From household toxins to drug overdoses, Portland poison center is on health care’s front lines

Posted March 20, 2014, at 5:54 p.m.
Nurse and poison specialist Shannon Smith takes a call at the Northern New England Poison Center in Portland recently. The call center covers Maine, New Hampshire and Vermont.
Nurse and poison specialist Shannon Smith takes a call at the Northern New England Poison Center in Portland recently. The call center covers Maine, New Hampshire and Vermont. Buy Photo
Dr. Tammi Schaeffer (right) and poison specialist Tami Perron look over the follow-up on a case at the Northern New England Poison Center in Portland recently. The staff at the center often stay in touch with callers to make sure their information and medical needs are met.
Dr. Tammi Schaeffer (right) and poison specialist Tami Perron look over the follow-up on a case at the Northern New England Poison Center in Portland recently. The staff at the center often stay in touch with callers to make sure their information and medical needs are met. Buy Photo
Poison specialists Shannon Smith (left) and Tami Perron take calls at the Northern New England Poison Center in Portland recently. The call center covers Maine, New Hampshire and Vermont.
Poison specialists Shannon Smith (left) and Tami Perron take calls at the Northern New England Poison Center in Portland recently. The call center covers Maine, New Hampshire and Vermont. Buy Photo
Poison specialist  Tami Perron takes calls at the Northern New England Poison Center in Portland recently. The call center covers Maine, New Hampshire and Vermont.
Poison specialist Tami Perron takes calls at the Northern New England Poison Center in Portland recently. The call center covers Maine, New Hampshire and Vermont. Buy Photo
Reference materials line a shelf at the Northern New England Poison Center in Portland recently.
Reference materials line a shelf at the Northern New England Poison Center in Portland recently. Buy Photo
Dr. Tammi Schaeffer (right) and poison specialist Janet Lund talk over  a case at the Northern New England Poison Center in Portland recently. Schaeffer is the medical director at the center and Maine's only board-certified hospital toxicologist.
Dr. Tammi Schaeffer (right) and poison specialist Janet Lund talk over a case at the Northern New England Poison Center in Portland recently. Schaeffer is the medical director at the center and Maine's only board-certified hospital toxicologist. Buy Photo
Toxicologist Karen Simone is the director of the Northern New England Poison Center in Portland. The center serves Maine New Hampshire and Vermont and is staffed 24-hours a day.
Toxicologist Karen Simone is the director of the Northern New England Poison Center in Portland. The center serves Maine New Hampshire and Vermont and is staffed 24-hours a day. Buy Photo

PORTLAND, Maine — At first glance, the Northern New England Poison Center looks much like any other call center, its cubicles tucked into a nondescript building off Washington Avenue in Portland. But the posters of poisonous mushrooms and glittered skull and crossbones decorations belie the life-saving, parent-soothing work taking place under its roof.

On a recent afternoon, four of the center’s staffers answered a flurry of calls.

“Have you rinsed her mouth out?” Tami Perron, a certified poison specialist, asked a panicked mother who discovered her child spraying Scrubbing Bubbles cleaner into her mouth. “Have you given her anything to drink?”

The child would be fine, Perron soothed, telling the mother to give the child water, juice or milk and advising her to watch for signs of upset stomach or drooling.

Perron’s cubicle mate, Zachary Pushee, similarly calmed a nervous father who learned that his nonverbal, autistic child drank a small amount of gasoline. While dangerous if ingested in larger volumes, the gas posed little risk, Pushee advised.

Nearby, nurse Shannon Smith finished chatting with the mother of a child who had eaten moon dough, a molding putty similar in texture, if not taste, to Play Doh.

“She was laughing by the time she hung up,” Smith said.

In each case, the children avoided a trip to the emergency room.

For many, poison control is just the number to leave by the phone for the babysitter. But poison centers like this one, a nonprofit operating under Maine Medical Center and serving Maine, New Hampshire and Vermont, hold a crucial place in the health care system, preventing unnecessary and costly visits to busy ERs.

Every $1 spent on poison center services saves the health care system more than $13, according to a September 2012 report by The Lewin Group, prepared for the American Association of Poison Control Centers. One call to a poison center could save up to $2,500 in ambulance and emergency department charges.

“We’re the front line,” said Dr. Tammi Schaeffer, both the center’s medical director and an emergency physician at MMC. “Oftentimes we’re going to make the decision as to whether somebody goes in [to the ER] or stays home. We hope to catch people so sometimes they don’t have to go in.”

The center’s staff won’t hesitate to urge callers to visit the hospital when necessary, but “it’s incredibly powerful to say to a mom, ‘You do not need to go to the emergency department, we’re going to help you through this,’” Schaeffer said.

Plenty of the Portland center’s nearly 67,500 calls a year — about 200 calls a day, enough to fill three school buses with patients — involve children getting into household products and medications. But many others rely on the center for its free help, 24 hours a day, 365 days a year.

Businesses call when workers are exposed to toxic chemicals or fumes. Suicidal individuals call. Victims of sexual assault phone in with suspicions that they’ve been drugged.

“It’s usually someone they know,” said Dr. Karen Simone, a toxicologist and the center’s director.

Callers to the center can remain anonymous. Staffers alert law enforcement only when they believe someone’s in immediate danger, a situation that occurs fewer than four times a year, Simone said.

The staff makes no judgements about callers reporting illegal drug use, Schaeffer said. They would rather someone report a friend in trouble so the center can find a way to help.

“Sometimes calling us is the equivalent to driving up to the ER and throwing someone out and driving away,” she said.

Individuals involved in drug use often put off calling, raising the risk of life-threatening complications such as high fever that can lead to brain damage, Simone said. Feeling confused and disoriented after using drugs is a big red flag, she said.

“Often people get sick in a way that doesn’t make sense. … They need to contact someone soon.”

Some callers just want information, rather than help with an emergency. Of those calls, 93 percent involve probable substance abuse. That’s why the center’s typically among the first to recognize and share information when a new drug hits the streets, as when bath salts first emerged in the Bangor area in 2011. More recently of concern are stronger, adulterated batches of heroin and the synthetic stimulant Molly, which users are dangerously combining with psychiatric medications.

The center provides real-time surveillance of such trends, assisting with identification and tracking of public health and environmental threats.

“We were one of the first groups to pick up Suboxone hitting the street,” Simone said.

The center also manages medication and antidote stockpiles for hospitals and the government.

A sizeable chunk of the center’s calls come from doctors, nurses and first responders looking for help nailing down what a patient ingested or guidelines for treating them.

“If you look at who calls us, a fifth or more are health care professionals, hospitals, doctor’s offices,” Simone said. “Lots of calls from school nurses, when kids are snorting Smarties or swallowing the class newt, or whatever strange thing it is that they’re doing.”

If callers end up in the hospital from a poisoning, the center’s involvement continues after hanging up the phone. Its nurses follow the patient through their treatment, and may offer recommendations to the care team. The staff checks back in with other callers, too, even if a child was exposed to something ultimately harmless.

“Even if we think the exposure’s completely nontoxic, we may call back if we think there’s a need for the parent to have further reassurance,” Schaeffer said. “Because we’re not only treating the kiddo, we’re treating mom and dad as well.”

Schaeffer is one of just 500 board-certified toxicology doctors in the country, the “geeks of medicine” as she calls them, and said she’s the only one working at a Maine hospital. Either she or Simone is always on call for the center. If the call comes in the middle of the night, Schaeffer has ascertained she can fall right back asleep if it lasts fewer than 9.5 minutes.

“That’s the detective part of this job that I love,” she said. “I close my eyes and I listen to what the doc has to say and I paint a picture of what they’re describing to me.”

Only about 30 percent of the center’s Maine calls involve human poisonings. Most aren’t emergencies, often seniors trying to identify the pills in a prescription bottle with a faded label or wondering about medication interactions.

Then there are the critters. While veterinary poison centers are available, they charge for their assistance, contributing to the two percent of calls to the Portland center that involve animal poisonings.

“Labrador retrievers are our biggest animal customers for some reason, they’ll eat just about anything and they’re a popular breed,” Simone said. “We also get the occasional cat, goat or other animal, maybe a bird.”

One woman switched her medications with her pet’s, taking her dog’s dewormer and feeding it her birth control.

Whether it’s a predicament like that or a serious poisoning, the Northern New England Poison Center is ready for the call. Or the online chat, a new feature recently added to its website. Next, the center hopes to add text messaging, particularly to reach out to teens reluctant to hear a voice on the other end of the line.

“We’re no longer sitting around waiting to be called,” Schaeffer said.

 

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