Using U.S. Poison Control Center records to identify bystander pesticide exposures: a one-year surveillance of four southeastern states.

The extent to which bystanders are exposed to pesticide applications is unknown. Systematic monitoring around spray areas is not routine. Quantifying exposures is extremely difficult. Persons inadvertently exposed to pesticides often do not know the chemical or quantity, and persons living near areas of frequent field spraying may receive multiple exposures. In the U.S., concerns about health consequences from these exposures may prompt calls to poison control centers. The goal of this study was to determine what surveillance poison control centers can provide on environmental pesticide exposures to bystanders. We searched the American Association of Poison Control Centers' 2001 electronic medical records for exposure reports involving persons from 129 agriculturally intensive counties in Kentucky, Tennessee, Louisiana, and Arkansas that implicated at least one of 54 generic classifications of agricultural chemicals. We abstracted 980 pesticide-related records. Narrative sections were reviewed to determine bystander status of the exposed person. Forty-six bystander exposures were identified from 32 events. Bystander ages ranged from 2 to 81 (median: 45; 16 females, 13 males). All pertinent information for bystander classification came from narrative sections of the record. 28% identified aircraft crop dusters as the pesticide source. The most implicated substance was malathion (30.4%), while 19.6% did not know the exposure substance. 73.9% of cases were symptomatic; 65.2% of the exposed persons were seen in or referred to a healthcare facility. No hospitalizations or deaths were reported. Although they may underestimate the true numbers, U.S. poison control center data can provide valuable information about bystander environmental pesticide exposures.