[Severe and fatal cases of poisoning in the emergency medical services-A 5-year analysis from the Poisoning Information Center North].

BACKGROUND

Cases of poisoning account for 3-7% of all emergency medical services (EMS) calls. At present it is not known which toxins are responsible for severe and fatal poisoning in Germany.

METHODS

In this study, all cases of poisoning with a severe or fatal course reported to the Poisoning Information Center (GIZ) North by the emergency services over a 5-year period were analyzed. The severity of poisoning was classified using the poisoning severity score (PSS) [4] and the causative noxious agents were assigned according to the anatomical therapeutic chemical (ATC) classification system [6].

RESULTS

In 259 cases out of 8528 consultations by the EMS the poisoning was severe and in 14 cases it was fatal. Most commonly involved were patients between 20 and 49 years. In 221 (81%) of these cases the poisoning was with suicidal intent and most often at home. In 199 cases the cause was pharmaceuticals, mostly taken by women (60.8%). Most substances were pharmaceuticals with effects on the central nervous system, the second most frequent but only in 16 cases were drugs with effects on the cardiovascular system. Chemical products accounted for 29 (10.6%) and drugs for 14 (5.1%) of the cases. The outcome was fatal in 14 (5.1%) patients. Most of these patients were already dead when found and resuscitation efforts were unsuccessful. Of the patients three were transported to hospital but were dead on arrival. In fatal intoxications suitable specific antidotes were principally available only in three cases but resuscitation efforts were either no longer indicated or were unsuccessful.

CONCLUSION

This study shows that most severe and fatal poisonings occur at home with suicidal intent using pharmaceuticals. Due to the possible number of different substances and the possible combinations, it is not possible for EMS personnel to assess all effects and substance interactions. If contacted early, due to their access to large data banks poisoning information centers are able to provide important recommendations with respect to symptomatic and further treatment as well as to suitable target hospitals.