Established in 1982, the Canadian Association of Poison Control Centres provides a centralized forum for communication, information & idea exchange among Canadian Poison Centres. While its members are primarily professionals working in Poison Control Centres, other members have included pharmacists, pharmaceutical companies, forensic toxicologists, public health staff and emergency physicians.
History of Poison Control in Canada
In 1958, Health and Welfare Canada (now Health Canada), established the Poison Control Program, within the Product-Related Diseases Division. Product formulation cards (and later microfiche) served as the database for information requests regarding exposures. These cards were distributed to all active treatment hospitals throughout Canada. Manufacturers would voluntarily submit this information to Health and Welfare Canada. Missing information would be solicited by Health and Welfare Canada staff when an exposure occurred to a product about which no information was available. In exchange for these information cards, Centres kept statistics and reported these back to the Program. Annual reports were produced from the data until 1988 when the federal program folded.
Although the database and statistical reports came from the Federal Poison Control Program, funding for the Centres was provincial and varied from province to province. In the ‘60s and ‘70s, most Centres were in the Emergency Departments of active treatment hospitals. The Poison Telephone was usually answered by the ER nurse. In the ‘80s, most of these local centres were replaced by regional or provincial centres with dedicated, trained staff. Physicians with specific training in Toxicology were hired to give medical direction and continuing education. As many of the exposures were pediatric, four of the dedicated centres were located within pediatric hospitals. Although, initially, calls to the Poison Information Centres were from the public, over the years, increasingly, health care providers have come to rely on the toxicological expertise of the staff at Poison Centres to assist with the management of poisoned patients who present to Health Care facilities. Pediatric and adult calls are approximately equal in number.
In 1968, the Ottawa Civic Hospital Poison Information Centre was opened. During the day, a dedicated Registered Nurse answered calls from the public; at night, the intern staffing the Emergency Department answered these calls. Similarly, a dedicated Registered Nurse answered calls in the Emergency Department at the Hospital for Sick Children starting in 1977. Both Centres were staffed 24/7 with full time Medical Directors from 1981 forward. In 2005, the Regional Centre at the Children's Hospital of Eastern Ontario was closed. The Centre at the Hospital for Sick Children became the Ontario Poison Centre. In 2007 the Centre entered a partnership with Montfort Hospital and opened a satellite site in Ottawa, thereby ensuring the sustainability of providing services in both official languages.
The BC Drug and Poison Information Centre (DPIC) began as a research project in the mid-1960s at the Faculty of Pharmaceutical Sciences at the University of British Columbia (UBC). The project involved development and distribution of Poison Information Cards designed to assist practitioners in the diagnosis and treatment of poisoning incidents. DPIC was formally established at Vancouver’s St. Paul’s Hospital in 1975 through the cooperative efforts of the Hospital Programs Branch of the BC Ministry of Health and UBC. The original mandate of the Centre called for the development of centralized services to assist health professionals throughout BC in providing optimal levels of drug therapy and poison management. Public access to poison control began in 1981 for residents of the Vancouver area, further expanding to include the Victoria region in 1985. The following year, nurses joined the existing staff of pharmacists and consulting physicians, and the entire province was opened to toll-free poison information services. The Centre’s history of providing supplemental toxicology information in written form has continued with publication of the Poison Management Manual, which replaced the original Poison Information Cards in 1981. In addition to its UBC association, since 2002 DPIC has been affiliated with the BC Centre for Disease Control which is an agency of the Provincial Health Services Authority.
In 1986, three remaining regional poison centres in Quebec were amalgamated as one provincial centre at le Centre Hospitalier de l'Université Laval in Québec City. Specialist nurses are located in the Centre in Quebec. Toxicologists throughout the province remained on staff. In 2003, the Centre was moved and came under the jurisdiction of the CLSC-CHSLD Haute-Ville-Des-Rivières.
Alberta established the toll-free provincial Poison and Drug and Information Service (P.A.D.I.S.) in 1986 at the Calgary Foothills Hospital. The Centre was established to replace five regional centres and to link the provision of poison information services with that of drug information services already established and operating out of the Pharmacy Department at the Foothills. Both registered nurses and pharmacists now answer these information lines.
In 1993, a toll-free poison information number for southern Saskatchewan was established in Regina and another in Saskatoon for northern Saskatchewan, but with no dedicated staffing. In 2001, Saskatchewan contracted with the Alberta Poison Centre to provide comprehensive poison service to Saskatchewan through a dedicated toll-free number.
Also in 1993, the IWK Regional Poison Centre was established at the IWK Hospital in Halifax, Nova Scotia replacing the red phones in the pediatric emergency department. Specialist trained nurses and pharmacists answer the poison information lines. A physician toxicologist joined the Centre in 2005 and a complement of Emergency Physicians offer medical back-up.
Each of these Centres, strives to follow the criteria as set by the American Association of Poison Control Centers (AAPCC) for certification. The registered nurses and pharmacists answering the information lines in each of these Canadian Centres are eligible for certification as a Specialist in Poison Information. Eligibility for certification includes at least two years of full time employment at a Poison Centre, handling of two thousand human exposure calls and challenging a written examination as set by the AAPCC.
The Children’s Hospital in Manitoba has a dedicated telephone information line in the Emergency Department answered by physicians. The phone number is local only. No toll-free line is available for the Province. In Newfoundland, a registered nurse answers a dedicated province wide information line from 0800-2400. In New Brunswick, poison calls from the public are answered by a health information line registered nurse. These nurses have no specific training in toxicology. No information line is available for health care providers. None of the Territories have dedicated poison centres although poison calls are handled either by 911 operators or by personnel in the Emergency Departments in Whitehorse, Yellowknife and Iqualuit. Specific expertise and consultation may be sought as necessary from other provincial poison centres.
CANADIAN ASSOCIATION OF POISON CONTROL CENTRES
In order to provide some cohesiveness and sense of "system" to a fragmented group of Poison Centres dispersed across the country, a voluntary association, the Canadian Association of Poison Control Centres (CAPCC) was formed at a meeting of Medical Directors in Toronto in 1982.
The CAPCC provides a centralized forum for communication, information & idea exchange among Canadian Poison Centres. While its members are primarily professionals working in Poison Control Centres, other members have included pharmacists, pharmaceutical companies, forensic toxicologists, public health staff and emergency physicians.
PRODUCT FORMULATIONS DATABASE
The Federal Government Product database was maintained and distributed until 1988. At that time, the CAPCC and the Canadian Paediatric Society negotiated with Health & Welfare to take over responsibility for the database. The CPS agreed to use its permanent secretariat address for the receipt of Canadian product formulations. The CAPCC decided that the needs of its members would be best served by incorporating the Canadian data into the existing POISINDEX database that was presently being used by all members. Because of cross border trade, having access to American data was important. Subsequently, the Canadian federal data files were downloaded into the Poisindex System. These records are updated and new records are solicited through mailouts to lists of manufacturers. The submissions are funneled through the Ottawa Poison Centre under the auspices of the Canadian Paediatric Society, to Poisindex. Some Canadian companies, primarily industrial, only submit their information to the Centre for Occupational Health (Hamilton). Thus their CCINFO database, which is unedited MSDS', is also essential. Both databases are CD-ROM and Web based.
As poison centres are funded provincially, each province has different reporting requirements and formats. Currently, no federal government department keeps of reports national poisoning statistics, except for those resulting in death. An initiative by Health Canada to establish a Canadian poison database and statistics was piloted in 2002 but funding was cancelled prior to its national implementation.
The CAPCC remains committed to working towards the development of national statistics.