Poison Control Program

Authorizing Legislation: Section 1271-1273 of the Public Health Service Act, (42 U.S.C. 300d – 71), as amended by the Poison Control Center Enhancement and Awareness Act of 2003.

Program Description and Accomplishments
The Poison Control Center Enhancement and Awareness Act (P.L. 106-174) was enacted in February 2000 to provide a source of supplemental support to Poison Control Centers (PCCs) and was amended and reauthorized in December 2003 (P.L. 108-194). The purpose of the Act is to (1) implement and manage a national toll free poison hotline (1-800-222-1222) to access the nations 61 poison control centers, (2) implement a national media campaign to educate the public and health care providers about the national toll-free hotline, poison prevention and the availability of poison control resources in local communities, and (3) support efforts made by PCCs to stabilize their funding structure and improve or increase accessibility to poison prevention and control services.

The Poison Control Centers Stabilization and Enhancement Grant Program’s purpose is to support efforts by PCCs to stabilize their funding structure and improve or increase accessibility to poison prevention and control programs and services. The purpose of the certification grant program is to assist non-certified centers in achieving certification thereby enhancing the quality of poison control services available to the public. Fifty-eight (58) of the 61 poison control centers are now certified, making 95 percent of poison control centers certified. This is up from 78 percent in 2001. All grantees continue to implement financial stability activities, such as strategic planning, staff retention strategies and financial planning initiatives.

PCCs are our Nation’s primary defense against injury and death from poisonings. Approximately two and a half million poisonings are reported annually to the 61 PCCs across the country. Unintentional poisoning deaths are a leading cause of injury death for adults. Center for Disease Control and Prevention (CDC) analysis of 1999-2004 injury data show that increases in deaths among 20-29 and 45-54 year olds contribute to the first overall increases in years and that unintentional poisoning deaths accounted for more than 50 percent of the increase in each of these age groups. The increase in prescription drug abuse is considered a major risk factor contributing to these deaths.

Over half (52 percent) of poisonings occur to children younger than age five and over 70 percent of poisoning exposures can be treated over the phone with guidance from poison control centers’ trained healthcare professionals (nurses, pharmacists and certified specialists in poison information). Ready access to poison control services has been proven to reduce severity of illness, death, and health care costs. According to 2005 data from the American Association of Poison Control Centers, 72.5 percent of all human exposure calls (2.4 million) to poison centers were able to be managed on-site, avoiding unnecessary visits to healthcare facilities. With an average emergency room visit costing $560, poison center calls potentially saved almost $1 billion in annual medical expenses.

One of the performance measures for the program is to increase the percent of inbound volume on the toll-free number. The program has exceeded its goal each year since the baseline year in 2003. In 2007, 66 percent of the total calls to poison control centers were received on the national toll-free number. The 2007 figure rose 8.5 percentage points from 2006 (57.5 percent) and exceeded the 2007 performance goal by 2.7 percentage points.

A second performance measure for the program is to increase the number of PCCs with 24-hour bilingual staff. The number of PCCs with bilingual staff has remained unchanged, at four, since 2004. The program does not require hiring of specific personnel within poison centers; however the program has implemented key activities in support of addressing bilingual needs. In 2005, the program hosted a diversity forum to examine the issues surrounding the accessibility of poison control center services to diverse populations and to develop recommendations for improving these services and for increasing the availability of bilingual resources. This report was distributed to all of the PCCs. In addition, since September of 2006, HRSA has provided translation services under contract to all 61 PCCs through a service called Language Line. Language Line provides translation services in 161 languages thereby providing a cost effective means for all PCCs to offer 24-hour bilingual services. About a quarter of the poison centers are currently using the service supported by HRSA, with Spanish being the most requested language. Several other poison centers have continued to utilize translation services offered through their host institutions.

A third performance measure relates to the development and ratification of uniform and evidence-based guidelines for the treatment of poisonings. The program supported the development of uniform, evidence-based guidelines to assist PCCs in managing patient’s care out-of-the hospital. Seventeen (17) uniform guidelines have been developed, with one focusing on the treatment of 35 non-toxic substances and 16 for the treatment of toxic substances. While 17 is one less than the 2007 goal of 18, the program considers this a success because of the extensive work required to develop a guideline. All of the guidelines have been reproduced and distributed to the poison centers and are available on the HHS National Guideline Clearinghouse website. An evaluation on the usefulness of the guidelines is currently being conducted and expected to be completed in September 2008.

The Poison Control Program was reviewed using the Program Assessment Rating Tool (PART) in 2004 and was given a rating of Adequate. The assessment noted that the program has made progress toward stabilizing poison control centers and also showed progress toward its long-term goal of reducing emergency room visits due to poisoning. In connection with the PART assessment, the program is collecting data from program partners on new performance measures and assisting grantees with implementing and reporting on initiatives to address financial stability. Specifically, since 2003, through the program technical assistance contract, the program has assisted grantees with developing strategic plans, tapping into sources of funding, outside of federal grants, and beginning May 2006 has been offering PCCs financial planning services. For FY 2007, new program guidance was developed requiring grantees to include a plan for active and effective use of funds to achieve long-term financial stability, as well as using evaluation techniques to measure progress. Also, in April 2007, HRSA hosted a Financial Stability Workgroup made up of PCC leaders, to discuss options for achieving financial stability. A report of workgroup outcomes and action plans was developed and distributed to all grantees.

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

Budget Request
The FY 2009 Request of $10,000,000 is a decrease of $16,528,000 from the FY 2008 Enacted level. Poison Control Center grants have largely accomplished their original purpose of stabilizing funding for these centers as HHS funding now represents only 8 percent of total financing for PCC operations, compared with 19 percent in recent years. Ninety-five percent of poison control center are now certified, up from 78 percent in 2001. Many centers have implemented strategic planning initiatives and increased access to services. In FY 2009, the program proposes continuing to assist centers in their efforts to achieve financial stability, increase access to services, and achieve certification. HRSA will also use funding to support and promote the national toll-free number and language line services for non-English speaking callers. The following activities will be supported with the requested funding:

Stabilization and Enhancement Grant Program, Stabilization and Certification Grants ($8.9 million): Grant funds will continue to be utilized to conduct limited scope efforts toward meeting grant goals in relation to stabilizing their funding structure and improve or increase accessibility to poison prevention and control programs and services.

National Toll-Free Hotline Services and Promotion of Number ($0.70 million): Ensuring access to poison control centers through the national toll-free hotline is a critical public health service that improves the quality of healthcare. Funding will also be used to support Language Line services for non-English speaking callers and for continued promotion of the national toll-free number. The FY 2009 target is to increase the percent of all calls coming into the PCCs using the toll-free number to 69.3 percent.

Technical Assistance (TA) to Poison Control Centers ($ 0.4 million): TA to PCCs will continue in an effort to carry out the objectives of the PCP authorizing legislation. Continued activities will include strategic and financial planning assistance, marketing services, infrastructure development assistance and data analysis.

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