POISONS AND PANIC

Home management of the majority of poison center callers is safe and c ost-effective; but in the absence of poison center consultation, could callers correctly assess the severity of a poisoning? This study was conducted to determine indirectly whether callers can correctly assess the toxicity of a substance involved in a poison exposure by determin ing whether caller panic levels correlated with the expected toxicity of the exposure. Using a digital call recorder, 100 calls to the Natio nal Capital Poison Center involving children <10 y were reviewed. The panic level of each caller was assessed and scored on a It-point ratin g scale and compared to the toxicity of the substance implicated (also on a 4-point rating scale). Most callers were mothers (85%), most pat ients were <4 y (86%), and most exposure routes were ingestions (89%). Although there were only 12 male callers, male callers were significa ntly more panicked than females. Overall, there was a correlation betw een the panic level of the poison center callers and the toxicity of t he substance Involved in the exposure, with the mean panic level incre asing as the toxicity increased. However, only 36% of patients had a p anic level that was exactly appropriate for the toxicity level. Most c allers were more panicked than they needed to be (57%), including 14% of callers who were much more panicked than they needed to be. Seven p ercent of callers were too calm; they appeared not to understand how t oxic the exposure really was. Based on these data, one could predict t hat the majority of callers were sufficiently panicked that, had the p oison center not been available to provide immediate consultation, the callers may have over-reacted and called 911 or gone straight to a ho spital. Yet only of the 57 overly-panicked callers was calling about a patient who actually required medical intervention. Of great concern, the 7% of patients who were too calm may have required medical interv ention that, due to underestimation of the severity of the exposure, m ay have been withheld or delayed. Three of these ''too calm'' cases ac tually required medical intervention. Although subject to a number of design limitations, this study suggests that callers frequently over-r eact to poison exposures. In the absence of a well-utilized poison con trol system, excessive panic may contribute to excessive use of emerge ncy departments and ambulance services and create excessive health car e costs for poisoning emergencies.