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California Poison Control System’s emergency response role triggered by tsunami in Japan

California Poison Control System’s emergency response role triggered by tsunami in Japan

During the two weeks following Japan’s March 11, 2011 earthquake and subsequent tsunami, the California Poison Control System (CPCS) was as visible as ever, answering telephone calls on poisoning questions. At the same time, it stepped into its emergency response role as it teamed with other health and emergency response agencies, in California and nationally, to address public concerns about radiation emissions from the quake-damaged nuclear plants in Japan and the use of potassium iodide to guard against potential exposure.

Emergency response

“This was an unusual situation, but emergency response is also part of our portfolio. We are here and ready to assist as part of the response team,” says Stuart Heard, PharmD, executive director of CPCS and UCSF School of Pharmacy faculty member. “The public’s typical expectation is that we are the go-to professionals who advise mothers whose babies get into poisons and other dangerous substances. We are certainly that, but we also have a major public health and safety role during emergencies.”

The CPCS avoids health crises and directly saves lives with its free, round-the-clock telephone consultations to the public, and to healthcare and emergency medical providers, on more than 300,000 poisoning cases each year. At the same time, it provides fast, reliable information during major public health events that involve chemical, biological, radiological, nuclear, or explosive (CBRNE) agents, and it provides real-time surveillance and identification of hazards.

Earthquake and tsunami case in point

The system’s emergency response role after the March 11, 2011 earthquake and tsunami is a classic case in point, as public concern mounted over a perceived threat to California of radiation exposure from quake-damaged Japanese nuclear power plants, and Californians questioned the use of potassium iodide as a protective agent against perceived radiation exposure.

While agencies including the California Department of Public Health (CDPH), the California Emergency Management Agency (CalEMA), the U.S. Environmental Protection Agency (EPA), and the U.S. Nuclear Regulatory Commission monitored and reported radiation risks, the CDPH, U.S. Centers for Disease Control and Prevention (CDC), and CPCS advised the public that potassium iodide was not needed for protection at the time: Japan’s radiation emissions posed no risk to California state residents. In fact, the medication could trigger potentially serious allergic reactions and side effects in some people.

Consistency, coordination key

“In this kind of situation it is important for all agencies to work together, be on the same page, and deliver consistent, clear messages to the public,” says Heard.

“Here at the CPCS and nationally, we take the lead from the American Association of Poison Control Centers, working in partnership with state, local, and national agencies,” he explains. “Alerts from various agencies, the press, and CPCS staff observations trigger internal communications about emerging public health events. Additional information and messaging is provided to CPCS staff as needed. In cases where CPCS detects an issue, we reach out and contact appropriate local, state, and national agencies.”

Calls answered

For its part, the CPCS answered more than 150 calls about potassium iodide use and other concerns. An additional 210 calls were received by the nation’s 53 sister poison centers, all of which form a coordinated national network of poison centers.

Emergency communications to the public

Beyond responding to individual calls, the CPCS pushed out a series of communications to the public during the week following the March 11, 2011 earthquake and tsunami in Japan:

Press release:

On Wednesday, March 16 the CPCS issued a press release stating that there was no radiation risk from Japan at the time. The release asked the public to refrain from ingesting any drugs that are used for radiation incidents, and to keep abreast of updates through the CPCS.

News feeds:

By Tuesday, March 15 the system had already ramped up its newsfeed on Facebook (California Poison Control System) and Twitter (@PoisonInfo): "We ask that everyone refrain from ingesting any drugs used for radiation incidents. Being overly zealous can lead to harmful effects. If you have any questions, you can always call us (CPCS) at 1-800-222-1222.”

Updates:

Information was continuously added to the CPCS Facebook page and Twitter feed as the week went on, including video of a local television interview on radiation with CPCS San Diego division medical director, Rick Clark, MD.

Text message:

On March 20, 2011 the system’s weekly English / Spanish text message service for home and family safety (opt-in by texting TIPS to 69866) focused on the issue.

Uptick in calls

During the initial weekend following Japan’s catastrophes, the CPCS started receiving dozens of calls from state residents to its round-the-clock, professionally staffed, toll-free telephone number (1-800-222-1222), asking if they should take potassium iodide. Amid reports of soaring sales of what the New York Daily News sensationalized as “Anti-nuke pills,” some callers had already taken the medication and worried about side effects.

The CPCS fielded calls and provided statements warning people against taking potassium iodide pills.

 

Preparation:

A CPCS staffer in San Diego first alerted that division’s director and Heard. By Sunday night, March 13, 2011, Heard had contacted the director of surveillance for the American Association of Poison Control Centers (AAPCC), Alvin Bronstein, MD, who alerted other centers around the country, and set up special input codes to track calls related to the Japan earthquake and tsunami in AAPCC’s near-real-time National Poison Database System.

Heard and Lee Cantrell, PharmD, DABAT, managing director of the CPCS’s San Diego division, chair of AAPCC’s scientific review committee, and also a UCSF School of Pharmacy faculty member, worked with national leaders to send out guidance and talking points to poison control centers nationwide.

Coordinated response:

During the following week, Heard was on conference calls with other California state and national health and emergency officials, while checking with the CPCS’s four state division directors and staff member—all to ensure a well-coordinated response.

Indeed, as has become increasingly common, the system’s specialists—pharmacists, nurses, and trained poison information providers, backed by physicians and pharmacists board-certified in toxicology—provided appropriate health advice, 24/7. They heard from some callers who believed conflicting information from selective internet reading, and who were adamant about their views.

“It is understandable why the public was concerned, but it can be frustrating when some callers do not believe what government agencies and we are telling them,” says Heard. “This is why it is essential that all agencies—including our poison centers—send a correct, clear, and consistent message during these emergencies.”

Surge capacity being built

While the CPCS’s bump in potassium iodide queries was notable, it was small compared to historic call-spikes, such as the hundreds of calls per day during the national anthrax scare of October 2001.

In fact, the organization is bolstering its communications system with “surge capacity” to manage far larger events in addition to its ongoing regular calls about poisoning.

Thanks to a U.S. federal grant from the CDC, administered by the CDPH, the CPCS will be able to patch its specialists and others into the system’s secure phone and data system to handle a wave of calls remotely, if a situation should demand more personnel.

At the ready

“We are all about being prepared and coordinating with other agencies,” says Heard. “We are ready—whether it’s about a single child who has swallowed something from under the sink, or thousands of citizens worried about a CBRNE event.”

 

About the California Poison Control System

Follow CPCS on

Text TIPS to 69866 for weekly tips about poison prevention.

CPCS is dedicated to providing residents with the most up-to-date information and 24-hour help in case of poisoning. In case of an accidental poisoning, consumers should immediately call 1-800-222-1222 for advice. Pharmacists, nurses, physician-toxicologists, and poison information providers are available 24 hours a day, 365 days a year to help. In most cases, a poison exposure can be safely managed in your home, avoiding a call to 911 or a visit to a crowded hospital emergency room. Many parents think about contacting the poison control services only in case of an emergency, but experts are available to answer questions any time.

The CPCS has four divisions located at:

  • University of California, Davis Medical Center in Sacramento
  • San Francisco General Hospital in San Francisco
  • Children’s Hospital Central California in Fresno/Madera
  • University of California, San Diego Medical Center in San Diego.

The CPCS is part of the University of California, San Francisco School of Pharmacy, Department of Clinical Pharmacy, and is responsible to the California Emergency Medical Services Authority.

Main website: http://www.calpoison.org/


About the School: The UCSF School of Pharmacy is a premier graduate-level academic organization dedicated to improving health through precise therapeutics. It succeeds through innovative research, by educating PharmD health professional and PhD science students, and by caring for the therapeutics needs of patients while exploring innovative new models of patient care. The School was founded in 1872 as the first pharmacy school in the American West. It is an integral part of UC San Francisco, a leading university dedicated to promoting health worldwide.

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