Table 12)

(k) Comments

(a) Table 4: Victims of poisoning

Species Number

Human 27,643

Dog 1,174

Cat 121

Bird 10

Other 41

TOTAL 28,989

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(b) Table 5: Initial severity – human cases

Severity Number

None 15,618

Minor 10,670

Moderate 1,051

Severe 185

Fatal 2

Unknown/ not recorded

117

TOTAL 27,643

Severity at the time of the initial call to the WAPIC and is scored as per the Poison Severity Score – Persson, H.E., Sjoberg, G.K., Haines, J.A. and Pronczuk de Garbino, J. (1998) Clinical Toxicology, 36(3): 205-213.

(c) Table 6: Human case numbers by gender

Gender Number

Male 13,130

Female 14,319

Unknown/not recorded 194

Total 27,643

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(d) Graph 2: Case number by age group

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(e) Table 7: Routes of Exposure – human cases

Routes Number %

Ingestion 21,700 67.8

Inhalation 1,421 4.4

Cutaneous 2,651 8.3

Ocular 1,715 5.4

Otic 22 < 1

Bite 1,198 3.7

Sting 420 1.3

Injection 276 < 1

Mucosal: buccal 2,372 7.4

Mucosal: nasal 84 < 1

Mucosal: rectal 3 < 1

Mucosal: unspecified 59 < 1

Other 12 < 1

Unknown/not recorded 49 < 1

TOTAL 31,984

Data is total number of exposure routes, not case number. Multiple routes of exposure were recorded in many cases.

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(f) Table 8: Circumstance of Exposure – human cases

Circumstance Number

Unintentional

Accidental 18,085

Occupational 513

Therapeutic error 3,378

Environmental 31

Misuse 87

Food poisoning 56

Other/Unknown 100

Intentional

Suicide 3,513

Misuse 135

Abuse 357

Malicious /criminal 73

Other/Unknown 138

Adverse reaction

Food 44

Drug 616

Other /Unknown 195

Other 21

Unknown 301

TOTAL 27,643

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(g) Table 9: Location of exposure – human cases

Location of exposure Number

Home and surroundings 25,221

Workplace

Workplace: Agricultural/horticultural workplace 113

Workplace: Factory 25

Workplace: Mine site 52

Workplace: Other 425

Medical – Hospital

Medical – Hospital: Inpatient facility 201

Medical – Hospital: Nursing Home/Hospice 328

Medical – Hospital: Other 15

Medical – non hospital 42

Enclosed public space

Enclosed public space: Shop 71

Enclosed public space: Leisure facility 16

Enclosed public space: Other 39

Prison 26

Mode of transport 74

Education Facility 222

Open space 364

Other 40

Unknown/not recorded 369

Total 27,643

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(h) Table 10: Number of human cases by location of treatment pre-inquiry

Location of pre-inquiry treatment

Number of cases

%

Location of poisoning 22,683 82.0

During transport 105 < 1

Community Health Centre 476 1.7

Hospital 4,281 15.5

Other 59 < 1

Unknown/not recorded 39 < 1

TOTAL 27,643

(i) Table 11: Recommended treatment location of human cases where treatment pre-inquiry was the location of the poisoning

Location of recommended treatment

Number of cases

%

Location of poisoning 17,675 77.9

Community Health Centre 892 3.9

Hospital 4,095 18.1

Other 20 < 1

Unknown/not recorded 1 < 1

TOTAL 22,683

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(j) Table 12: Top 20 agents – human cases

Substance Number

Paracetamol 2,025

Detergents and soaps - anionic non-ionic 1,384

Ethanol (non-beverage) 936

Ibuprofen 660

Miscellaneous low-toxicity product 492

Silica gel 470

Quetiapine 448

Hydrocarbons - unspecified 431

Pyrethrins/ Pyrethroids 419

Sodium hypochlorite 400

Spider - unidentified 391

Codeine phosphate 390

Diazepam 347

Emollients and protectives 341

Sodium carbonate 332

Detergents - cationic 312

Eucalyptus oil 299

Redback spider 279

Dibutylphalate 270

Ethanol - beverage 254

TOTAL 10,888

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(k) Comments

Our centre handled 27,643 cases of human exposures in 2012. A total of 30,759 agents (substances) were involved in these cases.

At the time of the phone call, 43% of the victims were either displaying clinical features or biochemical evidence of poisoning. Our centre does not routinely follow-up calls and so final severity is not known in the majority of cases.

Children were the victims in 52% of all cases, with toddlers (1 to 4 years old) involved in 39% of all reported exposures. The most common childhood exposures were accidental, occurred in the home and involved pharmaceuticals or common household products. Adults were the victims in 42% of cases. Forty percent of adult exposures resulted from unintentional accidents. A disturbing 20% increase in the number of cases of deliberate self poisoning was recorded in 2012 (3,513 cases) compared with 2,923 cases in 2011. The most common agents involved in suicide attempts were pharmaceuticals.

At the time of the phone call to the WAPIC, 82% of the victims were at the location of poisoning and 18% had either reached a health care facility or were in transit. It is noteworthy that 78% of the victims that were at the location of the exposure at the time the first phone call were able to be managed at that site due to the advice of the Poisons Centre; thus substantially limiting unnecessary hospital attendances and conferring considerable health care savings.

© 2012 Department of Health 2012