WEBVTT - Ep 149 Poison Control Part 2: Call me maybe 0:00:38.320 --> 0:00:47.640 Hi, I'm Aaron Welsh and I'm Aaron Olman up dank 0:00:48.040 --> 0:00:50.199 and this is this podcast will kill. 0:00:50.040 --> 0:00:53.120 You And we're obviously doing things weird because why are 0:00:53.120 --> 0:00:54.360 you hearing from us? Straight away? 0:00:55.680 --> 0:00:58.280 That really felt weird. I was like, there's no first 0:00:58.360 --> 0:01:00.920 hand to count, so I just how do we begin. 0:01:01.040 --> 0:01:01.840 Ease into this? 0:01:02.080 --> 0:01:02.160 No? 0:01:04.600 --> 0:01:05.880 We eased in last week? 0:01:06.080 --> 0:01:07.959 Yeah, yeah, last week. 0:01:08.160 --> 0:01:10.520 Did you listen? If you haven't heard last week's episode, 0:01:10.680 --> 0:01:12.760 I'm not saying like you must pause this and go 0:01:12.840 --> 0:01:15.119 check it out, but like you probably should because we 0:01:15.200 --> 0:01:20.240 had so much fun talking and learning about what is 0:01:20.640 --> 0:01:24.000 poison control and how did poison centers come to be? 0:01:24.200 --> 0:01:27.680 Like where did they arise from? And how did we 0:01:27.760 --> 0:01:31.080 even figure out that that needed to happen. It's a 0:01:31.080 --> 0:01:35.040 great episode. Definitely check it out. And so today we're 0:01:35.080 --> 0:01:38.160 picking up essentially where that left off. 0:01:38.680 --> 0:01:41.040 Right, So we learned all about how they came to be, 0:01:41.200 --> 0:01:44.480 but we didn't learn what they do, how they work, 0:01:44.800 --> 0:01:48.320 who works there, all of these questions that are really 0:01:48.400 --> 0:01:53.120 kind of integral to the existence of poison control centers today. 0:01:53.920 --> 0:01:57.000 And so that is what we're getting into this week. 0:01:57.760 --> 0:02:01.320 And we are getting into that with the help of 0:02:01.880 --> 0:02:06.640 an actual, super duper expert doctor Suzanne Dourion, who is 0:02:06.680 --> 0:02:10.200 the medical director of the Connecticut Poison Control Center and 0:02:10.600 --> 0:02:14.080 is an associate professor at the University of Connecticut School 0:02:14.120 --> 0:02:17.880 of Medicine, and she's a toxicologist. I mean, like, honestly, 0:02:18.200 --> 0:02:22.840 it's this conversation was so much fun. She knows everything 0:02:22.840 --> 0:02:25.120 about all the stories she has. 0:02:25.680 --> 0:02:27.480 This is why we don't need another first hand account 0:02:27.480 --> 0:02:30.520 because she's got so many stories for us. It's phenomenal. 0:02:30.680 --> 0:02:33.800 She sat down with us to answer all of our 0:02:33.840 --> 0:02:36.519 burning questions about what it is like on the other 0:02:36.760 --> 0:02:39.120 end of that phone line when we call in to 0:02:39.200 --> 0:02:42.320 Poison Control, what it took to become a medical director 0:02:42.360 --> 0:02:44.040 of a poison center, what it takes to be a 0:02:44.040 --> 0:02:47.880 poison specialist, by the way, best job title I've ever 0:02:47.919 --> 0:02:51.520 heard of, And there's so much more in this interview. 0:02:51.520 --> 0:02:53.880 We are thrilled to be able to have had this 0:02:53.919 --> 0:02:56.120 conversation and to share it with all of you. It's 0:02:56.320 --> 0:02:58.240 it's going to be a really great episode. We're stoked, 0:02:58.520 --> 0:02:59.320 it really is. 0:03:00.000 --> 0:03:04.720 Before we get into all of that, it is quarantiney time. 0:03:04.919 --> 0:03:07.800 It still is. It still is the same drink as 0:03:07.880 --> 0:03:08.400 last week. 0:03:09.840 --> 0:03:10.960 It's just that good. 0:03:11.320 --> 0:03:12.359 Name your Poison? 0:03:12.720 --> 0:03:14.320 Yeah, I mean, and if you want to stick with 0:03:14.520 --> 0:03:19.800 last week's like recipe, it is whiskey again of whatever kind, 0:03:19.880 --> 0:03:22.800 probably not a pede scotch blah blah blah whatever. Do 0:03:22.880 --> 0:03:27.600 a whiskey and then peaches, lemon juice, simple syrup. It's delicious. 0:03:27.800 --> 0:03:30.520 But hey, it's called name your poison. If you're like, 0:03:30.680 --> 0:03:32.680 you know what, I'm going to do a variation on this, 0:03:32.919 --> 0:03:34.520 I'm going to do something else. I'm going to do 0:03:34.600 --> 0:03:41.840 nectarine instead of peaches. Wow, go wild, wild, go absolutely wild. 0:03:43.560 --> 0:03:47.360 All that to say, the recipe is on our website, 0:03:47.480 --> 0:03:49.800 it's on our social media. Do you follow us on 0:03:49.840 --> 0:03:53.600 social media? We're on TikTok, We're on Instagram, we're on Twitter. 0:03:53.680 --> 0:03:54.000 Rex. 0:03:54.520 --> 0:03:55.720 Is that what they're calling it these days. 0:03:55.680 --> 0:03:56.640 I'm not sure. 0:03:56.920 --> 0:03:59.440 I think it's it's like Prince the artist formally known 0:03:59.480 --> 0:04:01.400 as so it's like X formally. 0:04:01.320 --> 0:04:02.640 Website formally on Twitter. 0:04:02.720 --> 0:04:08.600 Yeah, yeah, okay, anyways, we're there, Aaron, Yeah, do peach 0:04:08.640 --> 0:04:10.120 pits contain cyanide? 0:04:10.600 --> 0:04:10.920 Great? 0:04:11.160 --> 0:04:14.160 Just have that realization accroutely question. 0:04:16.440 --> 0:04:17.040 I don't know. 0:04:20.000 --> 0:04:23.560 Okay, we just confirmed via the search engine that we 0:04:23.640 --> 0:04:28.760 all use that. Yes, indeed, peaches contain peach pits contain 0:04:29.400 --> 0:04:33.360 well a compound that gets turned into cyanide when digested. 0:04:33.760 --> 0:04:37.240 And we didn't realize this. I mean, we should probably 0:04:37.320 --> 0:04:40.600 have just like delete all this in editing and then 0:04:40.600 --> 0:04:42.320 claim that we knew it from the beginning, but. 0:04:42.640 --> 0:04:46.039 We record our other intro. Yeah it's too late now. 0:04:46.600 --> 0:04:53.720 Yeah anyway, Yeah, we totally this did this intentionally. Oh, 0:04:54.520 --> 0:04:57.800 to enjoy your drink. Back to the other stuff website. 0:04:57.880 --> 0:05:00.040 This podcast will kill you dot com check it. We 0:05:00.120 --> 0:05:00.880 got great stuff. 0:05:00.960 --> 0:05:01.160 You know. 0:05:01.200 --> 0:05:05.119 It's got transcripts, it has got links to merch links 0:05:05.120 --> 0:05:08.960 to music by Bloodmobile, links to our bookshop, dot org 0:05:09.000 --> 0:05:11.880 affiliate account, our Goodreads list. It's got to submit your 0:05:11.880 --> 0:05:15.560 first hand account form. If you all have a Poison 0:05:15.640 --> 0:05:19.599 Control Center story, send us it. We would love We 0:05:19.640 --> 0:05:22.440 would love to hear those stories. Use the first hand 0:05:22.480 --> 0:05:24.240 account form or email us whatever. 0:05:24.480 --> 0:05:24.800 We have a. 0:05:24.760 --> 0:05:29.240 Contact us form on our website. Things can we get 0:05:29.240 --> 0:05:30.440 into the episode. 0:05:33.600 --> 0:05:35.719 Let's take a quick break and then we'll get to 0:05:35.720 --> 0:05:38.200 hear from doctor Susanoyan herself. 0:05:38.680 --> 0:05:39.240 Let's do it. 0:06:13.480 --> 0:06:16.880 We are thrilled to have you here, Doctor Doyon, thank 0:06:16.880 --> 0:06:19.880 you so much for joining us. If we could start 0:06:19.960 --> 0:06:22.960 off with you introducing yourself a little bit and telling 0:06:23.040 --> 0:06:27.080 us how you became interested in the field of toxicology 0:06:27.160 --> 0:06:29.880 and how you ended up as the medical director of 0:06:30.040 --> 0:06:31.359 a poison control center. 0:06:32.040 --> 0:06:33.479 Thank you, thank you for having me. 0:06:33.560 --> 0:06:36.400 This is just for me, a wonderful opportunity to share 0:06:36.440 --> 0:06:40.159 a little bit about the world of poison centers. So 0:06:40.560 --> 0:06:44.760 my name is Suzanne Doyon or Duyon, and I'm a physician. 0:06:45.040 --> 0:06:49.440 I went through medical school, but after finishing medical school, 0:06:49.480 --> 0:06:52.960 emergency medicine was where I was headed. And so I 0:06:53.000 --> 0:06:57.120 did a residency in emergency medicine. And during those four 0:06:57.200 --> 0:07:00.360 years as an emergency physician, you rotate to a number 0:07:00.360 --> 0:07:03.599 of different places. You do a little bit pediatric work, 0:07:03.640 --> 0:07:06.040 you do this at the other one of the rotations 0:07:06.120 --> 0:07:09.480 was a whole month at the New York City Poison Center, 0:07:09.600 --> 0:07:13.000 and I just, you know, really really enjoyed that work. 0:07:13.720 --> 0:07:16.960 So upon finishing my four years, I chose to do 0:07:17.040 --> 0:07:20.240 what they call the fellowship. So that was my entire training. 0:07:20.280 --> 0:07:22.880 Four years of medical school, four years of emergency medicine, 0:07:22.920 --> 0:07:27.200 and two years of medical toxicology. What was it about 0:07:27.240 --> 0:07:28.880 the specialty that attracted you? 0:07:29.000 --> 0:07:33.400 Right? And so, of course poisonings are very, very interesting. 0:07:33.040 --> 0:07:40.000 But really it's the opportunity to really dig deep into 0:07:40.080 --> 0:07:45.680 a subject matter, to have an expertise, and to honestly 0:07:45.720 --> 0:07:49.360 bring that expertise to the bedside, to physicians with a 0:07:49.400 --> 0:07:53.119 little bit less expertise and guide them, you know, through 0:07:53.240 --> 0:07:56.920 through the process. Because I always found emergency medicine to 0:07:56.920 --> 0:07:59.560 be in more of a horizontal specialty, you know, a 0:07:59.600 --> 0:08:02.320 little bit a lot of different topics. This was an 0:08:02.360 --> 0:08:06.440 opportunity to know a lot about one small topic and 0:08:06.480 --> 0:08:10.280 that really attracted me. Now following that, you asked me, 0:08:10.440 --> 0:08:12.720 how do I become a medical director of a poison center? 0:08:12.960 --> 0:08:15.760 So once you do all this training, you have a 0:08:15.760 --> 0:08:17.640 couple of avenues you can go in the industry. 0:08:17.640 --> 0:08:18.560 You can do a number of things. 0:08:18.560 --> 0:08:21.160 But the two big avenues are are you going to 0:08:21.200 --> 0:08:24.000 be in a hospital where you consult at the bedside 0:08:24.320 --> 0:08:28.760 and see poison patients at the bedside and you're responsible 0:08:28.760 --> 0:08:30.600 for that one patient in front of you and make 0:08:30.640 --> 0:08:35.000 decisions accordingly. The other avenue, which is the avenue I chose, 0:08:35.200 --> 0:08:37.120 is to go more into a bit of more of 0:08:37.120 --> 0:08:41.240 a public health around, so to speak. You become medical 0:08:41.280 --> 0:08:45.000 director of a poison center, and then yes, you are 0:08:45.080 --> 0:08:47.880 to some degree involved with the management or the care 0:08:47.920 --> 0:08:49.920 of a patient at a bedside because you will be 0:08:50.080 --> 0:08:53.320 on call for the poison center. But also as a 0:08:53.320 --> 0:08:57.720 medical director, you will make more population based decisions. You 0:08:57.800 --> 0:09:00.520 will build kind of decision trees. You will have to 0:09:00.520 --> 0:09:04.520 make big decisions on you know, this antidote for my patient, 0:09:04.640 --> 0:09:08.360 my entire state patient population versus this antidote. How are 0:09:08.360 --> 0:09:10.960 we going to kind of deal with this. I found 0:09:11.000 --> 0:09:16.080 that to be very, very impactful because again, the decisions 0:09:16.120 --> 0:09:20.600 you may impact the population of your state. So that's 0:09:20.679 --> 0:09:23.880 millions of people usually. And then, as I said, we're 0:09:23.920 --> 0:09:26.840 on call, what does that mean. So when a poisoning 0:09:26.920 --> 0:09:30.280 is that that's severe, we have physicians on call twenty 0:09:30.320 --> 0:09:33.520 four to seven, three sixty five. So occasionally that's me, 0:09:34.000 --> 0:09:37.400 but I parachute in and talk to the physician at 0:09:37.400 --> 0:09:40.560 the bedside. So the physician at bedside sees whatever it 0:09:40.640 --> 0:09:44.079 is that they see, whatever poisoning that they're seeing, they 0:09:44.120 --> 0:09:46.320 give me the details. We go back and forth with 0:09:46.440 --> 0:09:49.040 questions to try to kind of get the stories. Rate 0:09:49.880 --> 0:09:54.440 I help with the diagnostic testing and any therapy that 0:09:54.520 --> 0:09:57.120 is administered at the bedside. So just to give you 0:09:57.160 --> 0:10:00.600 an idea. You know, cyanide poisonings don't occur very often. 0:10:01.160 --> 0:10:04.480 A given poison center of my size, Connecticut is about 0:10:04.480 --> 0:10:08.120 three point five million people will get about one sinid 0:10:08.200 --> 0:10:11.800 overdose per year. So there's no single physician in a 0:10:11.840 --> 0:10:14.000 hospital out there that has a lot of experience with 0:10:14.040 --> 0:10:18.280 sinnid overdose. It just doesn't exist. But I get to 0:10:18.320 --> 0:10:19.920 see about one a year. It's not a whole heck 0:10:19.960 --> 0:10:21.480 of a lot, but I get to see one a year. 0:10:21.520 --> 0:10:24.160 So after ten years, I've seen about ten ors roughly. 0:10:24.679 --> 0:10:25.880 And so there are. 0:10:25.800 --> 0:10:29.040 Antidotes for sinite poisoning, but often the physicians I'm speaking 0:10:29.040 --> 0:10:31.840 to have never given the antidote before. They're just like, 0:10:32.120 --> 0:10:35.360 I'm a little bit uncomfortable here. I've never given this before. 0:10:35.679 --> 0:10:37.880 And I'm like, that's okay. I'll stay on the phone 0:10:37.920 --> 0:10:40.840 with you. Just stick me on hold. I will not 0:10:41.000 --> 0:10:44.520 disappear from the phone, administer it. If you run into 0:10:44.600 --> 0:10:47.440 any problems, I'm right there and we can kind of 0:10:47.520 --> 0:10:49.480 navigate whatever difficulties you're having. 0:10:49.679 --> 0:10:49.920 Now. 0:10:50.040 --> 0:10:53.520 In reality, the sin aine antidote is pretty easy to administer, 0:10:53.559 --> 0:10:58.040 it's pretty safe, but still it's addressing that comfort or 0:10:58.080 --> 0:11:01.319 that lack of comfort. So sometimes we stay on the phone. 0:11:01.320 --> 0:11:03.720 We really do stay on the phone with the physician 0:11:04.520 --> 0:11:07.400 in a critically ill patient to really help them at 0:11:07.400 --> 0:11:10.000 the bedside. So I find that very rewarding as well. 0:11:10.000 --> 0:11:12.960 It's not population based medicine, it's a case by case medicine, 0:11:13.000 --> 0:11:14.640 but it's very, very rewarding. 0:11:15.800 --> 0:11:20.960 Of course, you get an incredibly diverse array of phone 0:11:21.000 --> 0:11:25.480 calls at a poison control center every single day, and 0:11:25.640 --> 0:11:27.720 I was hoping you could take us through sort of 0:11:27.760 --> 0:11:30.560 this decision tree for what happens when you get a 0:11:30.600 --> 0:11:32.959 phone call? What are the first steps, what are the 0:11:33.080 --> 0:11:38.520 questions asked? What sort of paths can you follow down afterwards? 0:11:39.360 --> 0:11:41.560 So first of all, let's talk about the phone and 0:11:41.600 --> 0:11:45.079 the phone system. We are not like nine to one one. 0:11:45.240 --> 0:11:47.960 Our phone number is a one eight hundred number. It's quaint, 0:11:49.520 --> 0:11:52.640 we're working. We would love legislation to have a three 0:11:52.679 --> 0:11:57.000 digit number, but getting Congress to dergree is a little 0:11:57.000 --> 0:12:01.720 bit difficult at times hundred number. No matter where dialed 0:12:01.760 --> 0:12:05.520 from a landline, cell phone, doesn't matter, will be answered 0:12:05.600 --> 0:12:08.520 twenty four seven three sixty five. And I want to 0:12:08.559 --> 0:12:12.600 specify here, not by AI, not by artificial intelligent A 0:12:12.920 --> 0:12:16.920 person will answer it on occasion, there's weight times, but 0:12:17.080 --> 0:12:21.680 we really strive to keep our weight times extremely short. 0:12:22.040 --> 0:12:25.800 So one eight hundred number available twenty four hours a day. 0:12:25.800 --> 0:12:30.040 We never, ever, ever not answer the phone. But what's 0:12:30.080 --> 0:12:31.840 going to happen? So you're going to get a person 0:12:31.880 --> 0:12:35.080 who's gonna first ask sort of what's the emergency? Is 0:12:35.080 --> 0:12:37.880 this really really something extra emergent or is this something 0:12:37.960 --> 0:12:40.839 I can take my time and get the patient's name 0:12:40.840 --> 0:12:41.679 and so on and so forth. 0:12:41.960 --> 0:12:44.000 But they will ask you your name or the name 0:12:44.080 --> 0:12:44.880 of the child. 0:12:45.200 --> 0:12:47.520 You know, if it's a parent calling, they will ask 0:12:47.600 --> 0:12:50.800 the age of the person. They will often ask, you know, 0:12:51.120 --> 0:12:57.199 a gender as well, And then what happened? What's the scenario? 0:12:57.520 --> 0:13:01.479 Was it ingested? Is this more of a dermal exposure 0:13:01.480 --> 0:13:04.040 that we're worried about. Is it an ocular exposure that 0:13:04.080 --> 0:13:07.320 we're worried about. Is it an injection exposure that we're 0:13:07.320 --> 0:13:10.400 worried about. Is this an acute exposure It just just 0:13:10.480 --> 0:13:13.240 happened one time right now, just happened or is this 0:13:13.320 --> 0:13:16.719 something that was every day for the last month or 0:13:16.800 --> 0:13:20.760 so or something like that. Is this an accidental exposure 0:13:20.880 --> 0:13:25.280 or is this something intentional? And ultimately, what is this substance. 0:13:25.760 --> 0:13:28.920 Is it a drug, Is it a chemical that we 0:13:29.000 --> 0:13:32.200 find in the household. Is it a snake bite, is 0:13:32.200 --> 0:13:35.280 it a spider bite? Is it something that was breathed in? 0:13:35.400 --> 0:13:37.280 Is it some kind of smell or some kind of 0:13:37.320 --> 0:13:40.240 smoke or some kind of gas in your neighborhood. So 0:13:40.280 --> 0:13:44.280 then once all this information is collected, often the poison 0:13:44.600 --> 0:13:47.640 they're called poison specialists. The poison specialists right off the 0:13:47.640 --> 0:13:50.920 top of their head, knows what the ingredients are, knows 0:13:51.160 --> 0:13:56.120 what are the potential pitfalls, and we'll make recommendations. So 0:13:56.160 --> 0:14:00.560 the recommendations will vary from stay at home and we 0:14:00.720 --> 0:14:02.880 don't need to worry about it too too much to 0:14:03.440 --> 0:14:08.440 you need emergent immediate medical help. How they make these 0:14:08.480 --> 0:14:14.440 decisions is based on their intrinsic sort of internalized knowledge 0:14:14.440 --> 0:14:19.240 of things. And then I create for them one hundred 0:14:19.280 --> 0:14:24.920 to two hundred different complicated algorithms that they can follow 0:14:25.000 --> 0:14:27.760 as well. The algorithms are available for them twenty four 0:14:27.760 --> 0:14:28.160 to seven. 0:14:28.320 --> 0:14:30.440 It's on a computer platform. 0:14:30.840 --> 0:14:33.280 And over time though they internalize again a lot of 0:14:33.280 --> 0:14:35.960 these algorithms. You use the same algorithm every day for 0:14:36.160 --> 0:14:39.520 you know, a weeqbe internalized. It usually so that's that's 0:14:39.520 --> 0:14:41.760 what happens when they call it poison center. 0:14:42.560 --> 0:14:45.840 I love it, having called the poison center several times. 0:14:46.840 --> 0:14:49.800 It's just it's always a phenomenal experience. If that, If 0:14:49.800 --> 0:14:51.360 that is a thing that you can say about an 0:14:51.360 --> 0:14:52.960 emergency situation. 0:14:54.800 --> 0:14:55.800 I'm happy to hear this. 0:14:56.000 --> 0:14:58.600 We strive to be nice, polite on the phone, but 0:14:58.680 --> 0:15:03.400 we almost we mostly strive to be helpful. Collectively, in 0:15:03.480 --> 0:15:06.520 the United States, every poison center feels the same way. 0:15:06.520 --> 0:15:09.280 If we're not helpful, we just get then we have 0:15:09.360 --> 0:15:10.920 failed terribly at our jobs. 0:15:12.720 --> 0:15:14.080 Let's take a quick break. 0:15:30.720 --> 0:15:34.200 So speaking of that, of your staff and everyone that 0:15:34.240 --> 0:15:36.880 you have at your poison center, who are the people 0:15:36.920 --> 0:15:39.680 the poison specialists who work at the poison center. What 0:15:39.800 --> 0:15:42.360 kind of training does someone need to have to be 0:15:42.400 --> 0:15:44.800 able to be a poison center phone operator? 0:15:45.400 --> 0:15:47.600 So who are the people answering the phones. They are 0:15:47.640 --> 0:15:52.760 not operators, they're not volunteers. They're paid. They are usually 0:15:52.840 --> 0:15:59.400 of two trainings. They are pharmacists or nurses. If they're pharmacists, 0:15:59.680 --> 0:16:03.440 usually they're licensed in the state in that state, and 0:16:03.560 --> 0:16:06.440 nurses are licensed as well. If they're nurses, they're usually 0:16:06.600 --> 0:16:09.080 they usually have one or two years of critical care 0:16:09.280 --> 0:16:13.600 experience or something like that, and that's to qualify for 0:16:13.720 --> 0:16:16.600 the job. Now, once they qualify for the job, there's 0:16:16.720 --> 0:16:20.640 usually about one year of solid training that goes on 0:16:21.400 --> 0:16:24.960 where they are supervised in real time. We listen to 0:16:25.000 --> 0:16:28.120 their calls to supervise and make sure that they do 0:16:28.160 --> 0:16:30.720 the job correctly. And as they get better and better 0:16:30.760 --> 0:16:33.160 at their jobs, of course, then we don't listen to. 0:16:33.120 --> 0:16:33.960 Every single call. 0:16:34.640 --> 0:16:37.479 A lot a lot of one on one teaching hours 0:16:37.520 --> 0:16:43.280 and hours hours of didactic training, all this culminating into 0:16:43.320 --> 0:16:47.600 a certification exam. Once they become certified, they can really 0:16:47.640 --> 0:16:50.880 fly solo on the phones. If the case is very, 0:16:50.960 --> 0:16:55.400 very serious, they will then immediately call the physician on call. 0:16:56.120 --> 0:16:58.720 The physician on call is someone like me, someone with 0:16:58.880 --> 0:17:03.560 medical toxic callology training. We can sometimes just speak to 0:17:03.640 --> 0:17:06.760 the poison specialists to give them some guidance, but sometimes 0:17:06.760 --> 0:17:07.400 this is just. 0:17:07.440 --> 0:17:08.520 Plain so serious. 0:17:08.600 --> 0:17:12.400 We must speak to the ED physician, to the intensive 0:17:12.400 --> 0:17:15.840 care physician whoever is at the bedside of the patient 0:17:16.240 --> 0:17:19.320 to help with what's going on. So yesterday I was 0:17:19.320 --> 0:17:21.879 on call. Sometimes the patient had been in the ED, 0:17:22.240 --> 0:17:25.280 the patient was stable, completely stable, but they had done 0:17:25.280 --> 0:17:28.200 all the labs, and the labs had been reported back 0:17:28.200 --> 0:17:30.960 to the poison specialist, and it is at that point 0:17:31.119 --> 0:17:34.120 that the poison specialists call me to review the labs 0:17:34.400 --> 0:17:37.560 to see if based on the labs, it was safe 0:17:37.720 --> 0:17:41.040 to send the patient home from the ED and not 0:17:41.119 --> 0:17:44.119 admit to patient. So sometimes the questions are those, you know, 0:17:44.160 --> 0:17:47.199 how can we safely take care of this patient and 0:17:47.240 --> 0:17:49.639 so on and so forth, And think about that that saves 0:17:49.640 --> 0:17:53.960 an admission, Yes, it's saves healthcare resources. But think about 0:17:53.960 --> 0:17:57.080 the patient. The patient is not facing an emission. The 0:17:57.200 --> 0:17:59.480 patient's family doesn't have to drive back and forth to 0:17:59.520 --> 0:18:03.040 the hospital to visit the patient, if the patient doesn't 0:18:03.040 --> 0:18:04.920 get pricked for blood work, and so on and so forth, 0:18:04.960 --> 0:18:07.200 the patient gets to sleep at home. All these things 0:18:07.240 --> 0:18:10.040 are good, good things for the patient, for the system 0:18:10.080 --> 0:18:13.000 in general. So we try as much as possible to 0:18:13.119 --> 0:18:15.959 keep the patients away from the hospital if we can. 0:18:16.119 --> 0:18:18.560 So this was a good use of poison centers in 0:18:18.680 --> 0:18:21.679 terms of health saving healthcare resources and doing right by 0:18:21.720 --> 0:18:22.159 the patient. 0:18:23.320 --> 0:18:27.000 The poison decks. What can you tell us about the 0:18:27.040 --> 0:18:27.919 poison decks? 0:18:29.640 --> 0:18:33.800 So poison index is how some people call it. Other 0:18:33.840 --> 0:18:37.200 people call it micromedics. We use the terms interchangeably. 0:18:37.320 --> 0:18:41.399 But what is this? What is this mammoth that it is? 0:18:42.040 --> 0:18:44.880 So I will tell you the poison specialists are probably 0:18:44.920 --> 0:18:49.159 in micromedics every minute of every shift. 0:18:49.960 --> 0:18:53.000 But what is it. It's an online database. 0:18:53.040 --> 0:18:56.280 There's an Internet and there's an intranet version there, but 0:18:56.400 --> 0:19:00.240 it's a huge, huge, huge database. You know, you just put, 0:19:00.280 --> 0:19:05.119 for example, mister clean whatever, some kind of cleaner you 0:19:05.200 --> 0:19:07.440 use in the household, but you put the brand name 0:19:07.800 --> 0:19:11.840 and it will start outlining the ingredients for you. But 0:19:11.960 --> 0:19:13.760 you say, you can get that from the label. So 0:19:14.359 --> 0:19:18.560 why do we have microetics Because then micromedics classifies the 0:19:18.640 --> 0:19:23.679 different individual ingredients into kind of categories or buckets, so 0:19:23.760 --> 0:19:27.919 to speak, and that helps us kind of understand the 0:19:28.000 --> 0:19:30.040 product much much, much much better. 0:19:30.400 --> 0:19:31.760 So they let me give you an example. 0:19:32.280 --> 0:19:36.160 Let's say this cleaning agent used in the household has 0:19:36.200 --> 0:19:37.679 benzol ammonium chloride. 0:19:38.200 --> 0:19:40.600 We and poison centers all know what that is, but 0:19:40.960 --> 0:19:43.040 you don't. Let's say you're a new poison specialist. You 0:19:43.040 --> 0:19:43.760 don't know what that is. 0:19:44.520 --> 0:19:47.840 Micromedics or Poison Index is going to classify bisol ammonium 0:19:47.880 --> 0:19:52.840 chloride into cat ionic detergents. Now the poison specialists should 0:19:52.840 --> 0:19:56.720 know catonic detergents. Of all the detergents out there, those 0:19:56.800 --> 0:19:59.280 are the ones I need to worry about. So there 0:19:59.400 --> 0:20:04.240 starts the process. And in caonic detergents, it's only concentrations 0:20:04.240 --> 0:20:07.199 of the desergents above seven point five percent or so 0:20:07.240 --> 0:20:09.520 that we worry about. So the next step once the 0:20:09.520 --> 0:20:14.520 poison specialists recognizes ca ionic detergent is go back what 0:20:14.680 --> 0:20:18.200 percentage this is this? Two, three percent, five percent, seventeen percent, 0:20:18.240 --> 0:20:21.080 what is this? And then take it from there. So 0:20:21.280 --> 0:20:23.960 it's a combination of knowing how to use the database. 0:20:24.040 --> 0:20:26.400 But that's what micrometics does. You need to be able 0:20:26.400 --> 0:20:28.880 to read labels as well. There's a so if we're 0:20:28.960 --> 0:20:31.400 very fortunate in the United States that we have very 0:20:31.440 --> 0:20:34.520 strong labeling laws. They date back to the nineteen sixties, 0:20:35.080 --> 0:20:37.879 and so they will list the active ingredients and they 0:20:37.880 --> 0:20:41.680 will list the inactive ingredients. And then when you see 0:20:41.680 --> 0:20:44.760 that list of active or inactive ingredients, this it doesn't matter. 0:20:45.160 --> 0:20:48.440 The most concentrated one will appear first, not the most 0:20:48.480 --> 0:20:52.359 toxic one. The most concentrated one will appear first, and 0:20:52.400 --> 0:20:56.760 then the least concentrated ones will appear least and usually 0:20:56.880 --> 0:21:01.399 if the concentration is less than one percent, mandated to 0:21:01.600 --> 0:21:04.280 put it on the label at all. Those are the 0:21:04.359 --> 0:21:08.240 basic basic rules, so that again, if you know these rules, 0:21:08.320 --> 0:21:11.320 you could start decoding a little bit these labels that 0:21:11.359 --> 0:21:12.760 we have on all. 0:21:12.640 --> 0:21:13.680 The products out there. 0:21:13.960 --> 0:21:16.000 But that's what we do with micromedics, that's what we 0:21:16.080 --> 0:21:19.840 do with labels using brand names. It helps us kind 0:21:19.840 --> 0:21:22.520 of drove down to what the ingredients are and what 0:21:22.560 --> 0:21:23.560 the toxicities are. 0:21:24.560 --> 0:21:29.080 So how do you analyze the risks of ingestion or 0:21:29.119 --> 0:21:32.720 exposure when there are multiple substances either the example that 0:21:32.760 --> 0:21:34.879 you gave of, like a cleaning product that has this 0:21:35.040 --> 0:21:39.240 long list of ingredients, or someone who either intentionally or 0:21:39.280 --> 0:21:43.480 accidentally took a mixture of different medications. Like, how do 0:21:43.600 --> 0:21:47.560 you I assume, with the assistance of micromedics, prioritize these 0:21:47.720 --> 0:21:50.320 ingredients and what other data do you need to be 0:21:50.359 --> 0:21:52.159 able to work through that problem? 0:21:52.720 --> 0:21:55.680 So I think we probably encounter that, honestly a little 0:21:55.720 --> 0:21:59.560 bit more when people ingest different medications, and these are 0:21:59.600 --> 0:22:03.440 called dr drug interactions, and they're getting a lot more 0:22:03.440 --> 0:22:05.959 common than they used to be. There are not that 0:22:06.040 --> 0:22:09.960 many honestly computer programs that help you with it. So 0:22:10.080 --> 0:22:14.320 what it is is, honestly just having a basic knowledge 0:22:14.359 --> 0:22:21.560 of what gets metabolized, what way, and what medications can 0:22:21.640 --> 0:22:26.679 interfere with that metabolism, So that's a pharmacokinetic or you know, 0:22:27.160 --> 0:22:31.640 just knowing intrinsically that, for example, a medication gets primarily 0:22:31.680 --> 0:22:35.600 eliminated by the kidneys, and then just hearing that either 0:22:35.680 --> 0:22:38.560 another medication is added, or just hearing that the patient's 0:22:38.680 --> 0:22:41.639 kidney function, the patient's renal function is a. 0:22:41.600 --> 0:22:42.359 Little bit off. 0:22:43.000 --> 0:22:47.200 So having a little bit of knowledge of these kinetics 0:22:47.760 --> 0:22:50.720 is important. So we have to teach the poison specialists. 0:22:50.720 --> 0:22:53.119 We really kind of just have to teach and teach 0:22:53.200 --> 0:22:55.920 and teach them. Then we have the other drug drug 0:22:55.960 --> 0:22:59.399 interactions that we call pharmacodynamics. So a drug binds to 0:22:59.480 --> 0:23:02.760 a and another drug is added that binds to the 0:23:02.800 --> 0:23:07.320 exact same receptor. That's basically bottom line, knowing how every 0:23:07.640 --> 0:23:11.800 drug out there works, and we carry that knowledge. We 0:23:11.960 --> 0:23:15.280 just have that knowledge, we teach it and so we 0:23:15.359 --> 0:23:18.359 can often just right off the top of our head 0:23:18.480 --> 0:23:20.680 say that mix of that drug with that drugs is 0:23:20.800 --> 0:23:23.440 not going to be a good mix, because they tackle 0:23:23.520 --> 0:23:26.560 the effect they target the same receptor, and that's going 0:23:26.600 --> 0:23:27.920 to be a bit of a problem. 0:23:27.960 --> 0:23:28.760 We're going to have too. 0:23:28.720 --> 0:23:31.200 Much of an effect or not enough an effect, depending 0:23:31.240 --> 0:23:33.520 on whether they're agonists and antagonists and so on and 0:23:33.520 --> 0:23:37.840 so forth. When we're talking about all the different chemicals 0:23:37.840 --> 0:23:41.760 in household cleaners, for example, the cleaners are all there 0:23:41.800 --> 0:23:45.280 to kind of clean, so they all have they're all 0:23:45.320 --> 0:23:48.960 there to aim for one given thing, and the active 0:23:49.119 --> 0:23:54.280 ingredient is the active ingredient for the purpose of that product. So, 0:23:54.320 --> 0:23:58.200 for example, and insecticide, you look at the active ingredient, 0:23:58.720 --> 0:24:03.119 the active ingredient is the ingredient to kill insects. So 0:24:03.359 --> 0:24:05.840 is that going to be an active ingredient in the 0:24:05.920 --> 0:24:11.280 human Maybe? Maybe not right, So, a lot of insecticides 0:24:11.359 --> 0:24:14.040 these days contain what we call pyrethrins. 0:24:14.440 --> 0:24:19.720 Pyrethrins kill insects, but they're not particularly problematic in humans. 0:24:20.320 --> 0:24:24.960 So we're not going to worry too much with the insecticides, 0:24:25.000 --> 0:24:26.680 or at least the active ingredients. Then we're going to 0:24:26.720 --> 0:24:29.640 start looking at all the other things they added there. 0:24:30.080 --> 0:24:32.919 Things to make it more liquid, things to make it smell, 0:24:33.000 --> 0:24:35.840 god knows what smell. They're searching for, things to make 0:24:35.880 --> 0:24:38.199 it maybe a bit oily, so when you spray it 0:24:38.240 --> 0:24:41.440 on your plants, because it's oily, it stays on the leaves. 0:24:41.960 --> 0:24:44.359 All these things we're going to look at and see 0:24:44.400 --> 0:24:50.520 if it's particularly problematic for humans. And then so if 0:24:50.520 --> 0:24:55.840 they patient ingested the insecticide but also then ingested turpentine, 0:24:56.880 --> 0:25:00.119 so then does the turpentine interact with the insecticides. So 0:25:00.160 --> 0:25:03.040 that's just a lot of thinking, a lot of thinking, 0:25:03.080 --> 0:25:04.800 but again we navigate that. 0:25:04.960 --> 0:25:08.320 And again try to figure out how to best help 0:25:08.359 --> 0:25:09.680 the patient at that point in time. 0:25:11.040 --> 0:25:28.000 Let's take another quick break. You mentioned how some of 0:25:28.040 --> 0:25:30.960 the calls that you're getting more of these days involve 0:25:31.320 --> 0:25:36.440 interactions between different medications. As people are going on more medications, 0:25:36.880 --> 0:25:40.000 have you noticed any other trends in what calls you're 0:25:40.040 --> 0:25:42.600 getting more or what types of calls you're getting more 0:25:42.640 --> 0:25:46.639 today compared to calls in the past, or even just 0:25:46.640 --> 0:25:49.560 like in the overall number of calls that you're getting. 0:25:50.200 --> 0:25:53.679 Absolutely, so we keep abreast of these trends, and so 0:25:53.720 --> 0:25:56.359 you're going to hear a whole host of things as 0:25:56.440 --> 0:26:00.720 just a population shifts in what it is that they purchase, 0:26:00.880 --> 0:26:02.679 what it is that they have in the home, what 0:26:02.800 --> 0:26:05.520 children have access to. So you're going to hear a 0:26:05.520 --> 0:26:08.639 lot of noise right now about melatonin, for example. So 0:26:08.720 --> 0:26:12.200 the melatonin products have been largely manufactured into gummies. 0:26:12.480 --> 0:26:14.679 They look like little candies. Some of them are actually 0:26:14.760 --> 0:26:18.240 shaped like little teddy bears, but they certainly have very 0:26:18.280 --> 0:26:21.200 beautiful colors. They look like candy. 0:26:21.520 --> 0:26:24.440 So not surprisingly, even though they are provided in big 0:26:24.560 --> 0:26:28.760 jars with child resistant caps, children are just either breaking 0:26:28.800 --> 0:26:31.720 through the child resistant cap or some way shape or 0:26:31.760 --> 0:26:35.720 form getting into the gummies. And so there's a lot 0:26:35.760 --> 0:26:39.760 of you know, melotone gummies. So on the issue of gummies, 0:26:40.080 --> 0:26:44.000 marijuana gummies, lots of those around. So the states that 0:26:44.160 --> 0:26:48.800 have legalized marijuana adult use marijuana will have usually a 0:26:48.920 --> 0:26:51.480 component of the marijuana products that are what we call 0:26:51.520 --> 0:26:54.359 the edibles. And the edibles can be all kinds of 0:26:54.359 --> 0:26:58.240 different confections, and so some states have been very strict 0:26:58.280 --> 0:27:00.199 on this. Connecticut that has been very strict on this 0:27:00.359 --> 0:27:06.080 are edibles must have uninteresting square shapes, they can't have 0:27:06.160 --> 0:27:08.480 any interesting colors, they're kind of bland. 0:27:08.600 --> 0:27:12.879 Really. They must be in child resistant containers. 0:27:13.400 --> 0:27:18.040 A given edible cannot contain more than five milligrams per edible. 0:27:18.320 --> 0:27:22.719 Five miligrams of THHC the five DELTAHC, the active ingredient 0:27:22.720 --> 0:27:26.320 in marijuana, and you cannot have more than one hundred 0:27:26.359 --> 0:27:29.160 milligrams in a bottle, so that if the child gets 0:27:29.160 --> 0:27:31.399 into the entire bottle, it's still a large amount of 0:27:31.440 --> 0:27:34.160 five PhD for the child. But we're not talking thousands 0:27:34.200 --> 0:27:38.720 of milgrams. We're talking one hundred milligrams. And so gummies, 0:27:38.800 --> 0:27:41.960 you're going to hear a lot about gummies as being 0:27:41.960 --> 0:27:47.600 a problem. The changes in abortion laws are recent, so 0:27:47.680 --> 0:27:51.640 we haven't quite quite studied yet or produced the data yet, 0:27:51.680 --> 0:27:59.000 but we expect an increase in use of herbals dietary 0:27:59.080 --> 0:28:04.920 supplements to terminate a pregnancy in women who have very 0:28:04.960 --> 0:28:09.280 few other options that I can't say that we've seen, 0:28:09.320 --> 0:28:11.960 but we're watching this. We're watching this right now, we're 0:28:11.960 --> 0:28:17.480 surveilling this. We've definitely seen an uptake in the GLP 0:28:17.680 --> 0:28:22.840 one receptor agonis, the ozempic go Z. There a couple 0:28:22.920 --> 0:28:26.439 of others out there, injectables that are used for the 0:28:26.480 --> 0:28:32.479 management of diabetes, but more recently for weight reduction, and 0:28:32.520 --> 0:28:36.399 we see all kinds of behavior with that from wellness 0:28:36.440 --> 0:28:41.320 spas that are dispensing ozempic. We've also had people who 0:28:41.360 --> 0:28:44.080 if one dose of ozempic is good to lose weight, 0:28:44.240 --> 0:28:46.320 then doubling the dose is probably better. 0:28:46.880 --> 0:28:49.680 You have to be very calpful with these products. The 0:28:49.840 --> 0:28:53.719 escalation of the dose is very very slow, So if 0:28:53.920 --> 0:28:56.760 you escalate the dose too quickly, you run into adverse 0:28:56.760 --> 0:28:59.720 effects and they get a lot of nausea and vomiting 0:28:59.800 --> 0:29:01.840 and lasts for days and days and days. It's a 0:29:01.880 --> 0:29:06.320 gesstro paresis type of nausea vomiting, so problematic. 0:29:06.600 --> 0:29:12.680 Back to the the ozembic dispensed from non retail pharmacies, 0:29:13.440 --> 0:29:17.000 one such product was analyzed. It contained insulin. It did 0:29:17.000 --> 0:29:20.600 not contain any sema glue type, which is the ingredient 0:29:20.760 --> 0:29:25.960 in ozembic. It contained insulin. So the Wellness Spa sent 0:29:26.200 --> 0:29:29.520 non diabetic patients who were looking to lose weight. They 0:29:29.560 --> 0:29:33.320 sent them home with syringes of insulin. Of course, the 0:29:33.360 --> 0:29:36.800 opioid epidemic, we're seeing a lot a lot of that. 0:29:37.120 --> 0:29:40.320 The opiod epidemic right now is really a fentinyl epidemic. 0:29:40.440 --> 0:29:44.080 That is our major major issue in the United States 0:29:44.240 --> 0:29:48.280 is the fentanyl. It's potency. Everybody is kind of hot 0:29:48.440 --> 0:29:51.800 under the collar about xylazine. But it's really the fentanyl 0:29:51.880 --> 0:29:54.600 that is the problem, and we're not out of it. 0:29:54.880 --> 0:29:56.480 Most of us don't predict we're going to be out 0:29:56.480 --> 0:29:58.239 of it for a good ten years. It's going to 0:29:58.360 --> 0:30:03.160 take time to change the tide on that big, big epidemic. 0:30:03.600 --> 0:30:05.400 So I would say those are the big, big trends 0:30:05.440 --> 0:30:08.920 we're seeing right now, but of course that will change 0:30:08.960 --> 0:30:09.640 in six months. 0:30:10.960 --> 0:30:14.560 What do you find to be the most rewarding aspect 0:30:14.800 --> 0:30:16.080 of this work that you do. 0:30:17.160 --> 0:30:23.840 I think the times I go yeah, right, usually the 0:30:23.880 --> 0:30:27.800 appropriate use of an antidote. Appropriate meaning we thought the 0:30:27.840 --> 0:30:31.120 problem was right, We aim to solve the problem with 0:30:31.200 --> 0:30:35.120 an antidote, and then the patient did well. A cyanide 0:30:35.160 --> 0:30:39.640 overdose that gets the appropriate antidote, turns the corner and survives. 0:30:39.680 --> 0:30:44.360 Because sind is quite toxic, is just a cause for celebration. 0:30:45.040 --> 0:30:47.479 But they come in all shapes and forms. I remember this. 0:30:48.360 --> 0:30:51.840 It was very way back, but funny story. The child 0:30:51.920 --> 0:30:55.280 was bidden by copperhead, had a pretty significant wound to 0:30:55.320 --> 0:30:58.200 the hand and was seen in the hospital that could 0:30:58.240 --> 0:31:01.640 not they could not emit pediatric. So this child went 0:31:01.640 --> 0:31:05.520 from this pripher hospital by helicopter to a what we 0:31:05.560 --> 0:31:09.120 call tru shree kre Pediatric Center and got the antidote. 0:31:09.160 --> 0:31:12.520 In the meantime, did very very well, did recovered. I 0:31:12.520 --> 0:31:14.560 think he was seven or eight and kind of left 0:31:14.560 --> 0:31:17.840 the hospital and so think about this. He was out there, 0:31:17.920 --> 0:31:21.320 got bidden by snake, got an antidote, helicopter, ride to 0:31:21.400 --> 0:31:23.719 the city, all this stuff. He goes, I've got a 0:31:23.800 --> 0:31:26.800 story for show and tell. I've just got the best story. 0:31:28.320 --> 0:31:31.440 That was just like, yeah, you probably do. And that 0:31:31.560 --> 0:31:33.840 was just it still brings a smile to my face. 0:31:34.320 --> 0:31:38.880 Just really really funny. Those are yay moments for us 0:31:39.160 --> 0:31:42.400 in poison center circles, but it's usually saving a life, 0:31:43.240 --> 0:31:45.720 getting the antidote right, getting it in quickly, and the 0:31:45.760 --> 0:31:48.760 patient turns the corner, and any physician will tell you 0:31:48.840 --> 0:31:52.160 that that's just you feel like a thousand bucks, our 0:31:52.240 --> 0:31:56.720 million bucks. You really really feel like you're superstar at 0:31:56.720 --> 0:31:59.200 that point in time, and it's so great to turn 0:31:59.280 --> 0:32:01.480 and turn to the family say yeah, he's going to 0:32:01.560 --> 0:32:04.920 do okay. So those are there, our great saves and 0:32:05.000 --> 0:32:07.320 our great great moments. They're few and far between, but 0:32:07.360 --> 0:32:07.840 they're great. 0:32:33.840 --> 0:32:38.000 That was such an amazing conversation, Aaron. We could have 0:32:38.320 --> 0:32:39.160 talked all day. 0:32:39.440 --> 0:32:40.920 I was just gonna say, I could have sat there 0:32:40.920 --> 0:32:43.320 for so many more hours, just like picking her brain 0:32:43.400 --> 0:32:47.800 and asking for stories, and no, I know, I would 0:32:47.880 --> 0:32:51.240 love to sit for a day in a poison center 0:32:51.280 --> 0:32:54.760 as well, just to like hear it and experience it. 0:32:54.840 --> 0:32:58.000 I yeah, well, and it's also I think what's really 0:32:58.360 --> 0:33:00.680 amazing to me is that, like, this is a hugely 0:33:00.720 --> 0:33:04.400 impactful area of public health that I didn't really ever 0:33:05.240 --> 0:33:07.320 think that much about, or know that much about, or 0:33:07.360 --> 0:33:10.160 know what's an option. And I just think it's really 0:33:10.200 --> 0:33:12.600 amazing to know that. Okay, let's say that you go 0:33:12.720 --> 0:33:14.920 into the field of medicine and you're like, I want 0:33:14.960 --> 0:33:18.320 something that has one foot in public health and one 0:33:18.320 --> 0:33:21.400 foot in medicine. This is a great opportunity for that. 0:33:21.560 --> 0:33:23.160 And if you're or if you're just like, hey, you 0:33:23.160 --> 0:33:26.200 know what I want to keep in my brain an 0:33:26.240 --> 0:33:31.560 absolute database of compounds and what organ metabolizes them and 0:33:31.640 --> 0:33:34.240 what receptor they use and blah blah blah, like it's 0:33:34.360 --> 0:33:35.760 so cool. Yeah. 0:33:35.840 --> 0:33:38.800 Also, Aaron, I will I agree one hundred percent that 0:33:38.840 --> 0:33:41.760 this is like, especially coming from the field of public health, 0:33:42.200 --> 0:33:47.320 not realizing how amazing and impactful poison control is. That's 0:33:47.360 --> 0:33:49.440 what we're about to get into is like, ye, what 0:33:49.600 --> 0:33:53.400 poison control can do for you, what it's already doing 0:33:53.440 --> 0:33:56.360 that you didn't even know about. I will say that 0:33:56.400 --> 0:33:58.760 we're going to focus on the US, and this has 0:33:58.800 --> 0:34:02.360 been a very US centric episode, but we're also going 0:34:02.440 --> 0:34:05.720 to get into just how much the US doesn't focus 0:34:05.920 --> 0:34:10.520 enough on poison control hint, hint, funding wise, and I 0:34:10.600 --> 0:34:12.880 will get a little bit into the global status of 0:34:12.920 --> 0:34:17.160 poison control centers worldwide. Spoiler there's never enough of them, 0:34:17.440 --> 0:34:20.799 but they do exist. Nope, and yeah, because there is 0:34:20.880 --> 0:34:23.680 just there's so much there, Aaron, I can't wait to 0:34:23.719 --> 0:34:27.600 get into it. So currently, as of twenty twenty four, 0:34:28.080 --> 0:34:32.320 there are fifty five poison control centers which have recently 0:34:32.400 --> 0:34:36.160 rebranded into poison Help Center. I think is that they're 0:34:36.200 --> 0:34:40.640 calling themselves. So not every state has their own poison 0:34:40.680 --> 0:34:43.720 control center, but every state in the US is served 0:34:43.800 --> 0:34:47.600 by at least one poison control as are all US territories. 0:34:49.160 --> 0:34:53.160 But here is a thing that I again thinking back to, 0:34:53.239 --> 0:34:56.799 like how this started, I just love this about the 0:34:56.800 --> 0:34:59.799 poison control centers in the US is that all fifty 0:34:59.840 --> 0:35:04.200 five five of these use a centralized reporting system which 0:35:04.239 --> 0:35:07.680 is called the National Poison Data System and we heard 0:35:07.680 --> 0:35:10.400 a little bit about this and the information system that 0:35:10.400 --> 0:35:13.759 they used in our interview. But this reporting system is 0:35:13.760 --> 0:35:19.120 the National Poison Data System or the NPDS. This uploads 0:35:19.480 --> 0:35:23.720 real time data of every single call that is made 0:35:23.840 --> 0:35:28.759 to all of these poison control centers. This generates so 0:35:29.600 --> 0:35:34.879 much data that we can use to understand the impact 0:35:35.239 --> 0:35:39.400 of poison control centers and be able to actively in 0:35:39.440 --> 0:35:42.400 like real time see trends like we talked about in 0:35:42.440 --> 0:35:45.400 our interview on like what are people calling poison control 0:35:45.440 --> 0:35:51.600 center about? Surprise, surprise, it's ozepic these days, right, Yeah. 0:35:52.280 --> 0:35:55.799 And so from this we also get these incredible annual reports. 0:35:55.840 --> 0:35:58.160 The most recent annual report that came out was from 0:35:58.200 --> 0:36:01.120 twenty twenty two that was released in January of this year, 0:36:01.960 --> 0:36:05.680 and it happened to be the fortieth NPDS report, so 0:36:05.800 --> 0:36:09.960 happy anniversary. And so this gives us some pretty solid 0:36:09.960 --> 0:36:13.280 statistics on how many people are calling and for what reasons. 0:36:13.719 --> 0:36:16.319 So in twenty twenty two in the US, there were 0:36:16.440 --> 0:36:22.600 over two point four million encounters logged. Of these, over 0:36:22.680 --> 0:36:26.040 two million of them two million, sixty four thousand, eight 0:36:26.160 --> 0:36:30.719 hundred and seventy five were human exposures. Fifty thousand of 0:36:30.760 --> 0:36:34.680 them were animal exposures and three hundred and sixty thousand 0:36:34.680 --> 0:36:38.000 of them were information requests, which means people contacted poison 0:36:38.000 --> 0:36:42.160 control even though there wasn't an actual exposure. Okay, And 0:36:42.239 --> 0:36:45.560 we can see what the top substances were that people 0:36:45.600 --> 0:36:49.960 called about or that people were exposed to. And these, interestingly, 0:36:50.440 --> 0:36:54.640 like the top four main categories, haven't changed a ton 0:36:54.920 --> 0:36:57.960 over the years. And what's interesting is that in this report, 0:36:58.000 --> 0:37:00.840 because it was the fortieth, they had a data table 0:37:00.920 --> 0:37:04.080 that was like, compared to nineteen eighty three when this 0:37:04.160 --> 0:37:07.600 started and twenty twenty two, what are the differences, And 0:37:07.640 --> 0:37:11.279 there are definitely some. But top of the list for 0:37:11.719 --> 0:37:15.719 exposures is analgy six and that is things like estatamenifin 0:37:15.800 --> 0:37:19.960 or titlanol and ibiprofen, which account for eleven percent of 0:37:20.000 --> 0:37:24.160 all calls. Ok Next on the list is household cleaning substances, 0:37:25.040 --> 0:37:28.960 followed by antidepressants and then cosmetics or personal care products, 0:37:29.120 --> 0:37:34.200 which is also interesting, now who is calling in we 0:37:34.280 --> 0:37:40.560 get that information as well. Unsurprisingly, unfortunately, kids under five 0:37:40.800 --> 0:37:45.000 account for the majority of exposures, like kind of overall, 0:37:45.480 --> 0:37:49.560 so kids under age three accounted for twenty eight percent 0:37:49.640 --> 0:37:53.239 of all exposure calls, and kids under five accounted for 0:37:53.239 --> 0:37:55.279 forty percent of all human exposures. 0:37:55.719 --> 0:37:57.600 Okay, and they are. 0:37:57.600 --> 0:38:01.919 Actually more likely to be exposed to cleaning over analgesics, 0:38:01.960 --> 0:38:05.239 which is like we talked about, because they're easily accessible 0:38:05.280 --> 0:38:07.160 and a lot of times we might not think about 0:38:07.200 --> 0:38:11.759 them having as kid proof of access like a lot 0:38:11.800 --> 0:38:16.440 of our medications do these days. All told, all of 0:38:16.480 --> 0:38:21.200 these over two million exposures resulted in three thousand, two 0:38:21.320 --> 0:38:25.840 hundred and fifty five cases of death, two thousand, six 0:38:25.960 --> 0:38:28.960 hundred and twenty two of which were judged as directly 0:38:29.000 --> 0:38:32.600 related to the exposure. And what I found really interesting 0:38:32.760 --> 0:38:35.360 is that out of all of these poison control calls, 0:38:35.400 --> 0:38:37.880 whenever there is a death that's reported, there's a really 0:38:37.920 --> 0:38:41.000 complex review process where they go back to that data 0:38:41.080 --> 0:38:44.360 to try and determine how likely it is that the 0:38:44.480 --> 0:38:48.040 exposure was related to the death. If that makes sense. 0:38:48.800 --> 0:38:51.719 Okay, interesting. Yeah, So that. 0:38:51.719 --> 0:38:54.640 Was like a lot of data thrown at us. And 0:38:55.800 --> 0:38:59.560 there was a really interesting radio Lab episode that I 0:38:59.640 --> 0:39:01.000 listened to. You listen to it? 0:39:01.000 --> 0:39:01.560 I did too. 0:39:01.680 --> 0:39:02.640 Yeah, it was so good. 0:39:03.120 --> 0:39:07.920 It's really great. Their production value can't be matched but 0:39:08.040 --> 0:39:10.120 one of the things that they mentioned in that episode 0:39:10.160 --> 0:39:13.000 is that calls have been on the decline to poison 0:39:13.000 --> 0:39:15.759 control centers, and it's in this report as well too. 0:39:15.920 --> 0:39:18.279 Calls have been on the decline. There have been a 0:39:18.320 --> 0:39:22.200 fairly continuous decline in total calls to poison control centers 0:39:22.200 --> 0:39:25.440 since about two thousand and eight, which is when it peaked. 0:39:26.000 --> 0:39:28.399 When it peaked, there were just over four point three 0:39:28.520 --> 0:39:31.480 million calls to poison control centers in two thousand and eight, 0:39:31.840 --> 0:39:36.960 which included two point four million exposure calls, human exposure calls, 0:39:37.480 --> 0:39:41.600 and one point seven million information calls. There was some 0:39:41.640 --> 0:39:46.000 spikes during the pandemic, especially related to disinfectant use and 0:39:46.040 --> 0:39:49.560 then COVID vaccines and things like that, which is probably 0:39:49.560 --> 0:39:52.920 interesting in its own right, very interesting, huh, But I'm 0:39:52.960 --> 0:39:55.080 not going to get into the detail. But what I 0:39:55.080 --> 0:39:58.839 think is so interesting about these trends specifically, are a 0:39:58.880 --> 0:40:03.360 few important detail that are even bigger picture than just 0:40:03.600 --> 0:40:08.239 a declining calls. What this declining call seems to reflect 0:40:08.560 --> 0:40:11.600 is a number of different things. The report from twenty 0:40:11.640 --> 0:40:15.320 twenty two sites that there has been overall declining birth rates, 0:40:15.600 --> 0:40:18.880 which is important because exposure rates are so much higher 0:40:18.920 --> 0:40:25.120 in children under age five interesting and an increasing reliance 0:40:25.280 --> 0:40:28.799 on the Internet because a huge part of what I 0:40:28.960 --> 0:40:33.120 just said, one point seven million calls were information only 0:40:33.200 --> 0:40:36.880 calls compared to three hundred and sixty thousand information calls 0:40:36.920 --> 0:40:39.920 in twenty twenty two. So when someone is looking for 0:40:40.040 --> 0:40:43.719 just information about a substance without a direct exposure, they're 0:40:43.719 --> 0:40:45.640 going to go to the internet first. And that makes 0:40:45.640 --> 0:40:51.000 a lot of sense. Now, as of twenty fifteen, poisonhelp 0:40:51.160 --> 0:40:55.640 dot org can actually get you really similar information to 0:40:55.680 --> 0:40:58.399 what you're going to get from a poison control call 0:40:58.560 --> 0:41:00.960 because you can get in touch with poison Control via 0:41:00.960 --> 0:41:04.560 their website poisonhelp dot org as of twenty fifteen, So 0:41:04.680 --> 0:41:06.920 some of these cases might still make it into the 0:41:06.920 --> 0:41:10.279 poison control database if they're coming from that website, if 0:41:10.280 --> 0:41:10.839 that makes sense. 0:41:11.360 --> 0:41:12.840 Uh huh. 0:41:13.200 --> 0:41:18.279 But what we can't necessarily interpret from this reduction in 0:41:18.400 --> 0:41:23.120 calls is that exposures are decreasing, because what this data 0:41:23.160 --> 0:41:26.520 from twenty twenty two shows is that exposures with more 0:41:26.560 --> 0:41:31.880 serious outcomes, including hospital facility calls and calls that result 0:41:31.920 --> 0:41:34.839 in major harm or death, have actually been on a 0:41:34.880 --> 0:41:37.640 slight increase across the same time period. 0:41:38.360 --> 0:41:41.480 Okay, what are the characteristics of these calls, Like, are 0:41:41.520 --> 0:41:42.520 there patterns in this? 0:41:43.600 --> 0:41:47.600 Not necessarily patterns aside from just that they're more serious 0:41:47.800 --> 0:41:52.839 calls that have a more serious outcome, whereas information only 0:41:52.840 --> 0:41:56.200 calls and calls about less serious exposures tend to be 0:41:56.280 --> 0:41:58.719 have been on the decline around the same period, and 0:41:58.760 --> 0:42:00.560 it's not a huge increase. I think it was like 0:42:00.600 --> 0:42:03.480 zero point one point seven percent from last year, for example, 0:42:03.480 --> 0:42:05.560 and that's about on average. I think it's like one 0:42:05.760 --> 0:42:10.360 percent ish over the years. But it is really important 0:42:10.440 --> 0:42:14.200 right that people are still having dangerous exposures and still 0:42:14.239 --> 0:42:18.319 relying on poison control to call, either from their home 0:42:18.560 --> 0:42:22.080 or health care facilities are relying on calling poison control 0:42:22.200 --> 0:42:25.439 for information, and so this is a really important thing 0:42:25.520 --> 0:42:28.239 that poison control centers are kind of grappling with, is 0:42:28.320 --> 0:42:32.040 like how to bring themselves into the twenty first century, 0:42:32.040 --> 0:42:35.400 which is really important because we can look at lots 0:42:35.400 --> 0:42:39.520 of data and see how important poison controls are in 0:42:39.640 --> 0:42:43.480 terms of lives saved and in terms of healthcare dollars saved. 0:42:43.520 --> 0:42:46.239 Aaron, uh huh, which. 0:42:46.760 --> 0:42:49.799 I love to talk about. We don't like to think 0:42:49.800 --> 0:42:52.040 about healthcare dollars, but we talk about them on this 0:42:52.120 --> 0:42:56.960 podcast a lot, because, especially in the world of public health, 0:42:57.080 --> 0:43:01.160 you have to unfortunately justify your existence using dollar signs, 0:43:02.640 --> 0:43:05.120 and it happens that in the case of poison control, 0:43:05.280 --> 0:43:08.680 we can absolutely do that. There was a ton of 0:43:08.719 --> 0:43:10.759 different studies that I saw, but I'm actually going to 0:43:10.800 --> 0:43:13.319 cite a few that were really old just because they 0:43:13.640 --> 0:43:17.560 highlighted this point so well. There was a paper from 0:43:17.680 --> 0:43:22.080 nineteen ninety one when the state of Louisiana closed their 0:43:22.080 --> 0:43:25.600 poison Control center, and then they were able to compare 0:43:25.760 --> 0:43:30.719 after this closure in Louisiana, information between Louisiana and Alabama, 0:43:30.880 --> 0:43:34.640 which is right next door, has very similar demographics and 0:43:35.080 --> 0:43:38.120 prior to the closure of the Louisiana Poison Control Center 0:43:38.440 --> 0:43:43.360 had very similar, almost identical triage patterns for exposures of 0:43:43.400 --> 0:43:45.359 their poison control center. So when they looked at the data, 0:43:45.440 --> 0:43:48.960 it was like really really similar calls that were coming in, Okay, 0:43:49.400 --> 0:43:52.680 And what they found is that the rates of people 0:43:52.719 --> 0:43:55.200 who had to end up going to the emergency room 0:43:55.600 --> 0:43:59.560 or urgent care or the doctor's office in Louisiana after 0:43:59.600 --> 0:44:03.160 the close sure of this poison control center, four times 0:44:03.160 --> 0:44:06.760 as many people sought care for poison exposures in Louisiana 0:44:06.800 --> 0:44:11.640 compared to Alabama during that time, and the estimated cost 0:44:11.760 --> 0:44:16.000 of this hospital and outpatient utilization for things that these 0:44:16.000 --> 0:44:18.440 are low level exposures that did not need to be 0:44:18.520 --> 0:44:21.920 managed by health care facilities at all, was one point 0:44:21.960 --> 0:44:23.640 four million dollars. 0:44:23.880 --> 0:44:25.760 Oh my gosh. 0:44:25.800 --> 0:44:29.320 And you might say, well, that's not that much money 0:44:29.360 --> 0:44:32.160 when you look at like huge health care spending overall, 0:44:32.640 --> 0:44:36.839 but it was also three times as much as the 0:44:36.840 --> 0:44:40.320 poison Control Center cost to run in its entirety. 0:44:40.560 --> 0:44:44.479 Oh my gosh. Okay, So I have a question though, 0:44:44.520 --> 0:44:48.879 just like logistically, when you call poison control, it's eight 0:44:49.000 --> 0:44:52.240 hundred two two two one two two two. That's the number. 0:44:52.560 --> 0:44:57.120 So when Louisiana shut down, it's poison control. What did 0:44:57.120 --> 0:44:59.200 that mean if you were in the state of Louisiana 0:44:59.239 --> 0:45:02.120 and you call that number. That is such a good question. 0:45:02.160 --> 0:45:04.000 I don't know what happened in nineteen ninety one. 0:45:04.400 --> 0:45:07.160 Okay, nineteen one, so things might have been organization. 0:45:07.320 --> 0:45:10.360 So I don't know if like they just lost access entirely. 0:45:10.440 --> 0:45:12.080 I know that they had enough data to be able 0:45:12.120 --> 0:45:14.719 to say there's no access here. Let the parent see 0:45:14.760 --> 0:45:18.680 what happens. Yeah, because right now, when a poison control 0:45:18.719 --> 0:45:21.600 center shuts down and we'll get there, then calls are 0:45:21.640 --> 0:45:24.040 going to be rerouted, and but it could end up 0:45:24.080 --> 0:45:26.640 then overwhelming another poison control center if you don't have 0:45:26.719 --> 0:45:28.439 enough people to kind of run it, and that sort 0:45:28.440 --> 0:45:28.799 of a thing. 0:45:29.760 --> 0:45:33.040 Okay, but yeah, that another question following get it to me. 0:45:34.080 --> 0:45:39.520 After this report came out, did Louisiana immediately go oh wow, whoops. 0:45:40.680 --> 0:45:43.960 I don't know the timeframe, but there is one now okay. 0:45:45.360 --> 0:45:47.920 Hopefully it was nineteen ninety two or like whenever. 0:45:47.640 --> 0:45:48.960 It was three. 0:45:49.000 --> 0:45:49.360 I don't know. 0:45:51.400 --> 0:45:53.239 But there are a lot of other things that go 0:45:53.360 --> 0:45:59.239 into how much poison control centers can help. Right There 0:45:59.280 --> 0:46:03.759 are a lot of other examples like this. There's also 0:46:03.920 --> 0:46:06.759 some really good ones. There's a paper that details how 0:46:06.800 --> 0:46:10.440 in El Paso, when they coordinated really well with a 0:46:10.440 --> 0:46:13.399 poison control center, they have documented that they were able 0:46:13.440 --> 0:46:16.879 to avert like seventeen hundred ambulance calls in a really 0:46:16.920 --> 0:46:20.400 short time period. There's a review paper from two thousand 0:46:20.400 --> 0:46:22.120 and nine, and a lot of these papers were really 0:46:22.160 --> 0:46:25.640 quite old, but it had a lot more numbers, and 0:46:25.800 --> 0:46:29.440 that combined with a report that I will say was 0:46:29.480 --> 0:46:34.160 commissioned by the American Association of Poison Control Centers, so 0:46:34.239 --> 0:46:36.440 there was some bias for that because it was a 0:46:36.440 --> 0:46:40.640 consulting firm commission by poison Control But looking at all 0:46:40.680 --> 0:46:44.880 of this data, the overall cost savings estimate of poison 0:46:44.880 --> 0:46:50.240 control centers is between seven and fifteen dollars per dollar spent, 0:46:50.840 --> 0:46:54.320 which accounts for close to a billion dollars in healthcare 0:46:54.360 --> 0:46:58.400 savings annually. And that's not even counting how many lives 0:46:58.480 --> 0:47:02.319 are saved, because there are a lot like there is 0:47:02.360 --> 0:47:04.720 a lot of data that shows that you can reduce 0:47:04.800 --> 0:47:08.560 hospital length of stay and you can improve health outcomes 0:47:08.760 --> 0:47:14.600 by having access to poison control center. Despite this, budgets 0:47:14.640 --> 0:47:18.400 are constantly at risk for poison control centers in the US. 0:47:19.120 --> 0:47:22.279 It's the same story for public health in general. And 0:47:22.360 --> 0:47:24.000 it is infuriating. 0:47:24.280 --> 0:47:27.799 It is the most infuriating and just the tail as 0:47:27.840 --> 0:47:31.640 old as time. Honestly, most of the funding for poison 0:47:31.640 --> 0:47:36.200 control centers is a mish mash cobbled together budget, right. 0:47:36.320 --> 0:47:38.719 Some of the funding comes from state budgets, some comes 0:47:38.760 --> 0:47:42.000 from federal budgets. There's like over twenty nine different agencies 0:47:42.000 --> 0:47:46.520 which contribute to various poison control centers and I said 0:47:46.520 --> 0:47:49.280 that there are fifty five poison control centers in the US. 0:47:49.920 --> 0:47:52.040 If you read some of these papers, they'll tell you 0:47:52.080 --> 0:47:54.400 that there are sixty one, because there used to be, 0:47:55.000 --> 0:47:57.200 but in the last few years several of them have 0:47:57.320 --> 0:48:01.520 closed due to budget cuts. Poison control centers in the 0:48:01.640 --> 0:48:06.680 US are so vulnerable it is bananas when you look 0:48:06.719 --> 0:48:11.239 at the data of how much they contribute, how many 0:48:11.320 --> 0:48:14.600 dollars they save, how much data we are able to 0:48:14.680 --> 0:48:18.600 generate from this real time reporting system, like the value 0:48:18.760 --> 0:48:26.520 that they bring is incredible. So that's our rant. I 0:48:26.520 --> 0:48:29.160 don't know how to fix that, but it's a thing. 0:48:29.880 --> 0:48:33.720 I mean invest in public health, yep, yep. 0:48:34.080 --> 0:48:38.440 Now, globally, speaking of investing in public health, as of 0:48:38.600 --> 0:48:42.440 January twenty twenty three, only forty seven percent of World 0:48:42.440 --> 0:48:47.200 Health Organization member states have poison control centers, so it's 0:48:47.200 --> 0:48:50.799 a pretty low number. Most of the countries in Europe, Australia, 0:48:50.880 --> 0:48:54.160 the UK, they all have poison control centers, but especially 0:48:54.160 --> 0:48:56.400 in low and middle income countries. There's a lot of 0:48:56.440 --> 0:48:58.640 parts of the world where people just don't have access 0:48:58.680 --> 0:49:02.040 to this information, which is a huge issue. 0:49:02.880 --> 0:49:04.960 Right well, and I think it just sort of shows 0:49:05.120 --> 0:49:09.880 in general that pattern where it's expensive to invest initially 0:49:10.360 --> 0:49:13.200 in poison control centers, but over the long run it 0:49:13.280 --> 0:49:16.720 saves money exactly. But if you don't have that initial 0:49:16.760 --> 0:49:21.440 investment and it's more like okay, well just triaging right 0:49:21.560 --> 0:49:27.280 the healthcare situation, then preventative stuff is like down the line, right, Yeah. 0:49:27.040 --> 0:49:29.800 If you're so deep in survival mode you can't think, 0:49:30.000 --> 0:49:33.919 yeah that ony steps ahead. Yeah it's tough, but they're 0:49:33.960 --> 0:49:38.680 incredibly valuable. I also so that everyone can say they 0:49:38.719 --> 0:49:41.960 know exactly how to contact if you are exposed to 0:49:42.000 --> 0:49:44.120 a potential poison, or you're worried you are exposed to 0:49:44.160 --> 0:49:47.160 something has it is, you too can have the joy 0:49:47.200 --> 0:49:50.359 of calling your friendly neighborhood poison control center. The phone 0:49:50.440 --> 0:49:53.239 number is one eight hundred two to two one two 0:49:53.280 --> 0:49:56.319 two two, or you can go to poisonhelp dot org. 0:49:56.840 --> 0:50:00.480 And another plug for the incrediblepoisonhelp dot org webs site 0:50:00.760 --> 0:50:04.319 is that in twenty twenty two they updated this website. 0:50:04.800 --> 0:50:07.520 So in addition to you, if you don't want to 0:50:07.520 --> 0:50:09.520 talk on the phone, you are not into talking on 0:50:09.560 --> 0:50:11.000 the phone, A lot of people aren't into talking on 0:50:11.000 --> 0:50:14.080 the phone, you don't necessarily have to. You can through 0:50:14.120 --> 0:50:17.719 their website fill out this information. They ask you very 0:50:17.719 --> 0:50:20.800 specific questions and you essentially go through the same exact 0:50:20.840 --> 0:50:24.319 steps as you would talking to someone on the phone, 0:50:24.560 --> 0:50:27.319 which is great. But as of twenty twenty two, they 0:50:27.360 --> 0:50:29.400 also have an option where you can say that this 0:50:29.560 --> 0:50:33.799 is a test or an information call rather than an 0:50:33.840 --> 0:50:37.880 actual exposure, which I think is just really really helpful. 0:50:37.880 --> 0:50:39.719 If you're like kind of worried about something but you 0:50:39.719 --> 0:50:41.840 don't know if anyone is exposed, but you're just worried 0:50:41.840 --> 0:50:44.160 about bringing something into your house or whatever it is, 0:50:44.760 --> 0:50:48.759 you can go there and get some information. It's phenomenal. 0:50:49.440 --> 0:50:51.520 M That's all I got. 0:50:51.640 --> 0:50:53.320 Erin poison controls. 0:50:52.960 --> 0:50:56.400 Wow, love them, love them. Are there poison control t 0:50:56.520 --> 0:50:57.640 shirts that we can. 0:50:58.000 --> 0:50:59.759 You know what we should find out? 0:51:00.040 --> 0:51:02.840 We should find it, get some but until then, until 0:51:02.840 --> 0:51:05.399 we can get our hands on a T shirt or 0:51:05.600 --> 0:51:10.319 make a T shirt or shirt, until then you can 0:51:10.360 --> 0:51:13.960 read more all about it. Specifically. Let me tell you 0:51:14.120 --> 0:51:17.200 where I got my information today. Saren already told you 0:51:17.280 --> 0:51:17.840 last week. 0:51:19.800 --> 0:51:24.480 Unsurprisingly, almost entirely, my information was from the twenty twenty 0:51:24.480 --> 0:51:29.719 two Annual Report of the National Poison Data Systems or NPDS, 0:51:29.760 --> 0:51:32.960 from America's poison centers it was their fortieth annual report. 0:51:33.040 --> 0:51:35.920 It was really phenomenal. There is literally so much detail 0:51:35.960 --> 0:51:38.440 in this report, it's like it just keeps going on 0:51:38.480 --> 0:51:40.840 and on and on. But I also had a number 0:51:40.880 --> 0:51:45.360 of really interesting papers about the impact of poison centers, 0:51:45.680 --> 0:51:48.400 both historically and today. And then a list from the 0:51:48.400 --> 0:51:51.920 World Health Organization of a directory of poison centers which 0:51:52.080 --> 0:51:54.920 isn't entirely up to date but is really interesting. You 0:51:54.960 --> 0:51:57.680 can find the list of these sources from this episode 0:51:57.680 --> 0:52:00.800 and every single one of our episodes on our website 0:52:00.800 --> 0:52:03.439 This podcast will Kill You dot Com under the episodes tab. 0:52:04.160 --> 0:52:08.400 Thank you again, so so much, doctor Doyon for taking 0:52:08.440 --> 0:52:11.880 the time to chat with us and sharing those amazing stories. 0:52:12.080 --> 0:52:14.200 We had the best time, we really really did. 0:52:14.600 --> 0:52:17.560 And also thank you for being so enthusiastic and like 0:52:17.920 --> 0:52:20.759 sending more ideas and things that we have so many 0:52:20.760 --> 0:52:24.440 more things to cover. I am thrilled about it, yes, totally. 0:52:25.080 --> 0:52:27.520 Thank you also to Bloodmobile for providing the music for 0:52:27.600 --> 0:52:29.680 this episode and every one of our episodes. 0:52:30.080 --> 0:52:33.200 Thank you to Tom Bryfocal and Leana Scuialacci for the 0:52:33.280 --> 0:52:34.600 amazing audio mixing. 0:52:35.040 --> 0:52:38.520 We love it. Thank you to everyone at Exactly Right Network. 0:52:38.239 --> 0:52:42.160 Thank you to you listeners for listening. I we really 0:52:42.160 --> 0:52:45.120 hope that you enjoyed these last two episodes and learned 0:52:45.160 --> 0:52:49.120 more and maybe if again. If you have a poison 0:52:49.160 --> 0:52:52.640 control story that you want to share, please send it 0:52:52.680 --> 0:52:53.080 our way. 0:52:53.560 --> 0:52:57.680 Yeah, love to hear it. Thank you especially to our patrons, 0:52:57.719 --> 0:53:00.160 Thank you so much for supporting us on Patreon on 0:53:00.239 --> 0:53:02.200 We really appreciate it. It means the world to us. 0:53:02.560 --> 0:53:03.279 It really does. 0:53:04.440 --> 0:53:07.440 Well. Until next time, wash your hands 0:53:07.680 --> 0:53:08.800 You filthy animals.