The Current Role of Clinical Toxicology and Poison Centers in Local and State Public Health

Background: The current state of collaboration among clinical toxicologists, poison centers (PC) and health departments (HDs) is unclear. Our primary objective was to describe current relationships among clinical toxicologists with local and state HDs. Our secondary objective was to identify areas of mutually beneficial collaborative partnerships that exist or may be formed. Methods: A on-line survey was sent to the medical or managing directors of PCs, state epidemiologists, and the most senior public health (PH) official within each state and selected major metropolitan areas. This survey was tailored to each group and focused on four topic areas: remuneration, service, structure within the local or state PH system, and overall opinions regarding the utility of enhanced PC collaboration with their respective HDs. Results: 171 subjects were contacted for the survey. 89/171(52%) surveys were completed. PC directors accounted for 33 responses (33/89, 37%), state epidemiologist accounted for 36 responses (36/89, 40%) and senior state and local PH officials accounted for 20 responses (20/89, 23%). Regarding remuneration, 30/33 (91%) of PC directors receive no specific local or state compensation for services as a consultant However, 15/32 (47%) of PC directors participate in PH epidemic and illness surveillance and 10/31 (32%) take PH rabies calls. 29/32 (91%) serve as advisors to PH officials for terrorism preparedness. Regarding structure, 18/33 (55%) PC directors, 22/26 (61%) of state epidemiologists and 17/20 (85%) of senior state and local health officials all feel PCs should remain separate organizations. However, all groups overwhelmingly believe that relations between PCs and HDs need to be strengthened with increased collaboration. Discussion: We identified areas where some PCs and HDs are collaborating in order to highlight opportunities for beneficial partnerships. Current areas of collaboration include rabies, terrorism preparedness, and epidemic and illness surveillance. Conclusion: PC and PH officials should seek to increase collaborations which will be mutually beneficial. These collaborations can reduce PH workload and improve remuneration to the PC.