Chapter 3701-41 Poison Control, Prevention, and Treatment

3701-41-01 Definitions.

As used in this chapter:

(A) "Director" means the director of health or an official or employee of the department of health who has been authorized by the director.

(B) "Entity" means an individual, hospital, institution of higher education, political subdivision, association, corporation, or public or private agency.

(C) "Poison prevention and treatment center" or "center" means an entity designated as a poison prevention and treatment center by the director under section 3701.20 of the Revised Code and rule 3701-41-02 of the Administrative Code. In the appropriate context,"poison prevention and treatment center" and "center" also mean an applicant for designation as a poison prevention and treatment center.

R.C. 119.032 review dates: 07/10/2014 and 07/01/2019
Promulgated Under: 119.03
Statutory Authority: 3701.20
Rule Amplifies: 3701.19 , 3701.20 , 3701.201
Prior Effective Dates: 3/29/1990 (Emer.), 9/16/90

3701-41-02 Designation of poison control network regions and poison prevention and treatment centers.

(A) For the purposes of this chapter, the director shall designate poison control network regions. In determining which geographic areas to designate as poison control network regions, the director shall consider:

(1) The groups of counties specified in paragraph (B) of this rule. The director may designate as regions areas larger or smaller than the groups of counties specified in paragraph (B) of this rule, but no region may have a population of less than one million;

(2) Which configuration of counties will minimize duplication and waste while assuring appropriate poison prevention and treatment services for the population of each region; and

(3) Any comments or suggestions provided by entities interested in poison prevention and treatment.

(B) For the purposes of designating poison control network regions under paragraph (A) of this rule, the director shall consider the following groups of counties:

(1) Allen, Hancock, Lucas, Sandusky, Auglaize, Hardin, Mercer, Seneca, Defiance, Henry, Ottawa, Van Wert, Erie, Huron, Paulding, Williams, Fulton, Logan, Putnam and Wood.

(2) Cuyahoga, Lorain, Geauga, Medina and Lake.

(3) Ashland, Crawford, Richland, Tuscarawas, Ashtabula, Holmes, Stark, Wayne, Carroll, Mahoning, Summit, Columbiana, Portage and Trumbull.

(4) Champaign, Miami, Clark, Montgomery, Darke, Preble, Greene and Shelby.

(5) Athens, Harrison, Meigs, Ross, Belmont, Hocking, Monroe, Scioto, Coshocton, Jackson, Morgan, Union, Delaware, Jefferson, Morrow, Vinton, Fairfield, Knox, Muskingum, Washington, Fayette, Lawrence, Noble, Wyandot, Franklin, Licking, Perry, Gallia, Madison, Pickaway, Guernsey, Marion and Pike.

(6) Adams, Clinton, Brown, Hamilton, Butler, Highland, Clermont and Warren.

(C) The director shall designate poison prevention and treatment centers within each region designated under paragraph (A) of this rule. The director may designate more than one center in a region.

(1) Any entity seeking designation as a poison prevention and treatment center shall apply in writing and shall provide the following information:

(a) The name and address of the applicant, its medical director and its project director;

(b) A description of the scope of poison prevention and treatment services provided by the applicant, directly and through contract;

(c) A description of the applicant's experience in providing poison prevention and treatment services;

(d) A description of the specific population and target area that the applicant intends to serve; and

(e) Documentation of compliance with section 3701.20 of the Revised Code and with this rule and rules 3701-41-03 and 3701-41-04 of the Administrative Code.

(2) Applications for designation may be submitted at any time.

(3) The director may request additional information necessary to review an application for designation as a poison prevention and treatment center and the applicant shall provide the requested information within the time specified by the director.

(4) The director shall provide written notice of decisions concerning applications for designation by certified mail.

(D) To be eligible for designation as a poison prevention and treatment center and to retain designation, a center must maintain compliance with the standards established by this rule and rules 3701-41-03 and 3701-41-04 of the Administrative Code.

(1) Each applicant shall document compliance with the applicable standards. If the applicant proposes to provide poison prevention and treatment services by means of contracts with one or more other entities, the applicant shall document that the services provided through contract will comply with the standards established by rules 3701-41-03 and 3701-41-04 of the Administrative Code.

(2) Each applicant shall demonstrate that it has the capacity to provide poison prevention and treatment services to the entire region or that it has established or will establish arrangements to provide services to the entire region through collaborative efforts with other centers within or outside the region. An applicant may propose to provide services to areas not included within the region for which the applicant has requested designation.

(E) In addition to submission of the annual report required by paragraph (C) of rule 3701-41-04 of the Administrative Code, each entity operating a poison prevention and treatment center shall:

(1) Notify the director promptly of any changes in the information included in its application for designation or in a grant application filed under rule 3701-41-05 of the Administrative Code;

(2) Provide the director, upon request, with any documents or materials necessary to verify compliance with section 3701.20 of the Revised Code and this chapter; and

(3) Allow the director access to its premises and records, including but not limited to the documentation prepared under rule 3701-41-04 of the Administrative Code, for the purpose of verifying compliance with section 3701.20 of the Revised Code and this chapter. The director shall make a site visit to each center at least annually and more often if the director considers it to be necessary.

(F) The director may revoke the designation of a poison prevention and treatment center or deny an application for designation if the center or applicant fails to comply with this rule or fails to meet or maintain compliance with the standards established by rules 3701-41-03 and 3701-41-04 of the Administrative Code. The notice of the denial or revocation provided under paragraph (C)(4) of this rule shall contain the reasons for the denial or revocation. The center may have the revocation or denial reconsidered in accordance with rule 3701-41-06 of the Administrative Code.

R.C. 119.032 review dates: 07/10/2014 and 07/01/2019
Promulgated Under: 119.03
Statutory Authority: 3701.20
Rule Amplifies: 3701.19 , 3701.20 , 3701.201
Prior Effective Dates: 3/29/1990 (Emer.), 9/16/90

3701-41-03 Standards for operation of poison prevention and treatment centers.

(A) To be designated as a poison prevention and treatment center under rule 3701-41-02 of the Administrative Code and to maintain the designation, a center shall conform to the standards of operation prescribed by this rule. A center may provide the services described in paragraphs (B) and (C) of this rule either directly or through contract with other entities, as the director considers appropriate.

(B) Each center shall maintain and staff a twenty-four-hour per day, toll-free telephone line to respond to inquiries and provide information about poison prevention and treatment and available services. A center may satisfy the requirement that the telephone line be toll-free either by maintaining a "1-800" number or accepting collect calls from within its region.

(C) Each center shall provide specialized treatment, consultation, information and educational programs to health care professionals and the public.

(D) Each center shall compile information on the types and frequency of treatment it provides.

(E) Each center shall have the following personnel, either on staff or by means of a contract with another entity:

(1) A medical director who:

(a) Is a physician licensed under Chapter 4731. of the Revised Code and board-certified or equivalently qualified in medical toxicology, internal medicine, pediatrics, family medicine or emergency medicine;

(b) Has ongoing interest and expertise in toxicology as evidenced by publications, research and meeting attendance;

(c) Has a medical staff appointment at a hospital providing poison treatment services;

(d) Is involved in the management of poisoned patients; and

(e) Assures that when he or she is not available to the center, qualified medical toxicology expertise is provided to the center by other physicians at all times.

(2) A managing director who has had substantial involvement in the operations of an entity providing services similar to those provided by poison prevention and treatment centers, including involvement in the areas of clinical toxicology, education and administration;

(3) Providers of poison information who:

(a) Are registered nurses licensed to practice nursing as a registered nurse under Chapter 4723. of the Revised Code, pharmacists licensed under Chapter 4729. of the Revised Code, physicians licensed under Chapter 4731. of the Revised Code or individuals currently certified by the "American Association of Poison Control Centers" as specialists in poison information. The center may use other individuals as providers of poison information upon a determination by the director of health that the center has documented that the individual possesses appropriate equivalent qualifications and training and that the medical director has approved of the use of the individual as a provider of poison information;

(b) Are capable of comprehending and interpreting standard poison information resources and of transmitting that information in a logical, concise and understandable way to both health professionals and the public; and

(c) Either are dedicated fully to poison prevention and treatment center activities during periods when they are assigned to the center or perform only those other duties that do not interfere with center activities;

(4) Administrative personnel who are qualified by training or experience to supervise finances, operations, personnel, data analysis and other administrative functions of the center. The administrative personnel may be on the staff of a parent entity of which the center is a part;

(5) Education personnel who are qualified by training or experience to provide, under the supervision of the medical director, educational lectures or materials to health professionals; and

(6) Education personnel who are qualified by training or experience to provide public-oriented presentations on poison prevention and treatment center awareness, poison prevention and first aid for poisoning. These individuals shall be capable of providing verbal presentations to public audiences and shall have sufficient understanding of the material to answer questions from members of the public accurately.

Nothing in this paragraph precludes staff members of a poison prevention and treatment center from serving a center in more than one of the capacities listed by this paragraph.

(F) Each center shall maintain a list of consultants who are qualified by training or experience to provide specialized toxicology or patient care information in their areas of expertise. The center shall document that these consultants have made an expressed commitment to provide consultation services on an on-call, as-needed basis. The list of consultants shall be consistent with the type of poisonings encountered in the area served by the center. Nothing in this paragraph shall be interpreted to prohibit consultants from charging fees to centers or callers for the provision of specialized expertise and consultation.

(G) Each center shall take measures to ensure the confidentiality of information about individuals to whom treatment or services are provided. These measures shall include but are not limited to:

(1) Assuring that only authorized persons are allowed in the area or room that is used to store records of persons receiving services from the center;

(2) Providing security measures to prevent inadvertent or unauthorized access to any case records containing sufficient information to identify the individual receiving services that are maintained in electronic or automated information systems; and

(3) Otherwise maintaining records according to procedures established by any applicable state or federal law.

(H) Each center shall develop and maintain on the premises of the center a written manual of policies and procedures that shall include, at a minimum, the following:

(1) A description of when the poison information providers are to contact the medical director or other on-call consultants;

(2) Descriptions of when first aid procedures are to be recommended to callers and of how the procedures are to be performed;

(3) A description of how callers are to be assigned priority for medical treatment or consultation, which may include a list, if applicable, of common substances with guidelines for when home and hospital management are appropriate;

(4) Guidelines for follow-up calls to patients managed at home or referred to a health care provider to determine case outcome;

(5) Procedure for handling information calls, animal exposure calls and human exposure calls;

(6) A schedule for reviewing and updating all protocols, policies and procedures; and

(7) A procedure for storing, processing, indexing, retrieving and destroying the center's medical and other case records.

(I) The center shall maintain on file a current table of organization that shall display, at a minimum, the following:

(1) All operating units of the entity involved in providing poison prevention and treatment services and all entities providing services for the center through contract and their interrelationships;

(2) Lines of responsibility and function for all administrative and service personnel of the center; and

(3) Any advisory boards, committees or similar bodies for the center.

(J) Each center shall maintain a written quality assurance plan which identifies an individual or individuals responsible for implementation of the plan and collection of necessary information. The center shall take and document corrective actions to improve service delivery as needed, based on its monitoring and evaluation under the quality assurance plan.

R.C. 119.032 review dates: 07/10/2009 and 07/10/2014

Promulgated Under: 119.03

Statutory Authority: 3701.20

Rule Amplifies: 3701.19 , 3701.20 , 3701.201

Prior Effective Dates: 3/29/1990 (Emer.), 9/16/90

3701-41-04 Maintenance and reporting of data.

(A) To be designated as a poison prevention and treatment center under rule 3701-41-02 of the Administrative Code and to retain the designation, a center or an applicant for designation as a center shall maintain and report data in accordance with this rule.

(B) Each center shall use all of the data elements and the procedures for recording those elements set forth in the appendix to this rule, "Instructions for the American Association of Poison Control Centers National Data Collection System" to document human and animal exposure calls. Centers may elect to use the same or other elements for documenting poison prevention and poison information cases. Within six months after the effective date of this rule, each center shall implement a uniform system for documenting the county of origin of calls that has been developed in conjunction with all other poison prevention and treatment centers in Ohio and the director. Nothing in this paragraph or the appendix to this rule shall be construed to prohibit data entry by techniques other than bubble coding for optical scanning.

(C) Each center shall submit a report to the director on a form prescribed by the director no later than September first of each year for the previous calendar year. At a minimum, the annual report shall include:

(1) Data reported by county regarding the incidence of both human exposure to poison and other cases handled;

(2) The incidence of each reason for exposure as defined in the appendix to this rule;

(3) The percentage of accidental exposure cases managed over the telephone as compared to the percentage referred for medical treatment; and

(4) The percentage of intentional exposure cases managed over the telephone as compared to the percentage referred for medical, psychiatric or other treatment or management.

Appendix A

NATIONAL CAPITAL POISON CENTER

GEORGETOWN UNIVERSITY HOSPITAL

3800 RESERVOIR ROAD, N.W.

WASHINGTON, D.C. 20007

Figure: Logo

For Logo -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us.

April 19, 1988

Dear AAPCC Data Collection Participants:

The enclosed pages in your AAPCC Data Collection Manual have been revised based on decisions made at the March 10-11 AAPCC Mid-year Board of Directors Meeting. Please insert these revised pages in your data collection manual and discard the old pages. A summary of the changes is provided below for your convenience:

1 PLEASE make sure your entire staff has reviewed and is using the CURRENT data collection manual which was sent to your center on December 15, 1987 and is labelled "effective January 1, 1988". There were significant changes in definitions of fields and requirements for participants incorporated in this manual.

2 Programs to scan the AAPCC data collection form are now available at no charge, and can be obtained from my office (National Capital Poison Center).

3 Center quality factors have demonstrated remarkable improvement over the years. In 1987, 42 of the 64 centers submitting data had a quality factor over 0.95 ; 54/64 had a quality factor over 0.90 ; and 58/64 had a quality factor over 0.80. Data submitted in 1988 and thereafter must have a quality factor of 0.80 or better to be included in the National Database. Centers with a quality factor less than 0.80 may still have their data processed by Micromedex for individual center reports, but will not be considered a participating center, and will not receive the rights, privileges, or reimbursements of participating centers.

4 Now that we have "cleaned up" our database from the perspective of completeness, we are obliged to assess the accuracy of the coded data. To accomplish this evaluation, AAPCC now requires all data collection participants to pull and submit copies of the medical record portion of 24 randomly selected cases within four weeks of the request for these records. This audit will be conducted annually (each spring), and will involve selected cases from the fourth quarter of the previous year. Centers concerned about medical record confidentiality may obscure patient identifying data on the chart prior to submitting the record. If you participated in the 1987 National Data Collection System, this list of cases is attached. Please pull the cases listed and send xerox copies (NOT ORIGINAL CHARTS) to the address below by May 25, 1988:

National Capital Poison Center

Georgetown University Hospital

3800 Reservoir Road, NW

Washington, DC 20007

Note that failure to submit these requested cases on time will compromise your center's status as a participant in the 1987 AAPCC Data Collection System. Submitted medical records will be compared with the computerized data, and an accuracy monitoring system will be developed and implemented. Feedback will be provided to each center. For 1987 data, the only requirement will be that you submit the cases on time (by May 25). In subsequent years, minimum accuracy levels will be required for continued participation in the National Database.

After completion of the accuracy audit, charts will be forwarded to AAPCC's regional certification committee for review. This committee will review these records with an eye to the development of minimum performance/output standards for regional poison centers, and will assess the role of random chart audits in the regional poison center certification process. The results of this 1987 chart review will NOT affect a center's current regional certification in any way.

5 New deadlines are outlined in the revised sheets attached. These changes result from the 6 week process of begging, pleading, and cajoling required to get data and death verification reports submitted this year. In the future, center reimbursement will be decreased by 5% per day for every day data or fatality verification is delayed or incomplete. Absolute deadlines are also included in the attached pages beyond which we will not include your center's data in the National Database at all. Besides submitting your data ON TIME, please be sure your death abstracts have correct units provided for all drug levels. In addition, have your medical director review (or write) the abstracts, and either the director or medical director sign the fatality verifications. Verifications submitted with blank fields, levels without units, incorrect signatures, or inadequate abstracts will be considered incomplete. We recognize that postmortem reports may be delayed, and will be acceptable as pending for all deaths occurring after October 1 of the prior year. Nonetheless, fatality verifications must be submitted on time (received by February 1) for these cases, and revisions may be received up to the final February 21 deadline.

6 A preliminary copy of 1987 National Data is enclosed for your local use if your center submitted acceptable data in 1987. The final version of the annual report will be published in the September issue of the American Journal of Emergency Medicine. Four copies will be sent to each AAPCC institutional member at that time.

7 And finally, Barbara and I would like to thank all of you for your cooperation with the 1987 death verification system. In particular, we would like to commend a few individuals (or the ghost writers in their centers) for submitting unusually well-written, comprehensive abstracts in a timely manner. Other centers provided quality abstracts, but often after the deadline. Our special commendations to:

Gary Reed, M.D. and the North Texas Poison Center

John Trestrail, B.S.Pharm. and the Blodgett Regional Poison Center

Phil Johnson, Ph.D. and the Rhode Island Poison Center

As you can imagine, there was intense competition for the "most incredible excuse" award, and as yet, we have been unable to select the finalists.

Please feel free to contact me if you have any questions.

Sincerely,

Toby Litovitz, M.D.

Chairperson, AAPCC Data Collection Committee

1. In-Center Scanning with an NCS Model 3000 Desk Top Scanner

A 50-sheet automatic feeder is recommended and an IBM PC, XT or AT is required to drive the scanner. A scanner and 50-sheet feeder can be obtained for approximately $4,150. Information on scanners can be obtained from:

Dennis Johnson

National Computer System

7600 France Avenue South

P.O. Box 9365

Minneapolis, MN 55440

800-328-6172, ext. 7700 or 612-830-7627

Programs to scan the AAPCC data collection form can be obtained at no extra charge from National Capital Poison Center, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, phone 202/784-2087.

2. Local Scanning Service

High speed NCS scanners may be available to you locally through a school, testing or data processing center. You will need to locate, contact and price these services yourself, but AAPCC can provide a Dossier program for most NCS scanners. Dossier programs are also available from National Capital Poison Center.

3. Central Scanning Service

AAPCC has provided Data Recognition Corporation with a copy of the Dossier program for scanning the data collection form. Data Recognition will scan your forms for approximately $ 0.05 per form. For further information contact:

Russ or Lu Hagen

Data Recognition Corporation

7550 Market Place Drive

Eden Prairie, MN 55344

612-944-3623

Data Recognition will scan your forms, send a tape of the data to Micromedex for processing and will return any forms containing errors. There may be an extra charge for returned forms if there is a large number of forms with errors. See Appendix I for interpretation of error codes which appear in the margin of your returned forms. Please correct these forms immediately, and submit the corrected forms for re-scanning. Corrected forms mustbe received by Data Recognition for rescanning by January 20 to be incorporated in the prior year's data.

Once programmed the scanner "reads" both sides of the form simultaneously and enters the data to either magnetic tape (9 track 1600 BPI EBCDIC) or floppy disk (if you have a desk top scanner). The optical scanning method of data compilation is rapid and accurate, however, the quality of the forms presented to the scanner impacts on the speed and accuracy of the data output. Your cooperation and care in completing the data portion of the form are essential to the collection of high quality data. No stray marks should intrude onto the right side (the data collection portion) of the report form. Stray marks may result in rejection of the data or tabulation of inappropriate data. Take special care not to damage or mark either the skunk marks (two black squares at the top of the form) or the timing marks (black rectangles along the right side of the form). Any stray mark, cut or mutilation of the skunk or timing marks will cause the form to be rejected.

Data are tabulated by darkening circles with a Sanford Sharpie, Expo Marker or a #2 pencil. The markers are available from most office supply companies. Only a Sharpie or Expo Marker contain ink of high enough carbon content to be "read" by the scanner. If errors are made with the markers they are easily corrected by using a paper punch to remove the incorrectly marked circle. Punches with a 3", 4" or 6" reach are available from:

Carol Casey Multicounter Mfg. Co., Inc.

P.J. Mieth Mfg. Co.

Stround Road

North Branford, CT 06471

203-488-1800

Approximate cost: 3" - $ 39.00 ; 4" - $ 71.00 : 6" - $ 102.00. You must specify 1/8" die. The punch with the 6" reach will allow you access to any circle on the data collection portion without separating the data collection portion. If a pencil is used to darken the circle and an error is made you must erase the mark completely. We recommend that you use a marker rather than a #2 pencil to record data on the form because of the inherent speed and consistency of the markers. Remember, only markers with ink of high carbon content are "readable" by the scanner: most black markers will not work. When filling in the data tabulation portion of the report form completely darken the appropriate circles. At least 2/3 of the circle must be darkened including the center of the circle for the scanner to "read" the data.

Figure: Examples - correct and incorrect

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

At a minimum, all calls involving an exposure require complete reporting. Each patient should have a separate form. Centers may also submit data on drug, poison or medical information calls for inclusion in individual center reports. However AAPCC utilizes only actual exposures.

Data Processing

Micromedex is the current Data Compiling Organization (DCO) for AAPCC. They maintain the National Database for AAPCC and will prepare reports for participating centers who contract with them for that service. All centers contracting with Micromedex for reports will have the choice of laser printed or microfiche output. Prices are outlined in Appendix II. For additional information, contact:

George Ward

Micromedex, Inc.

660 Bannock Street

Suite 350

Denver, CO 80204-4506

800-525-9083

Data ownership and access

The National Database will remain the property of AAPCC. Each poison center submitting data to the National Database will maintain ownership of its data and may access its own database at any time with the following restrictions:

1. The poison center may not withdraw its data after it has been submitted to the National Database.

2. Selected portions of the National Database may be accessed without prior approval of the individual participating poison center. This subset of the National Database is defined below and can only be accessed with prior approval of three members of the Data Access Subcommittee (DAS). More detailed searches of the center's data can only be performed with the written approval of the center's director.

3. The following selected items of the National Database may be accessed without prior approval of the submitting center; however, each request must be approved by DAS.

For Table -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

Any participating center may search or analyze its own portion of the National Database without prior approval of DAS. Each computer search, compilation or analysis will be provided at cost (including cost of programming, computer time, supplies and administrative costs) by the DCO. Such requests may be initiated and negotiated directly between the participating center and the DCO without consultation or approval of DAS. However, all requests to search, compile or analyze the National Database must be approved by DAS. Routine requests must be submitted in writing to Dr. Litovitz. Appendix III contains a complete copy of AAPCC's approved Data Access Policy Statement.

Generic code

AAPCC maintains a copyrighted list of 800-900 generic (category) codes. The more than 100,000 Poisindex product specific codes have been matched to the generic category codes. AAPCC requests that participating centers submit product specific data utilizing the Poisindex product code; however, centers may submit generic category data. If your center uses generic codes exclusively you may be ineligible to share revenues generated by the sale of data in the National Database.

Quality control

Maximum acceptable error rates have been set by the AAPCC Executive Committee for 15 fields on the data collection form, Appendix IV. For each of these fields the maximum acceptable rates of invalid, missing and unknown data have been specified. Each participating center receives a quality control report at least annually, with a summary quality factor. High error rates lead to a reduction in a center's quality factor. Submission of data containing <75% product specific data likewise leads to a reduction of this factor. In order to facilitate the submission of high quality data, edit programs have been developed for both desk-top and high speed scanners. These programs will reject forms with invalid and missing data in certain fields. Data from centers with a quality factor less than 0.8 (maximum possible is 1.0 ) will not be included in the National Database. Poison information specialists should note that the average national quality factor was 0.994 in 1987. High quality factors are easily obtained by meticulous history-taking and coding and by editing and re-scanning rejected sheets. Please code accurately. Never distort data to achieve a higher quality factor.

Data scanned centrally (Data Recognition Corp.) will be returned to the submitting center if errors are noted. AAPCC anticipates that these centers will correct the forms and resubmit them for scanning. This will cost an additional scanning fee. The new record will be merged with the original record by the DCO so that the quality of the data will be maintained at a high level. Forms that have been returned with errors in the T and V fields of the call class section were rejected without extracting any data from the record. These forms must be corrected and resubmitted, or the case will not be entered into the database.

At the beginning of each year, participating centers will be required to pull and submit the medical record portion of 24 randomly selected cases from the prior year's data within four weeks of request. These will be compared with the computer data submitted by the center to determine coding accuracy. Feedback will be provided to the centers, and eventually, a minimum accuracy score will be required.

Death verification

Death verification forms must be completed for each fatality, including an abstract of the case. Please send these forms as each fatality is closed to:

Toby Litovitz, M.D.

National Capital Poison Center

Georgetown University Hospital

3800 Reservoir Road, N.W.

Washington, DC 20007

Additional copies may be produced by xeroxing the form in Appendix V.

Record layout

Centers submitting compatible data on 9-track tape should refer to the record layout provided in Appendix VI. These data must be submitted either 1) in EBCDIC, on 9-track tape or 2) in ASCII on floppy diskettes with 1,000 records per file. No delimiters are utilized between fields on records. Any blocking factor may be utilized (preferably 1 or 10), but the blocking factor must be specified. Fields with multiple possible entries (route of exposure, age, decontamination, therapies, free areas) must be filled with spaces (blanks, not zeros). Center code numbers and serial numbers must be zero-filled.

Ordering forms

A year's supply of data collection forms can be ordered at a cost of $ 0.05 per form in September of each year. Midyear form orders may cost substantially more due to the small volume ordered. Please order forms through Dr. Toby Litovitz (at address above).

Deadlines

Appendix VII lists deadlines for data submission, form orders, etc. for Database participants. Please recognize that these deadlines are not negotiable.

Instruction for completion of the form and definitions

Participating poison centers must report all poison exposure cases. Each patient must have a separate form. Centers may use the form to record information calls, but AAPCC does not collate these data on a national level. If you have questions about coding of an unusual scenario, please submit your question in writing so we may reach a conclusion and incorporate it in future updates. Send problems/issues to Dr. Toby Litovitz. The guidelines follow the sequence of the data collection form (see sample, Appendix VIII), except that the information about free areas is found at the end.

Call class

In order to identify the type of cases handled by poison control centers a specific classification system is used which requires at least one determination and may require as many as four if the call involves an exposure. A matrix on the medical record portion of the form corresponds to call class section on the data collection portion of the form. For national data collection purposes, the call type (T) area and the victim (V) area are critical. If not completed correctly, the form will be rejected by the scanner. If the call concerns an exposure then you must gather data about the victim, type of exposure and the reason for the exposure. Conversely, if the call is informational (without a victim), then the V, E, and R columns may be left vacant.

Only exposure cases are included in the AAPCC National Database. Centers are not required to submit data for drug, poison or medical information calls. Your center director must determine whether these data will be submitted by your center and which fields must be completed for information calls.

For Table -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

CALL TYPE (T): Darken only one circle in the "T" column. If this column is left vacant or more than one response is marked, the form will be rejected. Use the following definitions to determine call type.

(1) Exposure: Actual or suspected contact with any substance which when ingested, inhaled, absorbed, applied to or injected into the body, may cause damage to structure or disturbance of function to living tissue. If this description fits, darken the circle corresponding to 1 in the T column. Nontoxic exposures are also coded in this category.

(2) Drug information: Problems of an informational nature about drugs such as dosage, indications, contraindications, side effects, adverse effects. The problem does not involve a poisoning, overdose or adverse reaction. If this description fits, darken the circle corresponding to 2 in the T column.

Note: Adverse drug reactions, drug interactions causing symptoms, or a person who takes an extra dose of medication should be coded as an exposure rather than drug information.

(3) Poison information: Problems or questions related to toxicology but not involving a victim. Questions regarding the prevention of poisoning, drug and substance abuse, analytical toxicology or the toxicity of an agent would be recorded here. If this description fits, darken the circle corresponding to 3 in the T column.

Example: a question about how long a person must wait before entering a room after it had been fumigated with a pesticide would be recorded here, as would urine testing for drugs of abuse or health effects of a chemical exposure.

(4) Medical/Other: Information calls that may come to a poison control center such as lecture requests, media interviews and the like may be recorded here. Medical problems or concerns not related to a toxic phenomenon should be recorded here. If this description fits, darken the circle corresponding to 4 in the T column.

Examples: sunburn, thermal burns, fever therapy, known prank calls, etc. If on follow-up the substance thought to have been ingested has been found, and unequivocally determined not to have been ingested, the case should be changed from call type "exposure" to "medical/other".

VICTIM (V): If the call type is an exposure, then you must darken only one circle in the V column. If the column is left blank or more than one mark is made, the form will be rejected. Use the following definitions to determine the victim.

(1) Human: An exposure involving a human victim.

(2) Animal: An exposure where the victim is not human.

EXPOSURE TYPE (E): If the call is regarding an exposure, then you must darken one circle in the E column. If this column is left vacant or more than one mark is made the response is invalid. Use the following definitions to determine the exposure type:

(1) Acute: A single, repeated or continuous exposure occurring over a relatively short period of time. If an exposure occurs over a time period of less than 8 hours it is considered acute. If this description fits, darken the circle corresponding to 1 in the E column.

Example: a patient with an occupational exposure at a low (generally considered safe) level who suddenly experiences a massive exposure should be coded here.

(2) Chronic: A single or repeated exposure to the same toxic substance lasting longer than 8 hours. If this description fits, darken the circle corresponding to 2 in the E column.

Example: an overdose of a medication taken more than one time over a period of more than 8 hours should be coded here.

(3) Unknown: A case where you cannot determine whether the exposure is acute or chronic. If this description fits, darken the circle corresponding to 3 in the E column.

REASON (R): Only one response is allowable. You must determine if the exposure is accidental, intentional, or an adverse reaction. After you've made that determination then choose the single response within the category which best describes the reason for the exposure. Darken the circle corresponding to your choice. Darken only one circle. If more than one mark is made the data are invalid.

ACCIDENTAL: An accidental exposure results from an unintended poisoning or exposure. Example, a child gains access to a toxic substance where it is obvious he did not realize the potential danger of his action would be an accidental exposure. The following five definitions relate to accidental exposures:

(1) General: All unintended poisonings or exposures that are not specifically defined below. Most accidental exposures in children should be recorded here. Include bites, stings, plant exposures and unintentional food poisoning here. If this description fits, darken the circle corresponding to 1 in the R column.

(2) Occupational: Any exposure that occurs as a directresult of the victim being on the job or in the workplace. If this description fits, darken the circle corresponding to 2 in the R column.

Note: do not code use of occupational or industrial materials outside the workplace here.

(3) Environmental: Any passive exposure that results from man-made contamination of the environment, e.g. exposures to contaminated water resulting from improper disposal of chemicals, passive inhalation of toxic fumes or gases as a result of discharge at a plant or a "HazMat" incident. If this description fits, darken the circle corresponding to 3 in the R column. DO NOT CLASSIFY BITES, STINGS AND PLANT POISONINGS HERE.

Example: many sewer gas, carbon monoxide, urea formaldehyde insulation exposures which do not occur in the workplace are coded here.

(4) Misuse: An accidental exposure which results from the improper or incorrect use of a substance where therapeutic or beneficial results were intended. Example, a case where both parents independently dose a child because neither was aware of the other's action or a person who misread (or didn't read) a product label and inadvertently mixed bleach and ammonia producing chloramine gas should be recorded here. Exposure following gasoline siphoning is also included. Accidental misuse differs from intentional misuse in that the intent is not purposeful. If this description fits, darken the circle corresponding to 4 in the R column.

Examples: pharmacy labeling or dispensing errors; oral decongestant placed in the nose due to a misunderstanding of instructions for use.

(5) Unknown: An exposure that is obviously accidental but the exact type of accident is unknown. If this description fits, darken the circle corresponding to 5 in the R column.

INTENTIONAL: A purposeful action. The following four definitions relate to intentional exposures:

(6) Suicidal: An exposure resulting from the inappropriate use of a substance for self destructive or manipulative reasons. Suicides, suicide gestures, and attempts should be included here. If this description fits, darken the circle corresponding to 6 in the R column.

(7) Misuse: An exposure resulting from the intentional, improper or incorrect use of a substance for reasons other than a psychotropic effect. This category should be used to identify cases of suspected child abuse involving a poisoning or overdose. Example, a parent who intentionally overdoses a child with aspirin in an attempt to relieve pain should be recorded here. Cases other than child abuse may also be captured here. Example, a person deliberately mixes or applies a pesticide inappropriately should be recorded here. Likewise, a person who increases the dosage of a medication to enhance its therapeutic effect should be coded here. If this description fits, darken the circle corresponding to 7 in the R column.

(8) Abuse: An exposure resulting from the intentional, improper or incorrect use of a substance where the victim was likely attempting to gain a high, euphoric or other psychotropic effect. If this description fits, darken the circle corresponding to 8 in the R column.

(9) Unknown: An exposure that is obviously intentional but the specific motive is unknown. If this description fits, darken the circle corresponding to 9 in the R column.

ADVERSE REACTION: An unexpected reaction to a drug, food or other agent where the patient was experiencing an unwanted effect, which is due to an allergic, hypersensitive or idiosyncratic response at normal doses or with normal use. The following three definitions relate to an adverse reaction:

(10) Drug: An unwanted side-effect which is due to an allergic or idiosyncratic reaction to a drug, excipient, or therapeutic agent or from a drug interaction. Also drug intolerance at therapeutic doses should be recorded here. If this description fits, darken the circle corresponding to 10 in the R column.

Examples: ampicillin rash or diarrhea: reaction to sulfites in drugs.

(11) Food: An unwanted effect which is due to an allergic or idiosyncratic reaction to food. Do notinclude food poisoning or food contamination. If this description fits, darken the circle corresponding to 11 in the R column.

Examples: MSG reaction, reactions to sulfiting agents in food, allergic reactions to food dyes.

(12) Other: An unwanted effect which is due to an allergic or idiosyncratic reaction to a substance which is not a drug or food. If this description fits, darken the circle corresponding to 12 in the R column.

Example: not sure if food or drug was source of reaction; nickel dematitis from jewelry; contact dermatitis from laundry soap.

UNKNOWN REASON (13): If none of the definitions really fit a case of human exposure then the unknown reason has been provided. Also use to classify a case of an obvious exposure but the reason for the exposure cannot be determined. If this description fits, darken the circle corresponding to 13 in the R column.

Figure: Examples - Center Code, Date/Time

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

CENTER CODE: This is important data used to identify your center's input into the National Database. If this information is missing it will be impossible to separate the data in the National Database into your individual center's data. Darken the circle corresponding to your center's code.

DATE/TIME: Space has been provided on the medical record portion of the form for an automatic date/time stamp if your center uses one. However, the date and time still has to be entered onto the data portion of the form to be entered into the computer.

MO. (MONTH): Darken the circle corresponding to the month the call is received. Mark only one month.

DAY: Darken the circle(s) from left to right, corresponding to the day the call is received. Make only one mark in each column. The left column must be left vacant for the first 9 days of the month. If the left column is marked, the right column must also be marked. Blank - 0 and 1 - blank are invalid responses.

YEAR: Darken the circle corresponding to the year in which the call is received. Make only one mark. If more than one mark is made the data are invalid. 88 = 1988; 89 = 1989.

HOUR: The numbers inside the circles correspond to the hour the call was received. Darken the circle(s), from left to right, corresponding to the hour the call is received based on a 24 hour clock. RECORD HOUR ONLY, NOT MINUTES. Make only one mark in each column; however, the left column may be vacant. 1 - blank is invalid.

midnight - 0:59 am = 0 hour noon- 12:59 pm = 12 hour

1 am - 1:59 am = 1 hour 1 pm - 1:59 pm = 13 hour

2 am - 2:59 am = 2 hour 2 pm - 2:59 pm = 14 hour

3 am - 3:59 am = 3 hour 3 pm - 3:59 pm = 15 hour

4 am - 4:59 am = 4 hour 4 pm - 4:59 pm = 16 hour

5 am - 5:59 am = 5 hour 5 pm - 5:59 pm = 17 hour

6 am - 6:59 am = 6 hour 6 pm - 6:59 pm = 18 hour

7 am - 7:59 am = 7 hour 7 pm - 7:59 pm = 19 hour

8 am - 8:59 am = 8 hour 8 pm - 8:59 pm = 20 hour

9 am - 9:59 am = 9 hour 9 pm - 9:59 pm = 21 hour

10 am - 10:59 am = 10 hour 10 pm- 10:59 pm = 22 hour

11 am - 11:59 am = 11 hour 11 pm- 11:59 pm = 23 hour

Example: 12:45 am = 0045 hours which is tabulated as the 0 hour. 2:57 pm = 1457 which is tabulated as the 14th hour.

Figure: Example - Patient Age

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

PATIENT AGE: For medical record purposes write in the patient's age and check the appropriate box for months (mo.) or years (yr.) In all cases the specific age of the patient should be captured when possible. Gather data in only one category; more than one mark in the area is invalid.

INFANT: Birth through 23 months. The patient's age should be recorded in months. Darken the appropriate circle(s) from left to right corresponding to the patient's age. Make only one mark in each column; however, the left column may be vacant if the patient is less than 10 months old. If you are sure the patient is less than 2 years old but can't determine the infant's exact age, then darken the circle corresponding to unknown infant.

CHILD: 2 through 12 years. The data should be tabulated in the child area. Darken a single circle corresponding to the patient's age in years. More than one mark in this area is invalid. A patient is not considered in an age until he attains that age. For example, a 31/2 year old is tabulated with 3 year olds. If the exact age of the child is unknown but you're sure the patient is between 2 and 5 years then darken the circle corresponding to 2-5 in the area labeled unknown child. If the exact age of the child is unknown but you're sure the patient is between 6 and 12 years then darken the circle corresponding to 6-12 in the area labeled unknown child. If you are unable to specify a child's age within these categories, tabulate as unknown age.

ADOLESCENT: 13 through 17 years. The data should be tabulated in the adolescent area. Darken the single circle corresponding to the patient's age in years. More than one mark in this area is invalid. If you are sure the patient is between 13 and 17 years but can't determine the patient's exact age, then darken the circle corresponding to unknown adolescent.

ADULT: Patients 18 years and older are recorded in the adult area. Enter the patient's age numerically from left to right. Darken only one circle in each column. If you are sure the patient is older than 17 years but can't determine the exact age, then darken the circle corresponding to unknown adult.

UNKNOWN AGE: If you can't determine the patient's age or if the patient is a child and you are unable to specify if the child is between 2 and 5 years or 6 and 12 years, then darken the circle corresponding to unknown age.

SEX: Darken the circle corresponding to the patient's sex. Darken only one circle; more than one mark is invalid.

Figure: Examples - Site of Caller, HCF, Site of Exposure

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

SITE OF CALLER: On the medical record check the term which accurately describes the site of the caller at the time of initial contact. Remember, this field addresses the caller's site, not the victim's. If a mother calls from work about a child exposed at home, the site of the caller is "workplace" and the site of exposure is "residence." For data collection darken a single circle corresponding to the term chosen on the medical record. Darken only one circle; more than one mark is invalid. Choose from the following definitions:

Residence: Any house, domicile or nearby phone used to serve the residence. Include neighbor's home, relative's home and phone booths.

Workplace: Any shop, building, office or non-residential room where a person is employed. Exposures occurring to employees of health care facilities while on the job should be coded here (unless the employee health unit places the call).

Health Care Facility (HCF

*): Any emergency department, ambulance or rescue dispatchers, hospital, first aid station, ambulance, clinic, medical office, nursing home, chronic-care residential facility for the retarded or handicapped, dentist's offices, vets, pharmacies, health departments, home health agencies, emergicenters and detox centers. If this response is chosen, the specific facility should be coded on the data collection portion to identify the health care facilities which call your center. HCF codes should be devised by your center. They should contain up to three digits and be right adjusted. Lead zeros may be deleted. ZEROS AND BLANKS ARE NOT THE SAME THING. More than one mark in any column is invalid.

School: Any school (or university) classroom, schoolyard, dormitory, or school sponsored activity. Child care centers should be coded here.

Other: Any case not specifically defined above. Calls from jails, police or crisis centers where the corresponding health unit is not involved should be coded here.

Unknown: Any case where the site of the caller is unknown or cannot be determined.

SITE OF EXPOSURE: On the medical record check the term which describes the location of the patient at the time the exposure occurred. For data collection, darken the single circle corresponding to the term chosen on the medical record. Darken only one circle in this area; more than one mark is invalid. Use the definitions listed under "SITE OF CALLER". DO NOT CODE THE HEALTH CARE FACILITY IN THIS SECTION.

Examples: A nursing home resident is exposed in a nursing home (site of caller = HCF; site of exposure = HCF). A hospital employee is exposed at work then goes to the emergency department and the emergency department calls the poison center (site of caller = HCF; site of exposure = workplace).

Figure: Examples - Caller Location Options

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

CALLER LOCATION: The Caller Location and State areas are designed to gather data about the distribution of calls to your center. Each center may choose from the following options, but must use that option exclusively.

Option #1 Telephone number: Your center may use the area code and prefix (first 3 digits) of the caller's telephone number. If you choose this option your data will be tabulated by city for that area code and prefix. If this option is selected enter the area code and prefix as if it were a 6-digit number and ignore the last four digits.

Example: 801/581-7504 would be entered as 801581. Darken the circles from left to right. Make only one mark per column. All digits including 0 must be marked. If the caller will not give the number, then ignore this area and code the state from which you believe the call originated. If the area code and prefix are known and entered, the STATE field does not need to be completed.

Option #2 Zip code: Your center may use the zip code of the caller's address. If you choose this option your data will be tabulated by zip code area. Since the zip code is a 5 digit number (use only the first 5 digits of a 9-digit zip code) enter the code right adjusted. LEAVE THE FIRST COLUMN ON THE LEFT BLANK. Darken the circles from left to right. Make only one mark per column. If the caller will not give or doesn't know his zip code, do not bubble this area, and code the state from which you believe the call originated. If the zip code is known and marked, the STATE field does not need to be completed.

Option #3 Other Caller Location: You may opt to use any code you wish other than the telephone number or zip code. However, you must devise your own code which may not be any more than 4 digits. Once you select your code (1, 2, 3 or 4 digits) it must be exclusive, i.e., only a 3-digit code. You may not interchange with a 1, 2 or 3 digit code. Specific programming will be developed for your center by the DCO. If you choose this option, your data will only be available by code number unless you make specific arrangements with the DCO to translate your code.IF YOU CHOOSE THIS OPTION YOU MUST ALSO USE THE STATE CODE FOR THE NATIONAL DATABASE.

Once you choose an option it will be registered with the DCO and you must use that option exclusively, until you notify Micromedex that you wish to change. Changes cannot be made mid-year. If your center wishes to gather data which only identifies the state from which a caller originates then the CALLER LOCATION area need not be marked and the response should be coded only in the STATE area.

STATE: Darken the circles (from left to right) corresponding to the two digit code for the state from which the call was made. DO NOT enter the victim's state of residence if it's different than the state from which the call was made. If the CALLER LOCATION field is completed, the STATE field may be left blank. Make only one mark in each column. Use the following codes to identify the state:

01 Alabama 15 Indiana 29 Nevada 43 Tennessee

02 Alaska 16 Iowa 30 New Hampshire 44 Texas

03 Arkansas 17 Kansas 31 New Jersey 45 Utah

04 Arizona 18 Kentucky 32 New Mexico 46 Vermont

05 California 19 Louisiana 33 New York 47 Virginia

06 Colorado 20 Maine 34 North Carolina 48 Washington

07 Connecticut 21 Maryland 35 North Dakota 49 West Virginia

08 Delaware 22 Massachusetts 36 Ohio 50 Wisconsin

09 D.C. 23 Michigan 37 Oklahoma 51 Wyoming

10 Florida 24 Minnesota 38 Oregon 52 Canada

11 Georgia 25 Mississippi 39 Pennsylvania 53 Mexico

12 Hawaii 26 Missouri 40 Rhode Island 54 Other foreign country

13 Idaho 27 Montana 41 South Carolina 55 Overseas military base

14 Illinois 28 Nebraska 42 South Dakota

56 Refused to give

57 Unknown

Figure: Examples - Substance Codes

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

SUBSTANCE CODES: Product specific data will be captured on the data collection form by using the Poisindex code which appears on the product fiche of Poisindex. In the fiche system, this number if found after the ingredients list and is preceded by (PRODUCT REF.) The seven digits immediately preceding a hyphen (-) is the code. See example below:

ANTI-DANDRUFF HAIR TONIC. FROM J.B.

BENZOIC ACID 0.1 %

DEHYDROACETIC ACID 0.1 %

QUATERNIUM-23 & QUATERNIUM 0.05 %

(PRODUCT REF 1799413-0482-L-WIL7)

In the computerized system, this number appears in reverse video at the lower right of the product screen.

If a product is not found in the Poisindex System, then enter the seven digit generic code found in the AAPCC Generic Code Manual. All generic codes begin with the number zero. Use the generic code that best fits the product involved. Product specific codes should be used in preference to generic codes whenever possible. Be careful not to use the product specific codes of outdated, discontinued or foreign products unless you are certain that this is the product involved. DO NOT use specific INGREDIENT codes if the specific PRODUCT code is unavailable. Use the appropriate AAPCC generic code. A maximum of two products may be entered on a single report. If more than one product is involved, you may enter two Poisindex codes, or two generic codes, or one Poisindex code and one generic code in the substance areas. Enter the numbers from left to right. You may use the boxes above the columns on the data collection portion of the form to write the number on the form but you must be careful not to write outside of the boxes provided. If more than one substance is implicated in an exposure, the substances should be prioritized by relative contribution to the patient's clinical condition or relative toxic hazard to the patient. Using the following 3 generic codes for exposure cases results in invalid data:

poison information

drug information

medical information

SUBSTANCE 1: This area is used to code the first substance. Darken circles corresponding to the numbers on the code. Enter the number from left to right. Darken only one circle per column; more than one mark per column is invalid. ALL NUMBERS INCLUDING ZERO MUST BE CODED.

SUBSTANCE 2: This area is used to code the second substance if more than one substance is involved in the exposure.

TOTAL NUMBER OF SUBSTANCES INVOLVED: This area is used to code the total number of substances involved in the exposure if more than two different substances were involved in a single exposure. In such cases enter the total number of products up to 12. Fixed combinations or single products of multiple ingredients are considered one substance.

_______________________ ROUTE OF EXPOSURE _______________________ ( ) Ingestion ( ) Inhalation/Nasal ( ) Ocular ( ) Dermal ( ) Bite/Sting ( ) Parenteral ( ) Other ( ) Unknown _______________________

ROUTE OF EXPOSURE: Multiple marks are acceptable in this area. Darken the circle(s) corresponding to the route(s) of exposure. Choose from the following definitions:

Ingestion: An exposure by the oral route. Exposures where the material was put in the mouth but unlikely to have reached the stomach should be classified as an ingestion. Ingestions accompanied by aspiration should be coded as both an ingestion and an inhalation.

Inhalation/Nasal: An expousure by the pulmonary route (tracheal or nasal). This route usually pertains to gaseous or vaporized agents. Record insufflation of cocaine here. Ingestions accompanied by aspiration should be coded as both an inhalation and an ingestion.

Ocular: An exposure involving the eyeball. DO NOT code peri-orbital exposures as ocular.

Dermal: An exposure involving the skin, hair or fingernails. Code peri-orbital exposures here.

Bite/Sting: An exposure resulting from the bite or sting of an insect, arthropod or mammal.

Parenteral: An exposure resulting from the injection of a substance into the body.

Other: Any other routes of exposure not listed above.

Example: penetrating (stab, gunshot) injuries; foreign body in rectum, etc.

Unknown: If the route of exposure is unknown.

__________________________ INITIAL SYMPTOM ASSESSMENT __________________________ ( ) Asymptomatic ( ) Symptomatic related ( ) Symptomatic unrelated ( ) Symptomatic unknown if related ( ) Unknown if symptomatic __________________________

INITIAL SYMPTOM ASSESSMENT: For data collection purposes you must make a judgment about the patient's symptoms and then darken a single circle corresponding to the single category which best describes the patient's symptom status from the time of the exposure to the time of the call. Choose from the following definitions:

Asymptomatic: The patient has or had no symptoms whatsoever (subjective or objective).

Symptomatic, related: The patient is experiencing or has experienced symptoms which are (or reasonably may be) related to the exposure.

Symptomatic, unrelated: The patient is experiencing or has experienced symptoms which preceded the exposure or are of such a nature that they are unlikely to be related to the exposure. Use your best clinical judgment to make this determination.

Symptomatic, unknown if related: The patient is symptomatic or was symptomatic, but you do not have enough information to reasonably determine the relationship between the exposure history and the symptoms reported.

Unknown if symptomatic: It is unknown whether the patient is or was symptomatic.

Figure: Example - Monitoring Patient Flow

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

MONITORING PATIENT FLOW: This area is designed to gather information about the management site of patients. In this area five (5) circles are numbered 1 through 5. You must choose only one of these responses. If you darken more than one of the numbered circles the response is invalid. If you choose response #2 or #3, then you must also darken one additional circle under each area regarding the disposition of the patient from the HCF. Darken the circle corresponding to the single term which best describes the initial management site of the patient from the following:

(1) MANAGED ON SITE - NON HEALTH CARE FACILITY: Use this area to record your response if you treat the patient at home or any other non-health care site. School or workplace exposures are included here only if the school or occupational health nurse were NOTconsulted. A hospital worker exposed on site is coded as "managed on site, non HCF" unless seen by a physician, or occupational health nurse. If you plan to refer the patient to a HCF, or eventually refer the patient to a HCF, even unexpectedly, ignore this response and darken circle #3.

(2) PATIENT WAS ALREADY IN (ENROUTE TO) HCF WHEN PCC WAS CALLED: At time of initial contact with the center the patient is already in or enroute to a primary health care facility such as an emergency department, clinic or physician's office. For the purposes of this field, health care facilities include only those sites where the patient is evaluated by a physician. Note that this differs from the definition of HCF used in the SITE OF CALLER and SITE OF EXPOSURE fields. Patients who go on to health care facilities after or despite poison center recommendations to stay at home should also be coded here. If this response is chosen then the specific health care facility should be identified by code in the HCF CODE area on the right side of this section. NOTE: Each center may develop its own HCF codes and HCF coding criteria. If this response is chosen, a further determination should be made about the disposition of the patient from that HCF. Choose from the following:

Treated and released: The patient is observed/treated then released to home. HCF code required.

Admitted for medical care: The patient is observed and/or treated and subsequently admitted as an inpatient primarily to receive medical care rather than psychiatric evaluation. DARKEN THE "ADMITTED" CIRCLE EVEN IF THE PATIENT IS TRANSFERRED TO AND ADMITTED TO AN HCF OTHER THAN THE ORIGINAL HCF so that the National Database will reflect the total number of admitted patients. HCF code required. Record the HCF code of an additional facility involved in a transfer in the "follow-up" area.

Example: A patient is in the emergency department at HCF-A and is transferred to HCF-B and admitted to HCF-B for medical care. You may code HCF-A in the monitoring patient flow section and HCF-B in the follow-up section; or code these HCF's in any manner designated by your director. However, for the purposes of the National Database you must code "admitted for medical care" rather than "treated and released" and you must utilize one of the other HCF codes or this will be coded as an error during scanning.

Admitted for psychiatric care/evaluation: The patient is observed and/or treated and subsequently admitted as an inpatient in the same facility and the patient is admitted primarily to receive psychiatric care or evaluation. HCF code required. If the patient is transferred to another facility for psychiatric care, the primary HCF should be indicated here and the second facility recorded in the "follow-up" area.

Patient lost to follow-up/left AMA: You have lost the patient to follow-up or the patient has left the HCF against medical advice or the patient never arrived at the HCF. HCF code not required.

(3) PATIENT WAS REFERRED BY PCC TO A HCF: Any case where the patient is referred to a primary HCF (Emergency Department, physician's office) as part of your management recommendation. For the purposes of this field, health care facilities include only those sites where the patient is evaluated by a physician. Note that this differs from the definition of HCF used in the SITE OF CALLER and SITE OF EXPOSURE fields. If this response is chosen then the specific health care facility should be identified by code in the HCF CODE area in the right side of this section. NOTE: Each center may develop its own HCF codes and HCF coding criteria. If this response is chosen, a further determination should be made regarding the disposition of the patient from that HCF. Choose from the following:

Treated and released: The patient is observed/treated then released to home. HCF code is required.

Admitted for medical care: The patient is observed and/or treated and subsequently admitted as an inpatient primarily to receive medical care rather than psychiatric evaluation. DARKEN THE "ADMITTED" CIRCLE EVEN IF THE PATIENT IS TRANSFERRED TO AND ADMITTED TO AN HCF OTHER THAN THE ORIGINAL HCF so that the National Database will reflect the total number of admitted patients. HCF code required. Record the HCF code of an additional facility involved in a transfer in the "follow-up" area.

Admitted for psychiatric care/evaluation: The patient is observed and/or treated and subsequently admitted as an inpatient in the same facility and the patient is admitted primarily to receive psychiatric care or evaluation. HCF code required. If the patient is transferred to another facility for psychiatric care, the primary HCF should be indicated here, and the second facility recorded in the "follow-up" area.

Patient refused referral/did not arrive at HCF: Patient declined to follow your referral recommendation or failed to arrive at the HCF to which you referred him. HCF code not required.

Patient lost to follow-up/left AMA: You have lost the patient to follow-up or the patient has left the HCF against medical advice. HCF code not required.

(4) OTHER: Any management site not identified above. If a non-physician health care provider such as a nursing home, dentist's office, detox center, jail, mental health center, occupation health nurse or school nurse is involved in the patient's care, code this option.

(5) UNKNOWN: The management site of the patient is unknown.

___________________________________________________________________________ FOLLOW-UP ___________________________________________________________________________ If it is determined that the patient leaves the initial management site for additional medical care, the health care facility where the patient was ultimately managed should be identified by code __________________________________________> If during follow-up patient develops symptoms which are likely related to the exposure, capture that data by marking this bubble _________________________________________________> ( ) ___________________________________________________________________________

FOLLOW-UP: During follow-up if you determine that the patient leaves the initial management site or is transferred from the referral site for additional medical or psychiatric care, this response should be coded by entering the HCF code of the facility at which the patient was ultimately managed. Enter the code in the HCF CODE area to the right of the arrow. If more than one transfer facility is involved, the center may choose which facility is coded.

FOLLOW-UP/SYMPTOMS: This response applies only if you determine that the patient develops symptoms related to the exposure sometime after the initial call. If during follow-up, you determine that the patient has subsequently developed symptoms, document the time of onset on the medical record anddarken the circle to the right of the arrow. NOTE: THIS RESPONSE IS NOT VALIDIF THE INITIAL SYMPTOM ASSESSMENT IS SYMPTOMATIC, RELATED.PLEASEdo not skip this field.

TERATOGENICITY: If you are able to determine that the patient is a pregnant female at the time of her exposure then darken the bubble to the right of the arrow.

_________________________________________________________________________________________________ ( ) No therapy necessary THERAPY ( ) Observation only PROVIDED ( ) Patient refused any help _________________________________________________________________________________________________ DECONTAMINATION ( ) ipecac ( ) lavage ( ) fresh air ( ) activated charcoal ( ) dilute ( ) other decontamination ( ) cathartic ( ) irrigate/wash ( ) other emetic OTHER THERAPIES ( ) acidification ( ) EDTA ( ) naloxone ( ) alkalinization ( ) ethanol ( ) oxygen ( ) anticonvulsants ( ) exchange transfusion ( ) 2-PAM ( ) antihistamines ( ) Fab fragments ( ) penicillamine ( ) antivenin ( ) forced diuresis ( ) peritoneal dialysis ( ) atropine ( ) glucose ( ) physostigmine ( ) BAL ( ) hemodialysis ( ) pyridoxine ( ) cardiopulmonary resuscitation ( ) hyperbanc oxygen ( ) resin hemoperfusion ( ) charcoal hemoperfusion ( ) methylene blue ( ) other ( ) cyanide antidote kit ( ) NAC. IV ( ) deferoxamine ( ) NAC. P.O. _________________________________________________________________________________________________

THERAPY SECTION: On the medical record you should document any therapy which you recommend including those which you anticipate may be needed during the course of the exposure. You should also document any therapy which was provided which you did not recommend. In these latter cases be sure to document the circumstances on the medical record portion of the form. It is quite possible that you may not find all the therapies that you provided. The form is not intended to capture all possible therapies. Therefore, if your center finds therapies which they wish to have coded but are not on the form we encourage you to use one of the free areas to record that data.

On the data collection form you should code only those therapies which were actually provided including those you may not have recommended. Darken the circle corresponding to only those therapies which were actually used to treat the patient for the exposure or a medical complication associated with that exposure.

_________________________________________________________________________________________________ ( ) No therapy necessary THERAPY ( ) Observation only PROVIDED ( ) Patient refused any help _________________________________________________________________________________________________

NO THERAPY NECESSARY: Darken the circle corresponding to "No therapy necessary" if you determine that the patient can be managed without any therapy.

OBSERVATION ONLY: Darken the circle corresponding to "Observation only" if you determine that the patient can be managed without any therapy other than observation (medical and nonmedical observation are included here).

PATIENT REFUSED ANY HELP: If you believe that the exposure is potentially toxic, but the caller or the patient refuses to accept your help or they will not give you a return phone number and you have no way to determine whether therapeutic intervention was provided, code this response.

DECONTAMINATION: Multiple responses are acceptable in this area. IF YOU LEAVE THIS AREA BLANK THE DATA FOR THIS CASE WILL BE INTERPRETED AS "NO DECONTAMINATION PROVIDED". Darken all the circles corresponding to the decontamination procedure(s) used to treat the patient. Darken all circles that apply. Choose all that apply from the following:

Ipecac: Ipecac syrup was administered.

Activated Charcoal: Activated charcoal was given.

Catharsis: The patient was given a laxative, cathartic or enema resulting in purgation of the gastrointestinal tract.

Lavage: Gastric lavage was used to decontaminate the stomach.

Dilute: The patient does something to decrease the concentration of a substance by ingesting water or other fluid.

Irrigate/wash: The substance is removed from the eye or skin by flooding the area with water or by cleansing with soap, detergent or similar substance. Nasal/aural irrigation are also coded here.

Example: acetone for cyanoacrylates; vegetable oil for dermal capsicum exposures

Fresh air: The patient was removed from a contaminated environment and provided a source of fresh air. This response will usually pertain to inhalation exposures.

Other decontamination: Any decontamination proceudre not specifically listed above. Food administration should be listed here.

Other emetic: Emesis was induced with an agent other than syrup of ipecac. Mechanical stimulation, a detergent solution, apomorphine and the like should be coded here.

OTHER THERAPIES: Multiple entries are acceptable in this area. This area is provided to code procedures and chemical therapies which were actually used to treat the patient. Darken all the circles corresponding to the therapies which were actually used to treat the patient.

__________________________________________________________________________________ MEDICAL OUTCOME __________________________________________________________________________________ ( ) No effect ( ) Unknown, non toxic exposure ( ) Minor effect ( ) Unknown, potentially toxic exposure ( ) Moderate effect ( ) Unrelated effect ( ) Major effect ( ) Death __________________________________________________________________________________

MEDICAL OUTCOME: This area is designed to record the medical effects experienced by the patient as a result of this exposure. Periodic follow-up should continue until a reasonably certain medical outcome can be documented. Darken the circle which best describes the medical outcome from the following:

No effect: The patient developed no symptoms as a result of the exposure. Follow-up is required to make this determination unless the initial poison center call occurs long after the exposure.

Minor effect: The patient exhibited some symptoms as a result of the exposure, but they were minimal or no treatment was provided. The symptoms resolved rapidly and usually involve skin or mucous membrane manifestations. The patient has returned to a pre-exposure state of well being and has no residual disability or disfigurement. Follow-up is required to make this determination unless the initial poison center call occurs long after the exposure. Some examples of minor symptoms are: mild GI symptoms, drowsiness, skin irritation or 1 burn, sinus tachycardia without hypotension.

Moderate effect: The patient exhibited symptoms as a result of the exposure which are more pronounced, more prolonged or more of a systemic nature than minor symptoms. Usually some form of treatment is or would have been indicated to treat the patient. Symptoms were not life threatening and the patient has returned to a pre-exposure state of well being with no residual disability or disfigurement. Follow-up is required to make this determination unless the initial poison center call occurs long after the exposure. Examples of moderate symptoms are: a corneal abrasion, acid-base disturbance, high fever, disorientation, hypotension which rapidly responds to treatment, and isolated brief seizures which resolve spontaneously or readily respond to treatment, transient renal failure not requiring dialysis, hepatic injury without encephalopathy, GI symptoms causing dehydration, caustic injury to esophagus without perforation or residual injury.

Major effect: The patient has exhibited some symptoms as a result of the exposure. The symptoms were life-threatening or resulted in residual disability or disfigurement. Follow-up is required to make this determination unless the initial poison center call occurs long after the exposure. Examples include patients who require intubation plus mechanical ventilation, who sustain repeated seizures, or experience ventricular tachycardia, cardiovascular instability or coma.

Unknown, nontoxic exposure: The patient was lost to follow-up or was not followed. However, in your estimation the exposure was likely to be non toxic because the agent involved was non toxic or the amount of the exposure, (or route) was insignificant and unlikely to result in toxicity.

Unknown, potentially toxic exposure: The patient was lost to follow-up and in your estimation the exposure was significant and may have resulted in toxic manifestations.

Unrelated effect: The patient exhibited symptoms which were ultimately diagnosed as not related to a toxic problem. Deaths which are clearly unrelated to a toxic exposure should also be coded here.

Death: The patient died as a result of the exposure or a direct complication of the exposure which was unlikely to have occurred had the toxic exposure not preceded the complication.

Figure: Example - AAPCC Prospective Studies

For Figure -- To obtain the appendix, table, image, etc. please call LSC's ERF Helpdesk at 614-387-2078 or send an email to erfhelpdesk@lsc.state.oh.us..

AAPCC PROSPECTIVE STUDIES: This area has been provided specifically for AAPCC sponsored studies. DO NOT USE THIS AREA FOR YOUR CENTER'S INDIVIDUAL NEEDS. If you wish to use this area for a national study please submit a brief proposal to the chairperson of the Data Collection Committee.

SINGLE CASES HANDLED BY 2 OR MORE CENTERS: When 2 or more centers that participate in the National Database consult on the same case, secondary centers must identify the case in AAPCC PROSPECTIVE STUDIES area or the case will be duplicated in the National Database. We will use section C, row III, circle 6 for this purpose. Collaborating centers must decide between themselves which center will be the primary center and which will be the secondary center. Usually the center with the most information on a case will be the primary center. The secondary center should darken circle C, III, 6 in the AAPCC Prospective Studies area. Those cases will be reported in the center's individual data but will be dropped from the National Database.

FREE AREAS: The form has five areas (three on the front and two on the back) to gather data for individual center needs and special studies. If you choose to use the free areas you will receive a numeric tabulation of the codes which you enter from the DCO. Only specified Free Areas may be used for individual center purposes. Do not divert other fields for your center's special coding needs!

FREE AREA 1: Only a single response may be coded in this area; however, it provides for up to 100 choices (0-99). Enter codes from left to right and darken only one circle in each column.

FREE AREA 2: Only a single response may be coded in this area; however, it provides for up to 1,000 choices (0-999). Enter codes from left to right and darken only one circle in each column.

FREE AREA 3: Only a single response may be coded in this area; however, it provides for up to 100 choices (00-99). Enter codes from left to right and darken only one circle in each column.

FREE AREA 4: Multiple responses may be made in this area (up to 59). Darken all circles for which a response is appropriate.

FREE AREA 5: Multiple responses may be made in this area (up to 54). Darken all circles for which a response is appropriate.

R.C. 119.032 review dates: 07/10/2009 and 07/10/2014

Promulgated Under: 119.03

Statutory Authority: 3701.20

Rule Amplifies: 3701.19 , 3701.20 , 3701.201

Prior Effective Dates: 3/29/1990 (Emer.), 9/16/90

3701-41-05 Standards and procedure for awarding grants.

(A) In accordance with this rule, the director shall make grants to poison prevention and treatment centers. Subject to the availability of an appropriation for grants, the director shall make grants annually on a fiscal year (July first to June thirtieth) basis.

(B) To be eligible to receive a grant under division (D) of section 3701.20 of the Revised Code and this rule, an entity shall:

(1) Be designated as a poison prevention and treatment center under division (A) of section 3701.20 of the Revised Code and rule 3701-41-02 of the Administrative Code; and

(2) Agree in writing that the level of the total funds, labor and services devoted by the entity to the center during the period of the grant will approximate, as determined by the director, the level of total funds, labor and services devoted by that entity in the fiscal year preceding the fiscal year in which the grant begins. The entity shall submit verifiable financial data demonstrating its compliance with this paragraph. In determining whether grant period funds, labor and services devoted by the entity approximate the previous level, the director shall consider, among other relevant matters, the degree to which the preceding fiscal year's funds resulted from irregular revenues such as donations, bequests, grants and contracts.

(C) An application for a grant shall be filed with the director no later than May first for the fiscal year beginning on the following July first. The applicant for a grant shall file an original and one copy of a completed application form prescribed by the director, which shall include:

(1) The name and address of the applicant, its project director and its fiscal contact person;

(2) A narrative description of:

(a) The scope of poison prevention and treatment services provided and proposed to be provided by the applicant, directly and through contract, and a description of the applicant's experience in providing poison prevention and treatment services;

(b) The effectiveness of poison prevention and treatment services for the applicant's target population, including an analysis of the extent of poisoning and past and present service and educational efforts; and

(c) The applicant's proposals to provide additional services or educational programs or, subject to paragraph (B)(2) of this rule, to pay for services or programs currently provided, including identification of the proposed target population, the high-risk behaviors to be addressed and the methods and anticipated results of intervention;

(3) An itemized budget for the center, with supporting narrative explanation, and descriptions of the center's accounting system, procurement practices and auditing arrangements;

(4) Information about the qualifications and responsibilities of personnel and letters of support and commitment from other entities;

(5) The written agreement required by paragraph (B)(2) of this rule; and

(6) Statements of the applicant's compliance with Title VI of the "Civil Rights Act of 1964," 78 Stat. 252 (1964), 42 U.S.C. 2000d , as amended, and section 504 of the "Rehabilitation Act of 1973," 84 Stat. 394 (1973), 29 U.S.C. 794 , as amended.

(D) The director may request additional information necessary to review a grant application and the applicant shall provide the requested information within the time specified by the director.

(E) In determining the amount of money to award to each eligible grant applicant, the director shall consider:

(1) The amount of money available for grants for the fiscal year for which grants are being awarded;

(2) The percentage of the total state population that resides in the region served by the applicant;

(3) The anticipated effectiveness of the applicant's proposal to expand poison prevention and treatment services;

(4) The applicant's demonstrated ability to form collaborative relationships with other providers of poison prevention and treatment services in the region;

(5) The appropriateness of the budget for the proposed activities;

(6) The effect of the region's economic condition on the center's ability to generate other funding;

(7) The degree to which grant money will be spent to provide direct services to health care professionals and the general public; and

(8) Any other factors that the director considers to be significant to advancing the purposes of the Ohio poison control network established under division (A) of section 3701.20 of the Revised Code.

(F) The director shall provide written notice by certified mail of grants awarded under this rule. If the amount of money awarded is less than was requested, the notice shall contain an explanation of the reason for the reduction.

R.C. 119.032 review dates: 07/10/2014 and 07/01/2019
Promulgated Under: 119.03
Statutory Authority: 3701.20
Rule Amplifies: 3701.19 , 3701.20 , 3701.201
Prior Effective Dates: 3/29/1990 (Emer.), 9/16/90

3701-41-06 Reconsideration of denial or revocation of designation.

(A) An entity denied designation as a poison prevention and treatment center or a poison prevention and treatment center which has been notified that its designation has been revoked may request reconsideration of the decision in accordance with this rule. A request for reconsideration shall be in writing and shall be filed with the director no later than thirty days after the date of mailing of the notice of denial or revocation under paragraph (C)(4) of rule 3701-41-02 of the Administrative Code.

(B) Upon receipt of a request for reconsideration, the director shall forward the request to the chairman of the Ohio poison control network advisory committee established by section 3701.21 of the Revised Code.

(1) The chairman shall convene a committee meeting within thirty days after receiving the reconsideration request from the director for the purpose of selecting a subcommittee of no less than three individuals to review the matter. These individuals may be members of the committee or other individuals whom the committee considers appropriately qualified to participate in the review. None of the individuals selected shall have a conflict of interest.

(2) In conducting the review of a denial of designation, the subcommittee shall consider the application and any additional information evaluated by the director in making the initial decision. In conducting the review of a revocation of designation, the subcommittee shall consider the information that was available to the director in making the initial decision.

(3) The subcommittee shall complete its review and submit a written report containing its recommendation and the reasons for the recommendation to the director within thirty days of its appointment.

(4) After considering the subcommittee's report, the director shall notify the applicant or center of his or her final decision on the matter by certified mail.

R.C. 119.032 review dates: 07/10/2014 and 07/01/2019
Promulgated Under: 119.03
Statutory Authority: 3701.20
Rule Amplifies: 3701.19 , 3701.20 , 3701.201
Prior Effective Dates: 3/29/1990 (Emer.), 9/16/90