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Poison control Centers Ministry of Health & Population Occupational health department Poison Control Centers.

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1 Poison control Centers Ministry of Health & Population Occupational health department Poison Control Centers

2 Currently an exceedingly large number of chemicals is imported, manufactured, marketed, used, transported, stored and disposed of, thus creating huge benefits, but also health and environmental risks. Explosives are used in different activities, such as mining, police activities. Radioactive substances are used in clinical activities, research, welding and piping testing. Handling of such substances in an environmentally sound manner is of paramount importance for proper health and environmental protection as well as for the sound management of natural resources and life enjoyment. Currently an exceedingly large number of chemicals is imported, manufactured, marketed, used, transported, stored and disposed of, thus creating huge benefits, but also health and environmental risks. Explosives are used in different activities, such as mining, police activities. Radioactive substances are used in clinical activities, research, welding and piping testing. Handling of such substances in an environmentally sound manner is of paramount importance for proper health and environmental protection as well as for the sound management of natural resources and life enjoyment.

3 With general lack of effective control on handling of these chemicals, chemical emissions to the environment and inadequacy of facilities for toxic waste disposal, there is a potential for major health problems due to exposure of the population to these chemicals. Although the amount of pesticides used in agriculture has decreased considerably during the last decade, appreciable amounts are still being used. In Egypt used 1365 tons of pesticides for agriculture In Egypt used 1365 tons of pesticides for agriculture

4 Annual Egyptian imports of chemicals and chemical products (40 million Tons)

5 The major problems facing controlling chemicals in Egypt are: Inadequate capabilities to assess the potential toxicity and to control the nature and purity of imported or domestically produced chemicals. Inadequate capabilities to assess the potential toxicity and to control the nature and purity of imported or domestically produced chemicals. Handling of chemicals by inadequately informed or trained personnel, especially operators in small-scale enterprises. Handling of chemicals by inadequately informed or trained personnel, especially operators in small-scale enterprises. Shortage of management skills needed to deal safely with technology transfer and with the storage, transport, use or disposal of chemicals. Shortage of management skills needed to deal safely with technology transfer and with the storage, transport, use or disposal of chemicals. Lack of effective mechanisms for coordinating the work of those responsible for different aspects of chemical safety. Lack of effective mechanisms for coordinating the work of those responsible for different aspects of chemical safety.

6 The major problems facing controlling chemicals in Egypt are Lack of means of dealing with chemical accidents, including the treatment of victims and the subsequent rehabilitation of the environment. Lack of means of dealing with chemical accidents, including the treatment of victims and the subsequent rehabilitation of the environment. Inadequate proper management of chemicals and enforcement of regulations. Inadequate proper management of chemicals and enforcement of regulations. Lack of reliable information sources to establish properly coordinated infrastructures, controls and procedures to deal properly with chemical safety. Lack of reliable information sources to establish properly coordinated infrastructures, controls and procedures to deal properly with chemical safety.

7 More and more people are being exposed to hazardous chemicals, both occupationally and otherwise. The occupational health dept. ( chemical register ) MOHP registers cases of intoxication with chemicals which received by emergency room of MOHP hospitals. The occupational health dept. ( chemical register ) MOHP registers cases of intoxication with chemicals which received by emergency room of MOHP hospitals. Small outbreaks have been reported occasionally due to pesticides, chlorine and other chemicals Small outbreaks have been reported occasionally due to pesticides, chlorine and other chemicals Increased chemical risk exposure

8 Poisoning cases 2002 NumberCause Chemical poisoning Scorpion sting 3329 Snake bite Dog bite Total animal bite

9 Percentile distribution of poisoning by cause and sex

10 Distribution of chemical poisoning by age groups

11 Distribution of Scorpion poisoning by age groups

12 Distribution of Snake poisoning by age groups

13 Distribution of Dog poisoning b y age groups

14 Death cases record According to sex FemaleMaleCause Chemical poisoning 3137Scorpion 25Snake 512Dog Source: Health information system- MOHP

15 Death cases record According to Age More than 17 Less than 17 Cause Chemical poisoning 860Scorpion 34Snake 611Dog Source: Health information system- MOHP

16 Poison control center Functions Information Provision of information on the signs and symptoms of poisoning, both by individual chemicals and by mixtures of chemicals as found in commercial products to aid diagnosis with such information Toxicovigillance and advice on prevention of poisoning and development of preventive measures

17 Management of poisoned patients Management of poisoned patients (Clinical Toxicology) Teaching and training in prevention and control of poisoning Teaching and training in prevention and control of poisoning

18 Conduction of researches, epidemiological studies for risk factors identification Conduction of researches, epidemiological studies for risk factors identification Provision of laboratory analytical services for diagnosis and prognosis and to support the management of poisoned patients Provision of laboratory analytical services for diagnosis and prognosis and to support the management of poisoned patients

19 History In 1997, a ministerial decree( MOHP) was agreed to establish poison centers in 5 governorates In 1997, a ministerial decree( MOHP) was agreed to establish poison centers in 5 governorates Collaborating with WHO in implementation of those poisons information and control centers at 5 governorates(Menia, Dakahlia, Behira, Ismailia and Sohag) Collaborating with WHO in implementation of those poisons information and control centers at 5 governorates(Menia, Dakahlia, Behira, Ismailia and Sohag) Equipmentation of the above centers with the functions, specially: PC hardware & relevant software (intox and inchem CD ). Equipmentation of the above centers with the functions, specially: PC hardware & relevant software (intox and inchem CD ).

20 Ismailia Dakahlia Menia Behira Sohag Location

21 Constraints concerning Poison Control Center Budget limitation for training and staff. Weak response from the localities. Conflicts between preventive and curative health sectors. Newly graduated physicians are not interested. Unaware of policy and decision makers with information center ( management concept)

22 The development and strengthening of implementation process started in 2 pilot centers (Menia and Dakahlia)

23 Components Information system Information system Information system for poisoning cases Information system for poisoning cases Data retrieval software Data retrieval software Reporting system for communication records Reporting system for communication records Training Training Medical toxicology Medical toxicology Information technology Information technology Information system Information system Communication Communication Publications Publications Annual reports Annual reports Brochures and booklets Brochures and booklets

24 Training Toxicovigillance Toxicovigillance Expected outputs from poison centers Preventive aspect of chemical risks Regulations for chemical safety Chemical risks Technological disasters Medical Toxicology Medical Toxicology Guidelines for acute poisoning management Drugs Interaction Information system Information system Information technology Data retrieval Data entry and analysis of poisoning cases and communication records

25 . Role of concerning ministries

26 Within the MOHP, several health directorates and districts are involved in chemical safety through : Within the MOHP, several health directorates and districts are involved in chemical safety through : The General Directorate (G.D.) of Occupational Health The General Directorate (G.D.) of Occupational Health which established a central unit for chemical safety which established a central unit for chemical safety

27 Chemical Safety Unit: Chemical Safety Unit:Aim: Safe handling of chemicals throughout the whole process (importation, transportation,storage, use and waste management). Safe handling of chemicals throughout the whole process (importation, transportation,storage, use and waste management). Function : It has national chemical register-to-register all used chemicals (imported or manufactured locally). It has national chemical register-to-register all used chemicals (imported or manufactured locally). Evaluating these substances, putting preventive measures to the whole process and reporting to the authorized agencies to avoid exposure of Egyptian citizens to these hazards. Evaluating these substances, putting preventive measures to the whole process and reporting to the authorized agencies to avoid exposure of Egyptian citizens to these hazards. Implementation of 5 poisons information and management centers at 5 governorates. Implementation of 5 poisons information and management centers at 5 governorates.

28 Training on : Training on : - Information services. - Information services. - First Aid services. - First Aid services. - Prevention handling and safe disposal - Prevention handling and safe disposal - Environmental toxicology - Environmental toxicology - Occupational toxicology - Occupational toxicology

29 Equipmentation of the above centers with : - - PC hardware & relevant software. - PC hardware & relevant software. - Specific medical equipments. - Specific medical equipments. Implementation of toxicovigilance program for the different levels of health officials at all governorates. Implementation of toxicovigilance program for the different levels of health officials at all governorates. Supply the above unit with audiovisual training and educational materials on chemical safety matters ( guidelines, brochures,posters). Supply the above unit with audiovisual training and educational materials on chemical safety matters ( guidelines, brochures,posters). Participation in the EMRO plan for preparedness to chemical accidents Participation in the EMRO plan for preparedness to chemical accidents

30 The Directorate of Emergency Medical care is responsible for ambulance and immediate care of chemical intoxication cases. is responsible for ambulance and immediate care of chemical intoxication cases. The G.D. of Environmental Health supervises hazardous materials and hazardous wastes generated by health establishments. supervises hazardous materials and hazardous wastes generated by health establishments. The G.D. of Food Control sets limits for food additives and food contaminants, inspects and analyses imported and locally produced foods and those on the market for safety and investigates food poisoning outbreaks.

31 The D. of Central Laboratories has laboratories which analyse vomitus,urine,blood of poisoned cases. The D. of Central Laboratories has laboratories which analyse vomitus,urine,blood of poisoned cases. The research institute of Medical Entomology : carries out laboratory and field research to examine the efficacy of public health pesticides and provide information for registration of pesticides used for public health and household purposes. These information are utilized by the Drug Policies and Planning Center ( DPPC ). The DPPC also participates in registration of PH. Preparation under the responsibility of the central directorate of pharmacy. The research institute of Medical Entomology : carries out laboratory and field research to examine the efficacy of public health pesticides and provide information for registration of pesticides used for public health and household purposes. These information are utilized by the Drug Policies and Planning Center ( DPPC ). The DPPC also participates in registration of PH. Preparation under the responsibility of the central directorate of pharmacy.

32 The General Organization for Health Insurance carries out periodic medical examinations for workers exposed to hazardous chemicals at work place. The General Organization for Health Insurance carries out periodic medical examinations for workers exposed to hazardous chemicals at work place. The Ministry of Manpower and Immigration is responsible for the health of workers. Labour law no. 137/1981 has a special chapter devoted to occupational safety and health. The executive regulations and Ministerial Decrees set standards for work place exposures and specify conditions to be observed to ensure safety in the use of chemicals. The Ministry of Manpower and Immigration is responsible for the health of workers. Labour law no. 137/1981 has a special chapter devoted to occupational safety and health. The executive regulations and Ministerial Decrees set standards for work place exposures and specify conditions to be observed to ensure safety in the use of chemicals.

33 The Ministry of Housing and Utilities and New Communities issues standards and safety procedures for Industrial, commercial and other work places concerning chemical pollutants. The Ministry of Housing and Utilities and New Communities issues standards and safety procedures for Industrial, commercial and other work places concerning chemical pollutants. The Ministry of Water Resources implements legislation to protect the River Nile and water ways from pollution with all kinds of waste especially chemicals. The Ministry of Water Resources implements legislation to protect the River Nile and water ways from pollution with all kinds of waste especially chemicals.

34 The Ministry of Petroleum implements chemical safety precautions in petroleum companies and has its own emergency plan for dealing with oil spills. The Ministry of Petroleum implements chemical safety precautions in petroleum companies and has its own emergency plan for dealing with oil spills. The Ministry of Interior- Civil defense Authority has plans for emergency actions towards chemical accident, trains personnel, inspects sites of potential risk The Ministry of Interior- Civil defense Authority has plans for emergency actions towards chemical accident, trains personnel, inspects sites of potential risk The customs Authority and the General Organization for Control of Export and Import make sure that all imported chemicals comply with specifications and that restricted chemicals are not permitted. They co-operate with agencies for which these chemicals are imported. The customs Authority and the General Organization for Control of Export and Import make sure that all imported chemicals comply with specifications and that restricted chemicals are not permitted. They co-operate with agencies for which these chemicals are imported.

35 The Ministry of Agriculture deals with the registration and safe handling of agricultural pesticides and monitors food for pesticide residues. The Ministry of Agriculture deals with the registration and safe handling of agricultural pesticides and monitors food for pesticide residues. The Ministry of Industry regulates the importation and use of industrial chemicals and restricts the importation and handling of hazardous chemicals. It prepared a list of chemicals used in industry. It also defines places and methods of treatment and disposal of hazardous chemical waste. The Ministry of Industry regulates the importation and use of industrial chemicals and restricts the importation and handling of hazardous chemicals. It prepared a list of chemicals used in industry. It also defines places and methods of treatment and disposal of hazardous chemical waste.

36 Poison Centers: Poison Centers: Three centers were established at the Universities of Ein Shams, Alexandria and Cairo.They carry out the following functions : Treat cases of chemical poisoning. Treat cases of chemical poisoning. Carry out research. Carry out research.

37 legislation legislation Several legislation have dealt with the proper handling of hazardous chemicals, including pesticides, which are implemented by concerned agencies.: Environmental law no Environmental law no Labor law no 12 year 2003 Labor law no 12 year 2003 Ministerial decree No. 55 year 1995 prohibits the use of 80 agrochemical. Ministerial decree No. 55 year 1995 prohibits the use of 80 agrochemical.

38 Egyptian activities in managing chemicals Egyptian activities in managing chemicals The Egyptian Environmental Affairs Agency (EEAA) is the national body, which is responsible for drawing up Egypt’s policy on the welfare of the environment and natural resources, endorsing executive plans and programs and the promulgation and follow-up of legislation. The Egyptian Environmental Affairs Agency (EEAA) is the national body, which is responsible for drawing up Egypt’s policy on the welfare of the environment and natural resources, endorsing executive plans and programs and the promulgation and follow-up of legislation.

39 In response to Agenda 21, The Minister of Health has approved a National Strategy of Health and Environment which was prepared in 1995, with assistance from the WHO. And which had a chapter on chemical safety, In response to Agenda 21, The Minister of Health has approved a National Strategy of Health and Environment which was prepared in 1995, with assistance from the WHO. And which had a chapter on chemical safety, The MOHP is working towards a co-ordinated national activity in the field of chemical safety and it would be essential to have the strategy on chemical safety approved by all concerned parties and to draw an integrated picture of the activities going on in that field. The necessary information has to be collected from different agencies so as to serve as a basis for this activity, to identify gaps and suggest further action. The MOHP is working towards a co-ordinated national activity in the field of chemical safety and it would be essential to have the strategy on chemical safety approved by all concerned parties and to draw an integrated picture of the activities going on in that field. The necessary information has to be collected from different agencies so as to serve as a basis for this activity, to identify gaps and suggest further action.

40 Poison centers Software

41 Benefits of the software To find out as rapid as accurate as the user can the chemical name that he search for a specific information. To find out as rapid as accurate as the user can the chemical name that he search for a specific information. To search either by generic or common names according to local data(Egyptian common names). To search either by generic or common names according to local data(Egyptian common names). To set queries for cases scenarios by signs and symptoms, uses, color and state to reach most possibilities. To set queries for cases scenarios by signs and symptoms, uses, color and state to reach most possibilities.

42 Search a chemical by generic name

43 Search a chemical by Common(trade) name

44 Search a chemical by Color, state, uses and Signs & Symptoms Signs & Symptoms Color State Uses

45 Search chemical via internet

46 Selecting source and category Source Category

47 Output document(Pdf)

48 Communication records

49 Reporting data entry of poisoning

50 Ministry of Health & Population Occupational Health Dept. Chemical Safety Unit Chemical Inventory sheet Date of Entry: Date of Entry: Chemical Name: Chemical Name: Importer: Importer: Exporter: Exporter: Origin: Origin: Quantity: ( X Kgm) Quantity: ( X Kgm) Port: Port: Class: Class: Status:[MM1] Status:[MM1][MM1] [MM1] [MM1][MM1]

51 Publications

52 Publications Management of acute poisoning Management of acute poisoning Drugs interaction Drugs interaction Prevention of poisoning(3 parts) Prevention of poisoning(3 parts) Chemical risk assessment Chemical risk assessment INTOX CD INTOX CD Data retrieval software CD and user manual Data retrieval software CD and user manual

53 Recommendation Strengthening of national capabilities and capacities for management of chemicals Basic elements of sound management of chemicals are: adequate legislation, adequate legislation, information gathering and dissemination, information gathering and dissemination, capacity for risk assessment and interpretation, capacity for risk assessment and interpretation, establishment of risk management policy, establishment of risk management policy, capacity for implementation and enforcement, capacity for implementation and enforcement, capacity for rehabilitation of contaminated sites and poisoned persons, capacity for rehabilitation of contaminated sites and poisoned persons, effective education programs and effective education programs and capacity to respond to emergencies. capacity to respond to emergencies.

54 recommendation Safe use of pesticides Health education Health education Environmental and biological monitoring Environmental and biological monitoring Personal protection and treatment programe are necessary Personal protection and treatment programe are necessary Measures should be planned to prevent major hazards Measures should be planned to prevent major hazards Training Training Information activities, modification of data collection Information activities, modification of data collection system and registration. system and registration. Epidemiological studies on population at risk Epidemiological studies on population at risk Risk assessment. Risk assessment. legislation : revision - enforcement - awareness legislation : revision - enforcement - awareness Public awareness Public awareness Coordination : GOs - NGOs - institutions. Coordination : GOs - NGOs - institutions. National Chemical Safety Profile. National Chemical Safety Profile.


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