About the Swedish Poisons Information Centre
The Swedish Poisons Information Centre (GIC) started in 1960 as one of the first in Europe. The centre, located at the Karolinska University Hospital area, is the only unit of this kind in Sweden and serves a population of 9.6 million inhabitants.
Since 1 November, 2009 the centre is part of the Swedish Medical Products Agency.
GIC has 37 employees: 6 physicians, 26 pharmacists, 3 administrative staff, 1 system administrator, and the unit director. The centre’s physicians are specialists in intensive care, and are available on duty for the pharmacists around the clock. They also have the possibility to practice in ICUs on a regular basis. The main task for the pharmacists is the telephone service, but among other tasks they also write substance monographs (new ones and quality revisions), summarize discharge records, prepare preventive material and make product risk assessments. An internal education and training period of approximately six months is required before new pharmacists are allowed to answer unsupervised telephone calls.
The main responsibility of the centre is to inform about risks, symptoms and treat-ment in cases of acute poisoning. The service is on a twenty-four hour basis and connected to the national alarm number 112. Inquiries are received from medical staff at hospitals or ambulances as well as from the general public. During office hours three pharmacists are at service answering calls, and additional pharmacists are available in case of queue situations. Evenings, nights and weekends, the staffing is reduced. One of the physicians is always on duty.
The poisons centre gives advice on the selection and amount of antidotes to be stored in hospitals all over the country. The centre keeps an updated register of stocks of antidotes in collaboration with hospitals and pharmacies in Sweden. An updated list on the use of antidotes with treatment instructions is also issued by the centre.
Toxicovigilance and prevention
An important task is to alert authorities and manufacturers on trends and risks of poisoning with e.g. new pharmaceuticals or chemical products. Information materials for different purposes, e.g. books, posters and brochures on the prevention of poisoning and first aid measures are regularly produced.
Swedish National ICE Centre
The poisons centre is the Swedish National ICE (International Chemical Environment) Centre, the Swedish part of a European network of emergency response centres for chemical accidents, initiated and financed by the chemical industry. This means that the centre, along with health hazards information and first aid advice, provides information regarding environmental hazards from safety data sheets concerning chemical products from the participating companies.
Major chemical accidents
In the field of major chemical accidents the centre is the expert body of the National Board of Health and Welfare and is also together with the National Board of Health and Welfare responsible for the antidote programme in case of major accidents.
Two publications are written by the centre on regular basis; a chapter on drug overdose, updated every year, as well as a list of antidotes with treatment instructions, updated every second year. The former is a chapter in the catalogue on Pharmaceutical specialities in Sweden, FASS. The list of antidotes is published in a book called Läkemedelsboken, LB. These books are distributed to all physicians and pharmacies in the country. The centre also publishes articles in medical journals, books etc
Studies of certain poisonings, often in close collaboration with hospitals, e.g. to elucidate the severity of poisoning, epidemiological data, circumstances of poisoning incidents or to evaluate new treatment recommendations, are continually ongoing activities.
The centre collaborates with a number of national organizations like the Public Health Agency of Sweden, the Swedish Chemicals Agency and the National Board of Health and Welfare.
Other assignments on a national basis are e.g. providing specialist education of physicians in training (Acute Poisoning and Metabolic Syndromes), providing expert educational/informative texts or lectures, and expert roles in publication reviews.
• Chairman of the Nordic Association of Poisons Centres (NAPC)
• General Secretary of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT)
• Evaluator of “Feasibility study for a sub regional Poisons Centre in Africa”
• Representative in EAPCCT working group on the harmonisation of information about chemical mixtures to be submitted to Poison Centres in accordance with the Regulation (EU) 1272/2008, Classification, Labeling and Packaging (CLP)
• Member of the editorial board for the journal of Clinical Toxicology, and referee assignments for the same journal.
• Member of the newly established EU-commission CPNP expert working group (Cosmetic Products Notification Portal)
• Member of the European Chemical Industry Council (CEFIC). ICE (Intervention in Chemical Transport Emergencies) Integration Group
• Lecture at “International Workshop for Clinical Toxicology Update”, Taiwan
Sources of Information
Toxicological and medical data is collected from different sources, processed by GIC staff, and integrated into our database, to be used as a basis for the advice given in the telephone service. Sources include articles published in the international medical literature, as well as information about newly registered drugs. The means and ways of poisoning are continuously changing, as well as treatment methodology, which makes it very important to continuously quality control and update the information in the GIC database.
A substantial part of the database consists of substance monographs focusing on risk, symptom and treatment in poisoning. The ambition is to have updated monographs of those pharmaceuticals, chemical substances and biological toxins, which are frequently causing poisonings.
Discharge records from hospitals
One important source in the telephone service is the discharge records (summary of medical records) that the hospitals on a voluntary basis send to GIC. Especially important is the information about new substances on the market, both pharmaceuticals and chemicals. During 2013, 80% of the discharge records sent to GIC involved pharmaceuticals and the remaining involved chemicals or biological toxins.
Incidents with chemical products are relatively common. In order to make an accurate risk assessment and give adequate advice, the poisons centre needs detailed information about the composition of chemical products. In spring 2013, GIC was officially appointed, according to Regulation (EU) 1272/2008 Classification, Labeling and Packaging (CLP), to be the body responsible for receiving information about chemical composition of mixtures to be used, in particular, for formulating preventative and curative measures, in particular in the event of emergency health response.
The Swedish government has during 2013 given an assignment to the Swedish Medical Products Agency together with the Swedish Chemicals Agency to investigate ways to simplify the process for companies notifying chemical product information which today is done to both GIC and the Products Register. GIC has an active role in this work, which is expected to be concluded and reported in late 2014.