Chemical use in Thailand has been increasing greatly in recent years due to a rapid growth of population, economy, industry, agriculture, as well as daily household use of drugs and chemicals.
The widespread use of chemicals has led to inappropriate application, misunderstanding, overuse or even misuse, resulting in environmental pollution and contamination of chemical residues in the food chain and water. These will harm and threaten the people's health which can create toxicities from chemical or drug use.
There are acute and chronic toxicities. Medical doctors or healthcare personnel are responsible for toxicity diagnosis. Only their expertise and experience in toxicology and clinical pharmacology can provide toxic treatment to patients. However, these experts have so far encountered the following problems.
- The inadequacy of data on toxic substances that patients have taken in terms of symptoms, toxicity, and treatment causes difficulty in updating knowledge for accurate treatment. Another reason is that doctors themselves have less available time because of other responsibilities. In addition, the doctors attending the emergency ward who usually first see and treat the patient have less experience in toxicological practice, resulting in less availability of data on toxic treatment.
- Patients reach the hospital too late for the doctor to provide treatment. This may be due to several reasons. For example, they may live some distance away from the hospital or they may have taken toxins without awareness of their hazards. So they ignore the treatment.
- Ineffectiveness in collecting data on the patient’s toxic consumption results from a lack of detailed and systematic plans. This leads to insufficiency in gathering data useful for developing better treatment and statistical application so that occurrences of toxicity can be prevented in the future.
- Due to inadequate information, unnecessary treatment could be provided to patients. Sometimes inappropriate use of antidotes could also be more harmful than the poison itself.
The poison center can help solve the aforementioned problems related to toxicology and pharmacology by means of collecting various types of toxic substances and also constantly adding up-to-date data of those substances. These can promptly provide service on toxic data and answers of questions from doctors, healthcare personnel and the general public, especially the poisoned patients.
Besides being a provider of toxic data, the center also provides professional help and advice for serious cases on first aid treatment as well as other preventive measures. For instance, how to wash the toxin off the skin, which is an easy and effective way of treatment before transferring the patient to the hospital. On the other hand, in case of non-poisoned patients, the center’s database can help the doctor not to provide excessive treatment. Furthermore, the center has been collecting data systematically leading to better assessment and medical treatment. Another advantage is that the database can be used for statistical analysis of toxicity from toxic substances, which is useful for toxicity prevention in the future.
In addition to those responsibilities mentioned, the center provides training courses for the public, i.e. teenagers, housewives to help them to be aware of the household toxic substances and toxicities caused by those chemicals as well as preventive measures and first aid treatment for the benefits of future prevention and toxicities.
The poison center which performs the above-mentioned tasks and services was first established in Chicago, U.S.A. by U.S. Food and Drug Administration. It was named “National Clearing House Poison Control Center”. During its first phase, the center was designed as a center for collecting data and answering questions on toxic substances. Due to its development in the later phase, the center set up a database system in the form of cardboards containing various kinds of data such as symptoms of toxicities and medical treatments. These data were sent to different places i.e. hospitals or public / private sectors which needed. Thus, searching for data related to poisonous substances could be done more rapidly and conveniently. However, due to rapid scientific development and more increasing of those substances with the enlarging database, the old data collection system in the form of using cardboards appeared to be ineffective. So the use of computers for storing data was introduced leading to more effectiveness and more conveniency. With this kind of database system, the center could provide public advice to 109 cases per day with complete answers of each question.
In terms of the center’s structural aspect, there appeared a change. The center used to be recognized as the central center but it was changed to be the provincial center. This change was thought to be able to solve two problems. One was to reduce the task of answering questions. The other was to increase accuracy of data in the database because substances of each province vary in terms of the rate of use and types of substances, especially those locally produced poisonous plants and animals. Therefore, the provincial center could perform these tasks more effectively than the central center.
There have been increasing responsibilities of various poison centers leading to considerations of the cost and effectiveness of those centers in terms of support and task expansion to reach the community level (instead of supporting only medical doctors or healthcare personnel). The Indianapolis Poison Center is given as an overseas example. Having been established for 10 years, the center was run by pharmacologists and nurses. Its first database system was in the microfiche form. It could answer 4,000 questions per year. Two year later, in 1984, the database system was changed to be computerized leading to an increase in answering more questions: 60,000 cases for answers of questions and 30,000 cases for advice of first aid treatment at home. In the aspect of cost and effectiveness, it was found that the 6-year expense from 1979 to 1984 cost $11,500,000. However, with free advice given to patients consuming toxins, the center could save money up to $ 3,075,000, and could reduce the toxic mortality rate of 33 % equal to 160 patients. In UK, the London Poison Center was able to answer 5,000 questions a year, and later in 1967, 55,000 questions a year. In the following years, the center had a tendency to serve the general public more than the medical doctors or the healthcare personnel.
As described above, most of the poison center’s tasks provide services of question answering. However, the ideal poison center should carry other responsibilities for medical treatment advantage. Those extra-services include medical treatment for patients suffering from toxic chemicals and research development aimed at improving medical treatment in the future. To meet the service requirements as mentioned, the poison center clearly needs a well-equipped laboratory for performing research on toxic substances and for supporting both medical treatment and prevention of poisonous hazards. To sum up, the center should aim to have a complete service cycle in three aspects which are medical treatment, research, and accurate information provision.
Besides having the problem of how to use drugs effectively without any side-effects with careful cost-effective consideration, Thailand also encounters another important problem that is it needs more sufficient research data to help doctors make decisions on selecting the right way of treatment for patients. In the meantime, the center has been gathering data related to pharmacokinetics, pharmacology, medical adjustment of diseases including medical controls on drug use and its side-effects as well as its reactions.
With the aforementioned factors, the poison center was set up at the Queen Sirikit Medical center of Ramathibodi Hospital under the Faculty of Medicine, Mahidol University. It is the first Thailand poison center which provides a complete cycle of service with reliable resources and accurate advice from medical experts. With convenient and up-to-date information provided, the doctor is able to promptly treat the poisoned patient.
Moreover, the center has been expanding its other activities including testing and monitoring the levels of toxic substances and drug use in the laboratory, allowing a referral to hospitals for severe patients suffering from poison or toxic drug.
In addition to these activities, the center is also acting as a resource center for data collection of various subjects i.e. occupational health and toxic substance control and management. These services are certainly of great benefit to medical doctors and other related personnel.
On the auspicious occasion of Queen Sirikit's official opening of the Queen Sirikit Medical Center on August 1996, the Ramathibodi Poison Center has been providing a 24-hour service to the public since then.
However, since 2005, the Ramathibodi Poison Center has been relocated to the 1st floor of Research and Welfare Building, Ramathibodi Hospital.
Importantly, the Center has been recognized and officially announced as “the Center of Excellence” of Ramathibodi Hospital under the Faculty of Medicine.
Moreover, as the Center's excellent performance in the past has gained both national and international recognition, the World Health Organization (WHO) has officially appointed it as “the WHO Collaborating Center for the Prevention and Control Poisoning” effective from October 18th, 2018 to October 17th, 2022.