History
of Poison Control in Canada
In 1958, Health and Welfare Canada (now Health Canada),
established the Poison Control Program, within the
Product-Related Diseases Division. Product formulation
cards (and later microfiche) served as the database for
information requests regarding exposures. These cards were
distributed to all active treatment hospitals throughout
Canada. Manufacturers would voluntarily submit this
information to Health and Welfare Canada. Missing
information would be solicited by Health and Welfare Canada
staff when an exposure occurred to a product about which no
information was available. In exchange for these
information cards, Centres kept statistics and reported
these back to the Program. Annual reports were produced
from the data until 1988 when the federal program folded.
Although the database and statistical reports came from the
Federal Poison Control Program, funding for the Centres was
provincial and varied from province to province. In the
‘60s and ‘70s, most Centres were in the Emergency
Departments of active treatment hospitals. The Poison
Telephone was usually answered by the ER nurse. In the
‘80s, most of these local centres were replaced by regional
or provincial centres with dedicated, trained staff.
Physicians with specific training in Toxicology were hired
to give medical direction and continuing education. As many
of the exposures were pediatric, four of the dedicated
centres were located within pediatric hospitals. Although,
initially, calls to the Poison Information Centres were
from the public, over the years, increasingly, health care
providers have come to rely on the toxicological expertise
of the staff at Poison Centres to assist with the
management of poisoned patients who present to Health Care
facilities. Pediatric and adult calls are approximately
equal in number.
PROVINCIAL CENTRES
In 1968, the Ottawa Civic Hospital Poison Information
Centre was opened. During the day, a dedicated Registered
Nurse answered calls from the public; at night, the intern
staffing the Emergency Department answered these calls.
Similarly, a dedicated Registered Nurse answered calls in
the Emergency Department at the Hospital for Sick Children
starting in 1977. Both Centres were staffed 24/7 with full
time Medical Directors from 1981 forward. In 2005, the
Regional Centre at the Children’s Hospital of Eastern
Ontario was closed. The Centre at the Hospital for Sick
Children became the Ontario Poison Centre. Front line staff
include both registered nurses and pharmacists.
The BC Drug and Poison Information Centre (DPIC) began as a
research project in the mid-1960s at the Faculty of
Pharmaceutical Sciences at the University of British
Columbia (UBC). The project involved development and
distribution of Poison Information Cards designed to assist
practitioners in the diagnosis and treatment of poisoning
incidents. DPIC was formally established at Vancouver’s St.
Paul’s Hospital in 1975 through the cooperative efforts of
the Hospital Programs Branch of the BC Ministry of Health
and UBC. The original mandate of the Centre called for the
development of centralized services to assist health
professionals throughout BC in providing optimal levels of
drug therapy and poison management. Public access to poison
control began in 1981 for residents of the Vancouver area,
further expanding to include the Victoria region in 1985.
The following year, nurses joined the existing staff of
pharmacists and consulting physicians, and the entire
province was opened to toll-free poison information
services. The Centre’s history of providing supplemental
toxicology information in written form has continued with
publication of the Poison Management Manual, which replaced
the original Poison Information Cards in 1981. In addition
to its UBC association, since 2002 DPIC has been affiliated
with the BC Centre for Disease Control which is an agency
of the Provincial Health Services Authority.
In 1986, three remaining regional poison centres in Quebec
were amalgamated as one provincial centre at le Centre
Hospitalier de l'Université Laval in Québec City.
Specialist nurses are located in the Centre in Quebec.
Toxicologists throughout the province remained on staff. In
2003, the Centre was moved and came under the jurisdiction
of the CLSC-CHSLD Haute-Ville-Des-Rivières.
Alberta established the toll-free provincial Poison and
Drug and Information Service (P.A.D.I.S.) in 1986 at the
Calgary Foothills Hospital. The Centre was established to
replace five regional centres and to link the provision of
poison information services with that of drug information
services already established and operating out of the
Pharmacy Department at the Foothills. Both registered
nurses and pharmacists now answer these information lines.
In 1993, a toll-free poison information number for southern
Saskatchewan was established in Regina and another in
Saskatoon for northern Saskatchewan, but with no dedicated
staffing. In 2001, Saskatchewan contracted with the Alberta
Poison Centre to provide comprehensive poison service to
Saskatchewan through a dedicated toll-free number.
Also in 1993, the IWK Regional Poison Centre was
established at the IWK Hospital in Halifax, Nova Scotia
replacing the red phones in the pediatric emergency
department. Specialist trained nurses and pharmacists
answer the poison information lines. A physician
toxicologist joined the Centre in 2005 and a complement of
Emergency Physicians offer medical back-up.
Each of these Centres, strives to follow the criteria as
set by the American Association of Poison Control Centers
(AAPCC) for certification. The registered nurses and
pharmacists answering the information lines in each of
these Canadian Centres are eligible for certification as a
Specialist in Poison Information. Eligibility for
certification includes at least two years of full time
employment at a Poison Centre, handling of two thousand
human exposure calls and challenging a written examination
as set by the AAPCC.
The Children’s Hospital in Manitoba has a dedicated
telephone information line in the Emergency Department
answered by physicians. The phone number is local only. No
toll-free line is available for the Province. In
Newfoundland, a registered nurse answers a dedicated
province wide information line from 0800-2400. In New
Brunswick, poison calls from the public are answered by a
health information line registered nurse. These nurses have
no specific training in toxicology. No information line is
available for health care providers. None of the
Territories have dedicated poison centres although poison
calls are handled either by 911 operators or by personnel
in the Emergency Departments in Whitehorse, Yellowknife and
Iqualuit. Specific expertise and consultation may be sought
as necessary from other provincial poison centres.
CANADIAN ASSOCIATION OF POISON CONTROL CENTRES
ASSOCIATION CANADIENNE DES CENTRES ANTI-POISONS
In order to provide some cohesiveness and sense of "system"
to a fragmented group of Poison Centres dispersed across
the country, a voluntary association, the Canadian
Association of Poison Control Centres (CAPCC) was formed at
a meeting of Medical Directors in Toronto in 1982.
The CAPCC provides a centralized forum for communication,
information & idea exchange among Canadian Poison
Centres. While its members are primarily professionals
working in Poison Control Centres, other members have
included pharmacists, pharmaceutical companies, forensic
toxicologists, public health staff and emergency
physicians.
PRODUCT FORMULATIONS DATABASE
The Federal Government Product database was maintained and
distributed until 1988. At that time, the CAPCC and the
Canadian Paediatric Society negotiated with Health &
Welfare to take over responsibility for the database. The
CPS agreed to use its permanent secretariat address for the
receipt of Canadian product formulations. The CAPCC decided
that the needs of its members would be best served by
incorporating the Canadian data into the existing POISINDEX
database that was presently being used by all members.
Because of cross border trade, having access to American
data was important. Subsequently, the Canadian federal data
files were downloaded into the Poisindex System. These
records are updated and new records are solicited through
mailouts to lists of manufacturers. The submissions are
funneled through the Ottawa Poison Centre under the
auspices of the Canadian Paediatric Society, to Poisindex.
Some Canadian companies, primarily industrial, only submit
their information to the Centre for Occupational Health
(Hamilton). Thus their CCINFO database, which is unedited
MSDS', is also essential. Both databases are CD-ROM and Web
based.
POISONING STATISTICS
As poison centres are funded provincially, each province
has different reporting requirements and formats.
Currently, no federal government department keeps of
reports national poisoning statistics, except for those
resulting in death. An initiative by Health Canada to
establish a Canadian poison database and statistics was
piloted in 2002 but funding was cancelled prior to its
national implementation.
The CAPCC remains committed to working towards the
development of national statistics.
