Keeping lethal substances from tiny fingers is harder than ever with more and more products on the market. But the National Poisons Centre is keeping tabs.
The trick to writing about a topic such as the National Poisons Centre is not to be seen googling “untraceable poison, kill somebody” as part of your research. Untraceable poisons and people who have been killed are not, as it turns out, a big part of the workload at the National Poisons Centre, which turned 60 in December.
Service delivery manager Lucy Shieffelbien has worked at the centre for 23 years. Her role doesn’t mean being called to give evidence as to the guilt or innocence of an accused in a poisoning case. It’s more focused on keeping picky little fingers out of the cleaning cupboard so that potentially horrendous consequences can be avoided.
The centre has a staff of 15 at its Dunedin headquarters and nine people are on hand 24 hours a day, seven days a week to take emergency calls. There’s no way of knowing how many lives have been saved by this free, accessible advice, but a safe estimate would be “a lot” – because our immediate surroundings are full of all sorts of potentially lethal substances.
The digital challenge has been met and overcome. When your child starts changing colour, googling “child turning purple” is definitely an inferior option. A quick call to the National Poisons Centre is likelier to get you the advice you need before it is too late.
“In the time it takes to google something and make sense of it when you’re not thinking straight, or to get to A&E, if your child’s screaming or vomiting and you have to find your car keys, strap your child into the carseat and back out of the drive, you could have phoned us and had the advice you’re actually looking for,” says Shieffelbien.
Chances are you’ll discover you don’t even need the hospital, “because our aim is to keep as many people at home as we can”.
The centre is also the sort of place where staff stay around long enough for institutional memory to develop, which means Shieffelbien is well placed to talk about changing trends in toxicity over the decades.
The no 1 call
The centre no longer sees much of “the real nasty things, like paraquat, a herbicide which is pretty much almost always fatal if it’s ingested. That’s a banned substance, but there is still paraquat lurking in back sheds and farmyards around the country. Probably once in every 10 years, we might get a call about it.” Poisons entered on the database are never removed, in case of those rare events.
That is at the extreme end of the scale. The poison that is the subject of more calls than any other is paracetamol. “Any house where there’s a child is pretty much going to have paracetamol in it. And generally, you go to your GP because one of your children is sick, and they’ll give you litres of the stuff, because they’ll go, ‘We know that Sarah is going to get sick, and then Mary …’
“Unfortunately, when they give it to you, it is prescribed for a particular child and a particular condition at a particular point in time, with a dose based on weight.”
This means parents can unwittingly end up double-dosing one of the other offspring at a later date.
“Even though that’s our No 1 call, fortunately we don’t see too many severe cases. There’s a very good antidote available, as long as treatment is sought within the appropriate time.”
The real nasty things, like paraquat, are pretty much almost always fatal if they’re ingested.
In fact, the greatest number of calls and most poisoning incidents involve kids getting into areas they shouldn’t.
“Nearly half of our calls are about children under five. They’re the ones who are crawling around on the floor and are really good at pulling out the bleach from under the sink, because it’s really accessible.
“That’s how children learn – they explore and they taste things. They put things in their mouths all the time. They get into cupboards that you think are up high enough. It’s never high enough.”
And there is no such thing as a child-proof cap. “We call them child-resistant closures, because if it was childproof, then adults would never get into them either.”
They’re designed to take longer to open: “As soon as you hear a child’s gone quiet, that’s them fiddling to get the lid open.”
Detergent danger
And although most cases end happily, there was that time “a wee boy climbed on his trike and got up on the sink, where a bottle of dishwasher powder was sitting on the bench. It had a child-resistant closure that wasn’t clicked on properly. As soon as he lifted up the bottle, the powder, just by the weight of it, forced its way down his throat. He had really horrific oesophageal burns.”
That time, though, there was one positive consequence. The centre does toxicovigilance – identifying and evaluating poisoning risks and potential avoidance measures. It monitors dangers and data constantly.
“If we notice something, we’ll make a noise about it. In this instance, we’d been making noise for quite some time about seeing children with really bad oesophageal burns from ingesting dishwash powders.” The noise had fallen on deaf ears, but this time an estimate of the child’s ongoing care was calculated and it came to about $4 million.
“That’s when the legislation was changed to stop manufacturing or selling of dishwash powders at a pH of higher than 12.5. Since they changed that law, we’re not seeing the same kind of injuries any more.”
The Covid Effect
The centre’s work is unique in other ways. For a start, no one has to take its advice. “Compliance is an issue,” says Shieffelbien rather drily. “We have had the odd time where we’ve said, ‘Look, your child really needs to be seen in hospital,’ and the parent has said, ‘But it’s 3 o’clock and I’ve got two other kids to pick up.’ They’re just thinking of other things first, but you hope that they have complied. Unfortunately, we can’t see hospital records, so we can’t see whether they did turn up.”
Unsurprisingly, Covid, that one-stop explanation for everything since 2019, has been part of the poisons mix. Surprisingly, perhaps, it seems to be connected to teenage self-harm.
“During Covid and after, there was a spike in the figures. I don’t know if mental health issues became more apparent during Covid, with the stress and the uncertainty that we were going through, but we certainly did notice an increase. And it’s not just here in New Zealand. Other poison centres have noticed an increase in teenage self-harm post-Covid.”
She says it’s not likely to have been bored teen experimentation in lockdown. “If that was the case, then I would have expected it to have peaked and then dropped again. But it’s just stayed.”
During Covid and after, there was a spike in the figures for teenage self-harm.
Teenage experimentation does prompt another category of inquiry: “We do get the odd phone call where mum’s been cleaning up her teenage son’s bedroom and finds some pills that could be illicit drugs, like MDMA, or they could be anything.” Again, compliance is likely to be up to mum and dad.
Methamphetamine and reactions to it were also part of a cycle of concern that reached the National Poisons Centre when hysteria about contaminated houses was at its peak. “There were a few cowboy operators who set up to decontaminate houses where, if there was even a suspicion that somebody had smoked meth in the house, there was a requirement to spend thousands of dollars to have every surface deep cleaned.”
There’s a big difference between smoking meth and running a manufacturing operation in the house, as the evidence is now showing.
On the centre’s website, there is only one category of product that gets its own section on the homepage. And it’s not paracetamol or methamphetamine. It’s hand sanitiser. Covid again.
“During Covid, they became the big thing. Mums and dads, backyard operators – everybody started producing hand sanitisers. Distillers couldn’t open during Covid, so instead of pumping out gin or vodka, they turned to making hand sanitisers with ethanol and other products. Because of the requirement to tell the poisons centre what’s in a product, we had all these operators sending us safety data sheets that weren’t even compliant.
“So [the website prominence] was our way of addressing the sudden influx of people going, ‘Hey, we’re selling this hand sanitiser. Do you want to know about it?’ Well, if it’s done properly, yes.”
Consumerism in general sends a lot of work the centre’s way. “The poisons centre came about because of the advent of more and more cleaning products post-war,” says Shieffelbien. “My grandfather, up to the day he died, had his cake of Sunlight soap and used that for everything from washing his dishes, to cleaning the car, to the floor, to showering. But slowly, over the years, we became a society with all these products.”
And the more products there were, the more ways there were for them to be misused, with results that could be toxic.
There’s always illicit substances for us to keep one step ahead of. Even things as simple as children’s toys.
So what are the new, potentially harmful products coming on stream as manufacturers continue to devise new ways to get people to pay for things they don’t need?
“There’s always illicit substances for us to keep one step ahead of. Even things as simple as children’s toys, like the ones with tiny little magnets in them or gel beads that expand to several times their size. We often don’t know these products exist until someone comes to grief with them.”
Also surprising in the user-pays world of today is the fact that the service is free, although there have been financial ups and downs along the way. After 60 years, the centre’s future seems secure, with staff employed by the University of Otago and subcontracted as part of the National Telehealth Service, funded by Te Whatu Ora.
And it has shown some initiative in developing a money-earning database of more than 125,000 substances. “Our original database has evolved,” says Shieffelbien. “It’s web-based, has been commercialised, and is now sold into over 30 countries around the world. The Australian government has purchased it. There’s about six poison centres in Canada that use it, quite a number in Europe. And just recently, I’ve managed – because the other part of my role is the commercialisation of the database – to crack the Middle East market.”
Backyard dangers
Lucy Shieffelbien’s best advice on how not to get poisoned
“One of the big things is the garden. The most common plant we get called up about is ‘the one that’s got green leaves and red berries’.”
Unsurprisingly, it’s difficult to identify plants from descriptions over the phone. “So, you should know what’s in your garden. Even if it is potentially toxic, be aware of the dangers and teach your children to appreciate them and not touch them. Certainly, know before you have to phone us what it is you’re growing.
“If you’ve got small children, any products, whether medicines, household products, stuff in the back shed – always lock them away. Don’t assume they can’t get into them. Keep them as high off the ground as possible, so they’re out of sight.
“One thing a lot of people don’t appreciate in New Zealand is inappropriate storage. There’s a lot of decanting when people have a wee bit of leftover petrol from the lawn mower. So they put it in this empty Coke bottle. And they think, ‘That’s okay because I’ve written “petrol” on it.’ But a 3-year-old can’t read. Now, if your 3-year-old does ingest petrol that’s in a Coke bottle, you can be prosecuted for it.”
The National Poisons Centre can be contacted on 0800 764 766 or visit poisons.co.nz