Poison control Poison control CentersCenters
Ministry of Health & Population Occupational health department
Poison Control Centers
Currently an exceedingly large number of Currently an exceedingly large number of chemicals is imported, manufactured, chemicals is imported, manufactured, marketed, used, transported, stored and marketed, used, transported, stored and disposed of, thus creating huge benefits, but disposed of, thus creating huge benefits, but also health and environmental risks. also health and environmental risks. Explosives are used in different activities, Explosives are used in different activities, such as mining, police activities. Radioactive such as mining, police activities. Radioactive substances are used in clinical activities, substances are used in clinical activities, research, welding and piping testing. Handling research, welding and piping testing. Handling of such substances in an environmentally of such substances in an environmentally sound manner is of paramount importance for sound manner is of paramount importance for proper health and environmental protection as proper health and environmental protection as well as for the sound management of natural well as for the sound management of natural resources and life enjoyment. resources and life enjoyment.
With general lack of effective control on With general lack of effective control on handling of these chemicals, chemical handling of these chemicals, chemical emissions to the environment and inadequacy emissions to the environment and inadequacy of facilities for toxic waste disposal, there is a of facilities for toxic waste disposal, there is a potential for major health problems due to potential for major health problems due to exposure of the population to these chemicals. exposure of the population to these chemicals. Although the amount of pesticides used in Although the amount of pesticides used in agriculture has decreased considerably during agriculture has decreased considerably during the last decade, appreciable amounts are still the last decade, appreciable amounts are still being used.being used.
In 1998-1999 Egypt used 1365 tons of In 1998-1999 Egypt used 1365 tons of pesticides for agriculturepesticides for agriculture
Annual Egyptian imports of chemicals and Annual Egyptian imports of chemicals and chemical productschemical products
(40 million Tons)(40 million Tons)
0.02%1.1%1.3%2.5%3.4%6.3%9%
27.4%
49%
0
10
20
30
40
50
60
The major problems facing controlling The major problems facing controlling chemicals in Egypt arechemicals in Egypt are::
Inadequate capabilities to assess the potential toxicity Inadequate capabilities to assess the potential toxicity and to control the nature and purity of imported or and to control the nature and purity of imported or domestically produced chemicals.domestically produced chemicals.
Handling of chemicals by inadequately informed or Handling of chemicals by inadequately informed or trained personnel, especially operators in small-scale trained personnel, especially operators in small-scale enterprises.enterprises.
Shortage of management skills needed to deal safely Shortage of management skills needed to deal safely with technology transfer and with the storage, transport, with technology transfer and with the storage, transport, use or disposal of chemicals.use or disposal of chemicals.
Lack of effective mechanisms for coordinating the work Lack of effective mechanisms for coordinating the work of those responsible for different aspects of chemical of those responsible for different aspects of chemical safety.safety.
The major problems facing controlling The major problems facing controlling chemicals in Egypt arechemicals in Egypt are
Lack of means of dealing with chemical accidents, Lack of means of dealing with chemical accidents, including the treatment of victims and the subsequent including the treatment of victims and the subsequent rehabilitation of the environment.rehabilitation of the environment.
Inadequate proper management of chemicals and Inadequate proper management of chemicals and enforcement of regulations.enforcement of regulations.
Lack of reliable information sources to establish Lack of reliable information sources to establish properly coordinated infrastructures, controls and properly coordinated infrastructures, controls and procedures to deal properly with chemical safety.procedures to deal properly with chemical safety.
More and more people are being More and more people are being exposed to hazardous chemicals, both exposed to hazardous chemicals, both
occupationally and otherwise.occupationally and otherwise.
The occupational health dept. ( chemical register ) MOHP The occupational health dept. ( chemical register ) MOHP registers cases of intoxication with chemicals which received registers cases of intoxication with chemicals which received by emergency room of MOHP hospitals .by emergency room of MOHP hospitals .
Small outbreaks have been reported occasionally due to Small outbreaks have been reported occasionally due to pesticides, chlorine and other chemicalspesticides, chlorine and other chemicals
Increased chemical risk exposure
Poisoning cases 2002Poisoning cases 2002
CauseCause NumberNumber
Chemical poisoningChemical poisoning 1429814298
Scorpion stingScorpion sting 2893328933
Snake biteSnake bite 33293329
Dog biteDog bite 4590045900
Total animal biteTotal animal bite 1223712237
Percentile distribution of Percentile distribution of poisoning by cause and poisoning by cause and
sexsex
55%54%69% 73%
46% 45%31% 27%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Chemicals Scorpion Snake Dog
FemaleMale
Distribution of chemical Distribution of chemical poisoning by age groupspoisoning by age groups
21.5
25.5 25.6
21.5
4.6
1.30
5
10
15
20
25
30
<5 5--16 17--24 25--44 45--59 >60
Distribution of Scorpion Distribution of Scorpion poisoning by age groupspoisoning by age groups
8.7
22.4
17.9
34.5
12.5
3.9
0
5
10
15
20
25
30
35
40
<5 5--16 17--24 25--44 45--59 >60
Distribution of Snake Distribution of Snake poisoning by age groupspoisoning by age groups
6
20.5 20
37.6
12.4
3.20
5
10
15
20
25
30
35
40
<5 5--16 17--24 25--44 45--59 >60
Distribution of Dog Distribution of Dog poisoning b y age groupspoisoning b y age groups
12.9
44
14
19
7.6
2.70
5
10
15
20
25
30
35
40
45
50
<5 5--16 17--24 25--44 45--59 >60
Death cases record Death cases record According to sexAccording to sex
CauseCause MaleMale FemaleFemale
Chemical Chemical poisoningpoisoning
295295 185185
ScorpionScorpion 3737 3131
SnakeSnake 55 22
DogDog 1212 55
Source: Health information system- MOHP
Death cases record Death cases record According to AgeAccording to Age
CauseCause Less than Less than 1717
More than More than 1717
Chemical Chemical poisoningpoisoning
170170 310310
ScorpionScorpion 6060 88
SnakeSnake 44 33
DogDog 1111 66
Source: Health information system- MOHP
Poison control centerPoison control center FunctionsFunctions
InformationInformationProvision of information on the Provision of information on the
signs and symptoms of signs and symptoms of poisoning, both by individual poisoning, both by individual chemicals and by mixtures of chemicals and by mixtures of
chemicals as found in chemicals as found in commercial products to aid commercial products to aid
diagnosis with such diagnosis with such information information
Toxicovigillance and advice on Toxicovigillance and advice on prevention of poisoning and prevention of poisoning and
development of preventive measures development of preventive measures
Management of poisoned Management of poisoned patientspatients
(Clinical Toxicology)(Clinical Toxicology)
Teaching and training in Teaching and training in prevention and control of prevention and control of
poisoningpoisoning
Conduction of researches, Conduction of researches, epidemiological studies for epidemiological studies for risk factors identificationrisk factors identification
Provision of laboratory Provision of laboratory analytical services for analytical services for diagnosis and prognosis and diagnosis and prognosis and to support the management to support the management of poisoned patientsof poisoned patients
HistoryHistory In 1997, a ministerial decree( MOHP) was agreed In 1997, a ministerial decree( MOHP) was agreed
to establish poison centers in 5 governorates to establish poison centers in 5 governorates
Collaborating with WHO in implementation of Collaborating with WHO in implementation of those poisons information and control centers at those poisons information and control centers at 5 governorates(Menia, Dakahlia, Behira, Ismailia 5 governorates(Menia, Dakahlia, Behira, Ismailia and Sohag)and Sohag)
Equipmentation of the above centers with the Equipmentation of the above centers with the functions, specially: PC hardware & relevant functions, specially: PC hardware & relevant software (intox and inchem CD ).software (intox and inchem CD ).
IsmailiaDakahlia
Menia
Behira
Sohag
LocationLocation
Constraints concerning Poison Control Center
•Budget limitation for training and staff.
•Weak response from the localities .
•Conflicts between preventive and curative health sectors .
•Newly graduated physicians are not interested.
•Unaware of policy and decision makers with information center ( management concept)
The development and The development and strengthening of implementation strengthening of implementation process started in 2 pilot centers process started in 2 pilot centers (Menia and Dakahlia) (Menia and Dakahlia)
ComponentsComponents Information systemInformation system
Information system for poisoning casesInformation system for poisoning cases Data retrieval softwareData retrieval software Reporting system for communication recordsReporting system for communication records
TrainingTraining Medical toxicologyMedical toxicology Information technologyInformation technology Information system Information system
CommunicationCommunication PublicationsPublications
Annual reportsAnnual reports Brochures and bookletsBrochures and booklets
TrainingTraining ToxicovigillanceToxicovigillance
Expected outputs from poison centersPreventive aspect of chemical risksRegulations for chemical safetyChemical risksTechnological disasters
Medical ToxicologyMedical ToxicologyGuidelines for acute poisoning managementDrugs Interaction
Information systemInformation systemInformation technologyData retrieval Data retrieval Data entry and analysis of poisoning cases and Data entry and analysis of poisoning cases and communication records communication records
.
Role of concerning Role of concerning ministriesministries
Within the MOHP, several health directorates and Within the MOHP, several health directorates and
districts are involved in chemical safety through : districts are involved in chemical safety through :
The General Directorate (G.D.) of Occupational Health The General Directorate (G.D.) of Occupational Health
which established a central unit for chemical safetywhich established a central unit for chemical safety
Chemical Safety UnitChemical Safety Unit: :
Aim:Aim:
Safe handling of chemicals throughout the whole process Safe handling of chemicals throughout the whole process (importation, transportation ,storage, use and waste (importation, transportation ,storage, use and waste management).management).
Function :Function : It has national chemical register-to-register all used chemicals It has national chemical register-to-register all used chemicals
(imported or manufactured locally).(imported or manufactured locally). Evaluating these substances, putting preventive measures to Evaluating these substances, putting preventive measures to
the whole process and reporting to the authorized agencies to the whole process and reporting to the authorized agencies to avoid exposure of Egyptian citizens to these hazards. avoid exposure of Egyptian citizens to these hazards.
Implementation of 5 poisons information and management Implementation of 5 poisons information and management centers at 5 governorates.centers at 5 governorates.
Training on :Training on :
- Information services. - Information services.
- First Aid services- First Aid services..
- Prevention handling and safe disposal- Prevention handling and safe disposal
- Environmental toxicology- Environmental toxicology
- Occupational toxicology- Occupational toxicology
Equipmentation of the above centers with : - Equipmentation of the above centers with : -
- PC hardware & relevant software.- PC hardware & relevant software.
- Specific medical equipments.- Specific medical equipments.
Implementation of toxicovigilance program for the Implementation of toxicovigilance program for the
different levels of health officials at all governorates.different levels of health officials at all governorates.
Supply the above unit with audiovisual training and Supply the above unit with audiovisual training and
educational materials on chemical safety matters educational materials on chemical safety matters
( guidelines, brochures ,posters).( guidelines, brochures ,posters).
Participation in the EMRO plan for preparedness to Participation in the EMRO plan for preparedness to
chemical accidentschemical accidents
The Directorate of Emergency Medical careThe Directorate of Emergency Medical care
is responsible for ambulance and immediate care of chemical is responsible for ambulance and immediate care of chemical
intoxication cases.intoxication cases.
The G.D. of Environmental HealthThe G.D. of Environmental Health
supervises hazardous materials and hazardous wastes supervises hazardous materials and hazardous wastes
generated by health establishments.generated by health establishments.
The G.D. of Food ControlThe G.D. of Food Control sets limits for food additives sets limits for food additives
and food contaminants, inspects and analyses imported and and food contaminants, inspects and analyses imported and
locally produced foods and those on the market for safety and locally produced foods and those on the market for safety and
investigates food poisoning outbreaks.investigates food poisoning outbreaks.
The D. of CentralThe D. of Central LaboratoriesLaboratories has laboratories has laboratories
which analyse vomitus,urine,blood of poisoned cases.which analyse vomitus,urine,blood of poisoned cases.
The research institute of Medical EntomologyThe research institute of Medical Entomology : :
carries out laboratory and field research to examine the carries out laboratory and field research to examine the
efficacy of public health pesticides and provide efficacy of public health pesticides and provide
information for registration of pesticides used for public information for registration of pesticides used for public
health and household purposes. These information are health and household purposes. These information are
utilized by theutilized by the Drug Policies and Planning Center Drug Policies and Planning Center
( DPPC ). The DPPC also participates in registration of ( DPPC ). The DPPC also participates in registration of
PH. Preparation under the responsibility of the central PH. Preparation under the responsibility of the central
directorate of pharmacy. directorate of pharmacy.
The General Organization for HealthThe General Organization for Health Insurance carries Insurance carries
out periodic medical examinations for workers exposed to out periodic medical examinations for workers exposed to
hazardous chemicals at work place.hazardous chemicals at work place.
The Ministry of Manpower and ImmigrationThe Ministry of Manpower and Immigration is is
responsible for the health of workers. Labour law no. responsible for the health of workers. Labour law no.
137/1981 has a special chapter devoted to occupational 137/1981 has a special chapter devoted to occupational
safety and health. The executive regulations and Ministerial safety and health. The executive regulations and Ministerial
Decrees set standards for work place exposures and specify Decrees set standards for work place exposures and specify
conditions to be observed to ensure safety in the use of conditions to be observed to ensure safety in the use of
chemicals.chemicals.
The Ministry of Housing and Utilities and New The Ministry of Housing and Utilities and New
CommunitiesCommunities issues standards and safety procedures for issues standards and safety procedures for
Industrial, commercial and other work places concerning Industrial, commercial and other work places concerning
chemical pollutants.chemical pollutants.
The Ministry of Water ResourcesThe Ministry of Water Resources implements implements
legislation to protect the River Nile and water ways from legislation to protect the River Nile and water ways from
pollution with all kinds of waste especially chemicals. pollution with all kinds of waste especially chemicals.
The Ministry of PetroleumThe Ministry of Petroleum implements chemical safety implements chemical safety
precautions in petroleum companies and has its own emergency precautions in petroleum companies and has its own emergency
plan for dealing with oil spills.plan for dealing with oil spills.
The Ministry of Interior- CivilThe Ministry of Interior- Civil defense Authority has plans for defense Authority has plans for
emergency actions towards chemical accident , trains personnel, emergency actions towards chemical accident , trains personnel,
inspects sites of potential riskinspects sites of potential risk
The customs AuthorityThe customs Authority and the General Organization for and the General Organization for
Control of Export and Import make sure that all imported Control of Export and Import make sure that all imported
chemicals comply with specifications and that restricted chemicals comply with specifications and that restricted
chemicals are not permitted. They co-operate with agencies for chemicals are not permitted. They co-operate with agencies for
which these chemicals are imported.which these chemicals are imported.
The Ministry of Agriculture deals with the The Ministry of Agriculture deals with the registration and safe handling of agricultural registration and safe handling of agricultural pesticides and monitors food for pesticide pesticides and monitors food for pesticide residues.residues.
The Ministry of Industry regulates the The Ministry of Industry regulates the importation and use of industrial chemicals importation and use of industrial chemicals and restricts the importation and handling of and restricts the importation and handling of hazardous chemicals . It prepared a list of hazardous chemicals . It prepared a list of chemicals used in industry. It also defines chemicals used in industry. It also defines places and methods of treatment and places and methods of treatment and disposal of hazardous chemical waste.disposal of hazardous chemical waste.
Poison Centers:Poison Centers:
Three centers were established at the Three centers were established at the
Universities of Ein Shams,Universities of Ein Shams, Alexandria andAlexandria and
CairoCairo..They carry out the following functions :They carry out the following functions :
Treat cases of chemical poisoning.Treat cases of chemical poisoning.
Carry out research.Carry out research.
legislationlegislation
Several Several legislationlegislation have dealt with the proper handling of hazardous have dealt with the proper handling of hazardous
chemicals, including pesticides, which are implemented by concerned chemicals, including pesticides, which are implemented by concerned
agencies.:agencies.:
Environmental law no.4 1994Environmental law no.4 1994
Labor law no 12 year 2003Labor law no 12 year 2003
Ministerial decree No. 55 year 1995 prohibits the use of 80 Ministerial decree No. 55 year 1995 prohibits the use of 80
agrochemical .agrochemical .
Egyptian activities in managing chemicalsEgyptian activities in managing chemicals
The Egyptian Environmental Affairs Agency (EEAA) is The Egyptian Environmental Affairs Agency (EEAA) is
the national body, which is responsible for drawing up the national body, which is responsible for drawing up
Egypt’s policy on the welfare of the environment and Egypt’s policy on the welfare of the environment and
natural resources, endorsing executive plans and natural resources, endorsing executive plans and
programs and the promulgation and follow-up of programs and the promulgation and follow-up of
legislation.legislation.
In response to Agenda 21, The Minister of Health has In response to Agenda 21, The Minister of Health has
approved a National Strategy of Health and Environment approved a National Strategy of Health and Environment
which was prepared in 1995, with assistance from the which was prepared in 1995, with assistance from the
WHO. And which had a chapter on chemical safety,WHO. And which had a chapter on chemical safety,
The MOHP is working towards a coThe MOHP is working towards a co--ordinated national ordinated national
activity in the field of chemical safety and it would be activity in the field of chemical safety and it would be
essential to have the strategy on chemical safety approved essential to have the strategy on chemical safety approved
by all concerned parties and to draw an integrated picture by all concerned parties and to draw an integrated picture
of the activities going on in that fieldof the activities going on in that field. . The necessary The necessary
information has to be collected from different agencies so information has to be collected from different agencies so
as to serve as a basis for this activity, to identify gaps and as to serve as a basis for this activity, to identify gaps and
suggest further actionsuggest further action..
Poison centers Poison centers SoftwareSoftware
Benefits of the softwareBenefits of the software To find out as rapid as accurate as the user To find out as rapid as accurate as the user
can the chemical name that he search for a can the chemical name that he search for a specific information.specific information.
To search either by generic or common To search either by generic or common names according to local data(Egyptian names according to local data(Egyptian common names).common names).
To set queries for cases scenarios by signs To set queries for cases scenarios by signs and symptoms, uses, color and state to reach and symptoms, uses, color and state to reach most possibilities.most possibilities.
Search a chemical by Search a chemical by generic namegeneric name
Search a chemical by Search a chemical by Common(trade) nameCommon(trade) name
Search a chemical by Color, Search a chemical by Color, state, uses and Signs & state, uses and Signs &
SymptomsSymptoms
Signs & Symptoms Color
State Uses
Search chemical via Search chemical via internetinternet
Selecting source and Selecting source and categorycategory
Source
Category
Output document(Pdf)Output document(Pdf)
Communication recordsCommunication records
Reporting data entry of Reporting data entry of poisoningpoisoning
Ministry of Health & PopulationMinistry of Health & PopulationOccupational Health Dept.Occupational Health Dept.Chemical Safety UnitChemical Safety Unit
Chemical Inventory sheetChemical Inventory sheet Date of Entry: Date of Entry: Chemical Name:Chemical Name: Importer:Importer: Exporter:Exporter: Origin:Origin: Quantity: ( X Kgm)Quantity: ( X Kgm) Port:Port: Class:Class: Status:Status:[MM1][MM1] [MM1][MM1]
PublicationsPublications
PublicationsPublications
Management of acute poisoningManagement of acute poisoning Drugs interactionDrugs interaction Prevention of poisoning(3 parts)Prevention of poisoning(3 parts) Chemical risk assessmentChemical risk assessment INTOX CDINTOX CD Data retrieval software CD and Data retrieval software CD and
user manualuser manual
Recommendation Strengthening of national capabilities and capacities for management of chemicals
Basic elements of sound management of chemicals Basic elements of sound management of chemicals areare: : • adequate legislation,adequate legislation,• information gathering and dissemination,information gathering and dissemination,• capacity for risk assessment and interpretation, capacity for risk assessment and interpretation, • establishment of risk management policy,establishment of risk management policy,• capacity for implementation and enforcement,capacity for implementation and enforcement,• capacity for rehabilitation of contaminated sites and capacity for rehabilitation of contaminated sites and poisoned persons,poisoned persons,• effective education programs and effective education programs and • capacity to respond to emergenciescapacity to respond to emergencies..
recommendationrecommendation
Safe use of pesticidesSafe use of pesticides Health education Health education Environmental and biological monitoringEnvironmental and biological monitoring Personal protection and treatment programe are necessary Personal protection and treatment programe are necessary Measures should be planned to prevent major hazards Measures should be planned to prevent major hazards TrainingTraining Information activities, modification of data collection Information activities, modification of data collection system and registration. system and registration. Epidemiological studies on population at riskEpidemiological studies on population at risk Risk assessment.Risk assessment. legislation : revision - enforcement - awarenesslegislation : revision - enforcement - awareness Public awarenessPublic awareness Coordination : GOs - NGOs - institutions. Coordination : GOs - NGOs - institutions. National Chemical Safety Profile.National Chemical Safety Profile.