If you have accidently swallowed something poisonous, or are trying to help somebody who has, do not make them vomit. It is not an effective way to remove poison from the system. The stomach contractions that cause vomiting can make the poison absorb more rapidly into the bloodstream. If the swallowed substance is corrosive it can do more damage to the oesophagus and mouth on the way up than if it stays is the stomach, and violent retching can push poison into the lungs, especially if it is a foaming substance like dishwashing liquid. Light liquids like petrol can release vapours that are harmful when inhaled. Small children can become drowsy after vomiting, which can be dangerous. Instead, you should call the National Poison Centre immediately.
Have you ever wondered who answers the phone when you call the number on the back of poisonous product bottles? Dunedin is home to the National Poison Centre, which gives free advice and peace of mind to New Zealanders every day.
A poison is any substance that is dangerous to health or life if it is ingested, inhaled or exposed to the skin or eyes. Almost anything, such as a medicine, chemical, plant, or hazardous creature can be a poison.
The National Poison Centre was opened at the University of Otago 51 years ago. Now they answer 30,000 calls a year, have eight regular staff members plus two poison information specialists. The staff have a variety of health-related degrees including Bachelors, Masters or PhDs in pharmacology, toxicology, neuroscience or nursing. They have also undertaken intensive training in the specific management of poisoning. Their work involves answering calls from concerned citizens and, between calls, updating the poison database, which now has information on about 200,000 substances collected over five decades. Over 20 countries, including many developing countries to which the Centre allows free access, use the database.
Workers at the Poison Centre also need the strength of character to deal with emotional, dangerous situations, and even some criminal behaviour.
I spoke to the Centre’s Operations Manager Lucy Shieffelbien. She told me the Centre deals mainly with four types of calls. The most common calls are about children who have swallowed things they shouldn’t have. Unintentional poisoning calls are when someone has used a product correctly but for whatever reason they have suffered an exposure, for example, if the wind picks up while you are spraying the garden and the spray blows in your face. There are calls concerning intentional misuse of substances for recreational or self-harming purposes. People also call with worries about “therapeutic error” – anything involving a medicine that went wrong. These include people taking the wrong medicine, the wrong dose or formulation (such as giving children adult paracetamol,) and taking medicine via the wrong route of exposure, such as putting eye drops in your ears or mouth. Medicine can also be given to the wrong patient, particularly in places such as care homes. Accidental poisoning is a huge problem to New Zealanders. 20% of families with pre-school age children have a poisoning scare every year. Keeping data helps the centre understand where mistakes happen and what they can do to educate people.
Poisonings tend to peak early in the morning when small children wake up, and around dinnertime when parents are busy with cooking. Daylight saving times mean more time for children to be outside in the sun, getting into strange plants, pesticides, and gardening products. Only one person is on from midnight to 8am. Nighttime calls are different to daytime. They often concern significant self-harm or multiple substance overdoses. People who have attempted suicide sometimes call the line after taking something poisonous, sometimes wanting to talk about their mental health predicament; the staff at the centre are not counsellors so only give advice on the poisoning at hand. They have to calmly tell them to call the hospital or go to their doctor. People will sometimes text their friends, often from other parts of the country, telling them they have self-harmed. The friend will call the poison line but struggle to give adequate information on the situation from a distance.
Some things many people think are poisonous actually aren’t. The little sachets of silica gel that come in shoeboxes won’t hurt you despite their melodramatic DO NOT EAT labelling. It says that because although they aren’t poisonous, you can choke on them if you swallow the packet whole. White-tail spiders are also not poisonous. They are, however, aggressive hunters who will not hesitate to attack a human. There are only two venomous land creatures in New Zealand – the native katipo and the Australian redback spider. The Centre also has pet fire-bellied newts that ooze poison out of their skin, the only poisonous pets they are allowed to keep. Shieffelbien introduced me to her favourite, Isaac Newt, a ten-year-old female who was heavily pregnant. The Poison Centre staff told me people can panic when their child is found fraternising with animals.
One small child was found eating ants in the garden. The child’s mother, terrified at the thought of ants living inside her child, called the poison centre after giving the child ant poison to drink. The poison was, of course, far more harmful than the ants.
The Poison Centre sometimes sees tragedies waiting to happen long before the government can be convinced to do something about it. They were trying to get a maximum pH level on washing powder for a long time, seeing the potential for injury to children if they managed to eat it. Nothing was done about it until a little boy tipped a bottle of the powder down his throat, causing massive injury and costing the country millions of dollars in health costs. The boy had to have a tracheotomy as the result of his accident. The price of his healthcare was the catalyst in importing and manufacturing laws being changed, not the trauma the child and his family went through. In 2007 the legislation was changed to prohibit the sale of powders with a pH higher than 12.5. “Often it’s not till something actually happens – risk is not enough. They have to see the results to make the changes.”
Every year when the government put up the price of cigarettes and tobacco the Centre notices a spike in nicotine poisoning. People call Quitline and get nicotine lozenges and gum, which children get into and eat, thinking they are lollies. Nicotine is highly toxic to anybody who is “nicotine naïve,” particularly small children. A high enough dose can kill a child. Medsafe at the Ministry of Health had trouble believing that a child would eat the gum, thinking it tasted too bad. The staff at the Poison Centre had to convince them that the poison risk was very real, and one child had managed to eat around 15 pieces of gum and become very sick.
Adults, too, can unintentionally harm themselves with household products. When a toxic product is put into an unlabelled container like a coffee cup, sometimes somebody will drink it by mistake. A mother called the Centre because her teenage son had accidently drunk a pesticide that had been stored in a drink bottle. He hadn’t mentioned it until the next day when his throat was so sore he couldn’t swallow. The call taker said this was one of her more distressing calls in the decade she has been at the centre. She knew the outcome of the poisoning would be dire, and could only tell the mother to take her son to hospital immediately.
Shieffelbien told me how the arrival of certain products into the country could increase the number of calls to the Centre. One such product was the Duck Fresh Disc - the little coloured disc that you put in your toilet to make it smell clean. Within a week of them going on the market they were the Centre’s number one call. Though not actually poisonous, they are a choking hazard, and because they make kids climb headfirst into toilets, they are a drowning hazard too. The Centre discovered that the same product had been withdrawn from Europe because of the danger it posed to children, so the company dumped it on Australasia.
Product labelling is useful in giving information about dangerous substances directly to the consumer, but often their legal obligations are not very helpful. Packages can be too small to list first aid procedures for every kind of poisoning – if the product is swallowed, in the person’s eyes, on the skin etc. – and so will have the Poison Centre’s number instead. Party pills and legal highs used to have to list the phone number, but because they weren’t legally required to inform the centre what was actually in the pills, sometimes the phone operator would be unable to help. Many parallel imported products at dollar stores do not have ingredients listed in English. If someone calls having swallowed hair dye but they can’t read the Chinese instructions, they are in trouble. The phone operators then have to go off symptoms and references to similar products to give advice.
The Poison Centre’s call database is also where dangerous trends in poisoning are often first observed. If there is a spike in poisonings from a particular product or medication, the poison helpline will know about it before the rest of the medical world. In the ‘90s there was a powerful antihistamine marketed as a sleeping aid, called “Goodnight,” which was available over the counter at pharmacies. The Poison Centre had noticed a trend of misuse and overdose of the drug, with at least 67 intentional recorded adult poisonings before the legislation around its sale was changed. Unfortunately fatalities did occur. Most were young women under the age of 30. The average overdose was about 30 tablets. The centre notified the Ministry of Health who changed the regulations on the product. The drug can now only be sold by licenced pharmacists. In 2009 Christchurch woman Helen Milner was convicted of murdering her husband by sedating him with the same drug. She slipped crushed tablets into his food before smothering him in his sleep with a pillow.
The Centre can also keep tabs on the general population’s poison habits by looking at what people have searched online in relation to poisoning. Sometime it will be a certain product or drug, but, Shieffelbien told me, “Generally people search things like ‘poisons that kill instantly.’” This is one kind of information the Centre never gives out. They will not tell people the toxic dose of any poison over the phone. The staff member will ask the weight of the person and calculate whether treatment is needed based on milligrams of poison per kilogram of human. They give medical advice without saying how much poison would be needed to kill the person.
This precaution is necessary. The poison line attracts some unsavoury behaviour. Colin Bouwer, the Dunedin psychiatrist who murdered his wife in 2003, used the poison helpline to assist them in their crimes. He called and asked under guise of a genuine medical enquiry how long hypoglycaemic drugs remained traceable in the blood. He used the information to time how long he would wait to call emergency services after he had put his wife in a hypoglycaemic coma with dangerous doses of the drug.
The Poisons Information Officers are aware of other unhealthy behaviours, such as Munchausen syndrome: a psychiatric factitious disorder where people feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. They had a case of a man who had been banned from the Wellington Hospital for impersonating a doctor. He started poisoning himself on purpose and calling the Poison Centre, then getting himself an ambulance so he could enter the hospital via A&E. The same individual also managed to hack into the Centre’s poisons information database, allowing him to expand his knowledge of all things poisonous. As a result criminal charges were laid and the man was successfully prosecuted.
The toxicologists are aware that despite their massive knowledge of poisons, there is probably the same number of unknown or unregistered poisons as there are in the database. Poisons also vary from country to country: for example, Australia has far more poisonous animals than we do. Shieffelbien was at a toxicology conference where some Dutch toxicologists told everybody they had seen a snake on the beach and had had a good look at it and took photos because it was “brown and not poisonous.” It turned out to be a deadly poisonous brown snake: an attack could have been embarrassing to the toxicology community!
The Poisons Information Officers answered several calls in the space of 40 minutes. They answered in calm voices and with fingers tapping on the keyboard as they listened to the problem. They need to find a balance between communicating the gravity of the situation and preventing undue panic. Most calls are from distressed parents. 75% of poisonings can be dealt with at home. I overheard a call about a two year old that had swallowed rat poison, but the dose was far too small to do much damage. Most of the rat bait is to attract the rodents – only a tiny portion is poison. Another person with a terrible rodent problem had laid poison and was also attracting rats to traps with peanut butter, but discovered peanut butter contains the antidote to rat poison, Vitamin K. The Poison Centre calculated that a rat would need to eat a couple of jars of peanut butter to counteract the poison.
The workers at the Poison Centre are unsung heroes in the medical world. I have gone through my whole life without ever thinking of the people who answer up to 120 calls a day, giving free advice to New Zealanders in moments of worry or desperation. They are saving children’s lives, giving parents peace of mind, helping adults who have made mistakes or hurt themselves, and even foiling the occasional criminal.
If you or somebody you know has been poisoned, call the New Zealand Poison Information Service immediately at 0800 POISON (0800 764 766) or seek medical advice from another health professional