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In 2013, the National 'Committee for the Assessment of Poisonings' at the Federal Institute for Risk Assessment (BfR) has founded a Working Group that evaluates opportunities for establishing a continuous national monitoring of poisonings in Germany, based on case data of all nine German poisons centres.

Objectives and results of this Working Group were presented in German language at the 50th anniversary celebration of the National Committee 'Assessment of Poisonings' in April 2014. A translation of this presentation is provided here:

 

Outview: National Monitoring of Poisonings in Germany National Register of Intoxications

Herbert Desel

Translation of Presentation at the 50th anniversary celebration of the Committee Assessment of Poisoningsat the Federal Institute for Risk Assessment (Bundesinstitut für Risikobewertung),
Berlin, 2014-04-29

Vision of the German Chemicals Act (chap 16 e) in 1990

Tasks for poisons centres and poisoning treatment units:

[1] (a) to collect and

     (b) to evaluate

findings concerning the health effects of hazardous substances and dangerous preparations

and

[2] to provide help in substance-related medical disorders by

(a) consultation and

(b) medical treatment.

Reality of the Chemicals Act in 2014

[1] to collect an evaluate findings: only minor activity

[2] to provide help in individual cases: major activity

New expectations for Poisons Centres from Different Stakeholders

Increasing enquiries related to retrospective analyses on the incidence of selected poisonings

- from authorities (federal, federal states, etc.)

- and also from industry (chemical/ pharmaceutical)

Prospective studies on products with poisoning risks (monitoring)

- cooperation with companies and industry associations

- including detailed reports on circumstances of poisonings (exposures) that may point to insufficient product safety measures

Quick identification / confirmation / treatment of initially hidden acute poisoning risks

- on national level: national exercises LÜKEX 2013

- on European level: assessment of potential of cross-border threats
(Resolution 1082/2013 / EU)

- example 1: use of sodium nitrite instead of sorbitol as a medical diagnostic (1 death in Italy, more severe poisoning in 2012)

- example 2: alkyl phosphate-contaminated ready meals in Japan 2014 (impact on Europe?)

Challenge: How can poisons centres meet these new requirements?

Fast and easy access to harmonised and real-time case reports is an important tool

Model USA: National Poison Data System (NPDS, earlier TESS)

Model for German Poisons Centres: The US National Poison Data System (NPDS)

55 independent poisons centres

collect case data in database maintained by the American Association of Poison Control Centres

in close cooperation with authorities and industry

Technical Achievements in the Past

National Research Projects: EVA (1994), TDI (1998-2004),

Experience from case data collection studies organised by the (German Speaking) Society for Clinical Toxicology (GfKT)

EU European Poisons CentresReport 1991 - 1994

IPCS INTOX Project

Conclusions from Recent Projects

Harmonised reporting is possible

Summary reports (eg number of requests in a period) is easily possible

Reporting with breakdown of agent groups requires an agent category system used in a harmonised way and often requires manual editing of the cases

Reporting with proven indication of poisoning severity also often requires post-processing of cases

Follow-up of cases and wrap-up of case documentation exceeding the requirements of patient-centred acute care advice is also a resource-intensive task

Establishment of the Subcommittee 'National Poisoning Monitoring' of the BfR 'National Committee for the Assessment of Poisonings'

To build a nation-wide register of poisoning

- planned to work continuously

Objective:

- National annual report(s) with breakdown by agent groups, patients ages and degrees of poisoning severity

- Enable / facilitate / accelerate case analysis based on case data of several poisons centres in cases newly detected or suspended risks or concerns

Concept for National Poisoning Monitoring

Independent organisation (foundation?) with own staff

- closely connected to Society of Clinical Toxicology (GfKT)

Membership of all/participating poisons centres

Financing by stable long-term public and private funding (eg. in the sense of sponsoring memberships)

(detailed business plan was drafted)

Previous Committee Work

Intensive discussions with various stakeholders

- poisons centres directors (GfKT AG-II): in principle affirmative

- authorities

- NPDS

- ... (..to be continued)

Other (Working Group) Tasks

Evaluation of contractual sponsoring models

Creation of the institutional framework

Engaging staff

Conclusion: The German National Poisoning Monitoring

Continuous reporting on poisoning in Germany

It is desirable and

it technically possible

it requires an organisational framework that facilitates constructive cooperation of poisons centres

a continuous coverage requires ongoing substantial additional work in the poisons centre, which is to be considered as part of an overall concept and financing.