Annals of Emergency Medicine
Volume 54, Issue 3 , Pages 386-394.e1 , September 2009

Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care

Presented at XXVIII International Congress of the European Association of Poisons Centres and Clinical Toxicologists, May 2008, Seville, Spain.

  • Richard C. Dart, MD, PhD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • Division of Emergency Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
    • Corresponding Author InformationAddress for correspondence: Richard C. Dart, MD, PhD, 777 Bannock Street, Mailcode 0180, Denver, CO 80204
    • ,
  • Stephen W. Borron, MD, MS

      Affiliations

    • Department of Surgery, University of Texas Health Sciences Center, San Antonio, TX
    • ,
  • E. Martin Caravati, MD, MPH

      Affiliations

    • Division of Emergency Medicine, Utah Poison Control Center, University of Utah Health Sciences Center, Salt Lake City, UT
    • ,
  • Daniel J. Cobaugh, PharmD

      Affiliations

    • ASHP Research and Education Foundation, Bethesda, MD
    • ,
  • Steven C. Curry, MD

      Affiliations

    • Department of Medical Toxicology and Banner Poison Control Center, Banner Good Samaritan Medical Center, Phoenix, AZ
    • ,
  • Jay L. Falk, MD

      Affiliations

    • Department of Emergency Medicine, Orlando Regional Medical Center, University of Florida, Orlando, FL
    • ,
  • Lewis Goldfrank, MD

      Affiliations

    • New York City Poison Center; New York University School of Medicine, New York, NY
    • ,
  • Susan E. Gorman, PharmD, MS

      Affiliations

    • Division of Strategic National Stockpile, Centers for Disease Control and Prevention, Atlanta, GA
    • ,
  • Stephen Groft, PharmD

      Affiliations

    • Office of Rare Diseases Research, Bethesda, MD
    • ,
  • Kennon Heard, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • Division of Emergency Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
    • ,
  • Ken Miller, MD, PhD

      Affiliations

    • Orange County Fire Authority and Orange County Health Care Agency Emergency Medical Services, Irvine, CA, and National Association of EMS Physicians, Lenexa, KS
    • ,
  • Kent R. Olson, MD

      Affiliations

    • University of California, San Francisco, and San Francisco Division, California Poison Control System, San Francisco, CA
    • ,
  • Gerald O'Malley, DO

      Affiliations

    • Division of Research, Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA
    • ,
  • Donna Seger, MD

      Affiliations

    • Tennessee Poison Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
    • ,
  • Steven A. Seifert, MD

      Affiliations

    • University of New Mexico School of Medicine & Medical Director, New Mexico Poison and Drug Information Center, Albuquerque, NM
    • ,
  • Marco L.A. Sivilotti, MSc, MD

      Affiliations

    • Department of Emergency Medicine and Department of Pharmacology & Toxicology, Queen's University, Ontario, Canada
    • ,
  • Tammi Schaeffer, DO

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • Division of Emergency Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
    • ,
  • Anthony J. Tomassoni, MD, MS

      Affiliations

    • Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine, and Yale-New Haven Center for Emergency Preparedness and Disaster Response, New Haven, CT
    • ,
  • Robert Wise, MD

      Affiliations

    • Division of Standards and Survey Methods, The Joint Commission, Oakbrook Terrace, IL
    • ,
  • Gregory M. Bogdan, PhD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • Department of Pharmaceutical Sciences, School of Pharmacy, University of Colorado Denver, Aurora, CO
    • ,
  • Mohammed Alhelail, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Jennie Buchanan, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Jason Hoppe, DO

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Eric Lavonas, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • Division of Emergency Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
    • ,
  • Sara Mlynarchek, MPH

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Dong-Haur Phua, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Sean Rhyee, MD, MPH

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Shawn Varney, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Amy Zosel, MD

      Affiliations

    • Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO
    • ,
  • Antidote Summit Authorship Group

Received 4 July 2008 ,Revised 10 January 2009 ,Accepted 16 January 2009.

References 

  1. Bronstein AC, Spyker DA, Cantilena LR, et al. 2006 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol. 2007;45:815–917
  2. Howland MA, Weisman R, Sauter D, et al. Nonavailability of poison antidotes. N Engl J Med. 1986;314:927–928
  3. Chyka PA, Conner HG. Availability of antidotes in rural and urban hospitals in Tennessee. Am J Hosp Pharm. 1994;51:1346–1348
  4. Dart RC, Stark Y, Fulton B, et al. Insufficient stocking of poisoning antidotes in hospital emergency departments. JAMA. 1996;276:1508–1510
  5. Nogue S, Soy D, Munne P, et al. Antidotes: availability, use and cost in hospital and extra-hospital emergency services of Catalonia (Spain). Arch Toxicol. 1997;19:299–304
  6. Ong HC, Yang C-C, Deng J-F. Inadequate stocking of antidotes in Taiwan: is it a serious problem?. Clin Toxicol. 2000;38:21–28
  7. Juurlink DN, McGuigan MA, Paton TW, et al. Availability of antidotes at acute care hospitals in Ontario. CMAJ. 2001;165:27–30
  8. Gorman SK, Zed PJ, Purssell RA, et al. Antidote stocking in British Columbia hospitals. CJEM. 2003;5:12–17
  9. Hruby K. Dostupnost antidote v nemocnicnich lekarnach ceske republiky. Ces Slov Farm. 2003;52:231–240
  10. Dart RC, Goldfrank LR, Chyka PA, et al. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med. 2000;36:126–132
  11. Bailey B, Bussieres J-F, Dumont M. Availability of antidotes in Quebec hospitals before and after dissemination of guidelines. Am J Health Syst Pharm. 2003;60:2345–2349
  12. Sivilotti MLA, Eisen JS, Lee JS, et al. Can emergency departments not afford to carry essential antidotes?. CJEM. 2002;4:23–33
  13. Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals. In: Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2007;p. 111
  14. California Department of Public Health. Hospital administration penalties by county. http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567OliveViewUCLAMedical-Sylmar-EventE-EW2J11.pdfAccessed May 22, 2008.
  15. In:  Flomenbaum NE editors. Goldfrank's Toxicological Emergencies. 8th ed.. New York, NY: McGraw-Hill; 2006;
  16. Dart RC, et al. Medical Toxicology. 3rd ed.. Philadelphia, PA: Lippincott Williams & Wilkins; 2004;
  17. Wolf SJ, Heard K, Sloan EP, et al. Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose. Ann Emerg Med. 2007;50:292–313
  18. McDowell MA, Fryar CD, Hirsch R. Anthropometric Reference Data for Children and Adults: US Population, 1999-2002 (Advance Data From Vital And Health Statistics; No. 361). Hyattsville, MD: National Center for Health Statistics; 2005;
  19. Berberet BR, Burda BR, Lodolce AE. Unavailability of 10% alcohol in 5% dextrose injection. Am J Health Syst Pharm. 2005;62:2344–2345
  20. Berndt E. Posted list of emergency drugs and antidotes. Am J Hosp Pharm. 1994;51:2602
  21. Pettit HE, McKinney PE, Achusim LE, et al. Toxicology cart for stocking sufficient supplies of poisoning antidotes. Am J Health Syst Pharm. 1999;56:2537–2539
  22. Ontario Poison Centre guidelines for stocking of emergency antidotes. http://www.ontariopoisoncentre.com/ontariopoisoncentre/custom/antidotes2006.pdfAccessed May 4, 2008.
  23. The Joint Commission on Accreditation of Healthcare Organization. 2009 Hospital Accreditation Standards. Oakbrook, IL: The Joint Commission; 2008;http://www.jointcommission.org/NR/rdonlyres/F42AF828-7248-48C0-B4E6-BA18E719A87C/0/06_hap_accred_stds.pdfAccessed May 6, 2008.

 Supervising editors: Lewis S. Nelson, MD; Michael L. Callaham, MD

 Dr. Nelson and Dr. Callaham were the supervising editors on this article. Dr. Dart did not participate in the editorial review or decision to publish this article.

 Panel decisions: Panelists without a conflict of interest were eligible to vote on any issue. Panelists with conflicts were prohibited from voting on the drugs involved in the competing interest. The chair was nonvoting and disclosed that Denver Health's Rocky Mountain Poison and Drug Center is a nonprofit governmental facility that provides poison and drug information, and research and consulting services to various entities under contract.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Complete disclosures can be found in Appendix E1, available online at http://www.annemergmed.com.

 Publication date: Available online May 5, 2009.

 Reprints not available from the authors.

PII: S0196-0644(09)00103-6

doi: 10.1016/j.annemergmed.2009.01.023

Annals of Emergency Medicine
Volume 54, Issue 3 , Pages 386-394.e1 , September 2009

Article Tools