The importance of interpersonal communication in poison centers.

BACKGROUND: Poison control center (PCC) personnel face many challenges in communicating with callers and with each other. The purpose of this study was to identify interpersonal communication issues that affect the work environment within PCCs. METHODS: As part of a larger questionnaire study distributed electronically to members of the American Association of Poison Control Centers (AAPCC) to assess communication training needs for PCCs, three questions were included to assess interpersonal communication within the work environment: (1) How important is interpersonal communication within your center to a positive work environment? (not at all to extremely important, 1-7); (2) How disruptive is interpersonal communication to your work? (not at all to extremely disruptive, 1-7); and (3) What communication issues do you find most disruptive to your work? (free-text response). Descriptive and qualitative content analyses were used to identify themes in responses. RESULTS: A total of 537 responses were received from SPIs, directors, medical directors, and other PCC staff. Interpersonal communication within the PCC was rated as extremely important to a positive work environment (median = 7 and IQR = 6-7; 62.3% rated as extremely important). Interpersonal communication was rated as less than moderately disruptive on average (median = 3 and IQR = 2-4). Free-text responses were received from 335 (62%) respondents. Free-text comments were broadly categorized as relating to PCC personnel and work environment and issues related to PCC callers. Categories that emerged from the PCC personnel and work environment category included the following: poor interpersonal communication (n = 104; 31%); background noise (n = 96; 29%); poor work procedures (n = 51; 15%); and poor management communication (n = 38; 11%). CONCLUSION: Interpersonal communication within PCCs was considered to be important for a positive work environment. Although not found to be strongly disruptive by most respondents, several specific interpersonal communication issues were identified by PCC personnel as disruptive to their work.

High call volume at poison control centers: identification and implications for communication.

CONTEXT: High volume surges in health care are uncommon and unpredictable events. Their impact on health system performance and capacity is difficult to study. OBJECTIVES: To identify time periods that exhibited very busy conditions at a poison control center and to determine whether cases and communication during high volume call periods are different from cases during low volume periods. METHODS: Call data from a US poison control center over twelve consecutive months was collected via a call logger and an electronic case database (Toxicall®).Variables evaluated for high call volume conditions were: (1) call duration; (2) number of cases; and (3) number of calls per staff member per 30 minute period. Statistical analyses identified peak periods as busier than 99% of all other 30 minute time periods and low volume periods as slower than 70% of all other 30 minute periods. Case and communication characteristics of high volume and low volume calls were compared using logistic regression. RESULTS: A total of 65,364 incoming calls occurred over 12 months. One hundred high call volume and 4885 low call volume 30 minute periods were identified. High volume periods were more common between 1500 and 2300 hours and during the winter months. Coded verbal communication data were evaluated for 42 high volume and 296 low volume calls. The mean (standard deviation) call length of these calls during high volume and low volume periods was 3 minutes 27 seconds (1 minute 46 seconds) and 3 minutes 57 seconds (2 minutes 11 seconds), respectively. Regression analyses revealed a trend for fewer overall verbal statements and fewer staff questions during peak periods, but no other significant differences for staff-caller communication behaviors were found. CONCLUSION: Peak activity for poison center call volume can be identified by statistical modeling. Calls during high volume periods were similar to low volume calls. Communication was more concise yet staff was able to maintain a good rapport with callers during busy call periods. This approach allows evaluation of poison exposure call characteristics and communication during high volume periods.

Fatal unintentional occupational poisonings by hydrofluoric acid in the U.S.

BACKGROUND: Case reports have identified hydrofluoric acid (HF) as causing fatal work injury, and HF has both local and systemic toxicity. Surveillance for HF-related mortality is problematic because of the lack of unique coding for this acid in hospital records and vital statistics. METHODS: We identified HF-related fatal work injuries investigated by the Occupational Safety and Health Administration (OSHA) for 1984-94 from coding of Hazardous Substance 1460 (HF) and requested case investigation files under the Freedom of Information Act. We attempted to identify HF-related deaths in the US for the same period through literature case reports, the Consumer Product Safety Commission, and the American Association of Poison Control Centers (AAPCC). RESULTS: For the 11 year period, OSHA investigated nine deaths in eight incidents which involved HF. Four deaths were from skin contact with concentrated HF, and five deaths involved both skin contact and inhalation of vapor. Unsafe work practices were factors in all of the deaths. Calcium chloride or gluconate was noted to have been administered to five of the nine victims. Calcium was administered 90 min after exposure to two victims, and more than 6 h after exposure to a third. We were able to establish that the regional poison control center had been contacted in regard to only one victim. For the period 1984-94, we were able to identify no additional deaths from CPSC reports, one additional death from AAPCC annual reports, and four other deaths from case reports in the medical literature. CONCLUSIONS: For the period of this study, OSHA records identified the greatest number of HF-related fatalities. The limited information in the records suggest that some victims did not receive appropriate medical care, nor was the regional poison center contacted regarding care. The full extent of health problems related to HF could be better quantified if usual surveillance sources, such as vital records, included unique coding for this acid.

Prevalence and patterns of alternative medication use in a university hospital outpatient clinic serving rheumatology and geriatric patients.

A random sample of 176 patients seen at least once during 1997 in a University hospital outpatient clinic serving rheumatology and geriatric patients were surveyed in a telephone interview to determine the prevalence of, and reasons for taking, alternative medications. Interviews were conducted from November 1997-March 1998. The survey elicited information about patients' ability to provide self-care, demographics, work status, satisfaction with current disease management, types of alternative medications taken, sources of information about the products, where they obtained the products, and reasons for taking the products. Patients also were questioned as to their knowledge of safety of these products. Statistical comparisons were determined between patients who used alternative agents and those who did not. Prevalence of use was 66%. Most patients thought that the agents were safe and took them because they believed they have "added benefits."

Benzonatate overdose associated with seizures and arrhythmias.

BACKGROUND: Benzonatate is an antitussive with a unique chemical structure. It can contain as many as 8 structural analogs. Therefore, laboratory analysis of benzonatate is difficult. We report 2 cases of benzonatate poisoning with seizures and cardiac arrest and an analytical method to identify and quantify benzonatate in human plasma. CASE REPORTS: Case 1: A 12-month-old male presented to the emergency department of a rural hospital following ingestion of an unknown amount of benzonatate. Upon arrival, the child was seizing and in full cardiac arrest. Resuscitative measures were unsuccessful and the child died shortly after arriving at the emergency department. Case 2: A 39-year-old male ingested 36 benzonatate capsules in a suicide attempt. Enroute to the health care facility, the patient experienced a seizure, had a cardiac arrest, and was cardioverted. Upon arrival at the emergency department, the patient was acidotic with a pH of 6.8. Gastric lavage was performed followed by the administration of activated charcoal. Six hours after arrival at the emergency department, the patient was alert, oriented, and hemodynamically stable. The patient was observed for 24 hours and subsequently discharged. Laboratory confirmation of benzonatate in the plasma of the patient was performed using high-pressure liquid chromatography with tandem mass spectrometry (MS/MS). The benzonatate concentration was estimated to be 2.5 micrograms/mL. CONCLUSION: Seizures and cardiac arrest are possible following an acute ingestion. Quantitative analysis of benzonatate is possible using high-pressure liquid chromatography with tandem mass spectrometry. Routine analysis for benzonatate is not common.

Fatal accidental dibucaine poisoning in children.

Dibucaine is a potent amide anesthetic available in over-the-counter preparations. Compared with lidocaine, substantially lower doses of dibucaine may result in seizures, dysrhythmias, and death. We present three fatal cases of accidental dibucaine ingestion in children and discuss the toxicity, treatment, and prevention of such ingestions.

Cyclizine abuse by teenagers in Utah.

Substance abuse by teenagers is common, often involving use of alcohol and illicit drugs. Ingestion of cyclizine hydrochloride, a nonprescription medication, was noted to occur frequently in Utah for abuse reasons. A retrospective review was conducted of patients younger than 18 years of age over a 3-year period who intentionally ingested cyclizine identified from Utah Poison Control Center records. Eighty patients were included; 42 patients underwent hospital record review. Abuse accounted for 89% of cyclizine ingestions; hallucinations (70%) and confusion/disorientation (40%) were the most notable symptoms. Tachycardia (52%) and systolic hypertension (69%) were frequently present in patients who presented to a hospital. No serious complications occurred. This study illustrates teenage abuse of one nonprescription antihistamine presumably to induce hallucinations. Abuse of over-the-counter medications by adolescents may be more appealing than illicit drug use for numerous reasons, and may be more common than appreciated.

A survey of pet owner views of veterinarians in Brisbane environs - a behavioral approach.

Three hundred and thirty-seven pet owners were interviewed by final-year veterinary students from the University of Queensland, using a questionnaire prepared by the authors. The survey area included Brisbane city and suburbs and was conducted in 1977. The majority of respondents (52.5%) reported that the pets were owned by the family, while 24.6% claimed that pets were owned by individual adults only. Dogs and cats were the most popular pets. Of the respondents sampled, 51% changed their veterinarian while 46% reported that they had not changed their veterinarian. Satisfaction with the service, nearness of the service and personal liking were the major reasons for continuing to use the same veterinary surgeon. Nearly 40% of respondents used the veterinary service on the basis of recommendation of friends, relatives and other people who owned similar types of pets. According to the respondents, major qualities for a good veterinarian are: competence and knowledge (86.9%), compassion for animals (61.7%), professional approach (which includes good listening and explanation, the instillation of confidence, integrity and appearance) (57.4%), regard for owners and their feelings (46.3%), good surgery conditions (14.2%) and reasonable fees (12.8%). While professional competence was reported as one of the important qualities of a good veterinary service, the majority (51%) of them disagreed with the statement that professional competence is the only thing that matters in the care of pets and many other social and interpersonal factors influenced their attitude towards the veterinary service. The application of behavioural sciences to the veterinary profession is discussed.

Rural alcohol abuse.

One hundred and forty-eight rural males between the ages of 18 and 60 volunteered to be tested and were interviewed with a series of scales and background information items that were selected to predict alcohol abuse or nonabuse. The subjects were classified as Black abusers, Black nonabusers, White abusers, and White nonabusers. Major sections of the test and interview format included measures of achievement need, alienation, tolerance of deviance, leisure time, religious fundamentalism, general deviation, mobility, age, family size, and education. Criteria of abuse and nonabuse were based on interview information related to quantity consumed, circumstances for drinking, problems related to drinking, and a community estimate from references. Field research data across 32 Texas villages were used to develop recommendations for education, information, and treatment for strictly rural American areas. Analysis of variance methods identified significant differences between abusers and nonabusers on measures of tolerance of deviance, religious fundamentalism, general deviation, mobility, age, and education.