Experience of Indian emergency physicians in management of acute poisonings

Abstract

Indian Emergency Departments (EDs) encounter a significant number of toxicologic cases each year, approximately half of which are attempts at deliberate self-harm. The objective of this study was to understand trends in the presentation and use of resources for the treatment of poisonings in the emergency department setting. Between September 2015 and May 2016, we administered an online survey to Indian emergency department (ED) physicians. We queried respondents about common poisonings, treatments, and educational resources, including use of Indian poison centers. A total of 152 individuals responded to the survey. Respondents living in the eastern (64% of respondents) and southern (57% of respondents) regions of India were most likely to report not having a poison center as compared to respondents from the north. Most physicians instead used hospital protocols, textbooks, or online resources to guide treatment and education efforts. Despite frequent presentations of potentially life-threatening ingestions, often EDs do not rely on extensive poison center consultation. Although India has a poison center hotline, most physicians in the south and east were unaware of this resource, suggesting an opportunity for better physician education.

Antidote Mastery: A Survey of Antidote Knowledge and Availability among Physicians in a South Indian District

“…Organophosphates get the highest score with 80.60 % of respondents naming them as one of the top three contaminants. This finding is consistent with the findings from India, Sri Lanka and a few African nations [13][14][15][16] . According to official data from 2005, self-poisoning with pesticides accounted for 19.6 % of India's suicides [17] .…”

“…Aside from physician knowledge, the antidote stocking status at the ED was also questioned in 3 out of 5 of the five physicians who received their toxicological expertise from reading the literature. As we had expected, the results were embarrassingly dismal [13] . Only 42.24 % of the needed antidotes were accessible in all the hospitals assessed.…”

“…Antidotes, specialized decontamination procedures and extracorporeal decontamination techniques, on the other hand, are all critical to properly treat patients. In India, there are currently no widely accepted precise criteria that determine an ED's preparation for the care of acute hazardous exposures and poisonings [13] .…”

Toxicoepidemiology of poisoning exhibited in Indian population from 2010 to 2020: a systematic review and meta-analysis

“…The overall quality of evidence for each of the outcomes was assessed using GRADEpro GDT (Guideline Development Tool) software based on the principles of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). 5 12 GRADEpro does not recommend grading of evidence if the study is a single-group analysis. Hence no grading of evidence was done for the endpoint.…”

Establishment of an Undergraduate FOAM Initiative: International Emergency Medicine (iEM) Education Project for Medical Students

“… 19 Electronic learning, particularly FOAM can facilitate international collaboration by removing geographical boundaries, and reduce the dependence on local educators by giving access to otherwise expensive information, saving trainers’ time for hands-on training, and making information available at the point of care. 11 , 19 – 22 …”