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Over the last 2 decades, an increasing number of emergency physicians have developed an area of specialty expertise in medical toxicology. Emergency medicine has had an impact on the growing subspecialty of medical toxicology, as emergency physicians now account for more than 80% of board-certified medical toxicologists.1 Emergency medicine/medical toxicologists typically divide their time between their practice of emergency medicine and medical toxicology, as the latter has limited clinical contact and tends to be poorly funded, particularly given the recent trend toward regionalization of poison control centers, which is discussed in more detail later in this chapter. The practice of medical toxicology includes

  1. Medical direction of a poison center

  2. Teaching of medical toxicology to medical students, emergency medicine, pediatric, internal medicine house staff, and paramedics

  3. Toxicological research

  4. The participation in a consultative and/or inpatient medical toxicology service

Practice diversification into medical toxicology provides an opportunity for the emergency physician to develop a subspecialty niche while continuing to confront the challenges of a diverse emergency medicine practice. This chapter discusses opportunities for emergency physicians in poison centers and medical toxicology practices.

Poison centers developed in the early 1950s as a means of centralizing information about toxic drugs and chemicals. As the number of available drugs and chemicals multiplied after World War II, individual physicians found it increasingly difficult to keep fully informed on product information and treatment recommendations for the growing number of potentially toxic agents available around the home and workplace.

Simultaneously, household poisoning became increasingly recognized as a problem area, especially among young children. A 1952 study showed that potentially poisonous ingestions accounted for more than 50% of childhood “accidents.”2 Responding to these developments, the first poison center opened in Chicago in 1953 as a collaborative effort among several local pediatric departments to meet the informational needs of local pediatricians.

Over the next few years, the poison center concept rapidly spread across the country. These first centers provided toxicity information on drugs and household products and made management recommendations to healthcare professionals. The National Clearinghouse for Poison Control Centers, established in 1957, helped standardize poison center informational resources by disseminating 5" × 8" index cards containing poison information to the various centers. In turn, the poison centers collected demographic data on toxic exposures that were tabulated by the Clearinghouse. As more centers opened, it became apparent that poison center services would also prove useful to the public. Accordingly, the public became the most frequent user at many centers.

By 1978 there were 661 poison centers in the United States. Many of these centers consisted of a part-time telephone service located in the back of the emergency department (ED) or pharmacy, often staffed by anyone who was free from other responsibilities.3 A survey of those varied poison centers in 1970 revealed wide disparities in the level of care, documentation, access, utilization, laboratory capability, and public education....

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