What Resources do Indian Emergency Medicine Providers Access in the Treatment of Acute Toxic Ingestions?

Indian Emergency Departments (EDs) see a significant number of toxicologic cases each year, approximately half of which are attempts at deliberate self-harm. However, the available data are limited to deaths or certain cities or states in India. Additional data are needed on the most common agents and treatment practices. The objective of this study was to understand trends in the presentation and management of poisonings in India. Between September 2015 and May 2016, an online survey was administered to ED practitioners. Respondents were queried about common poisonings, treatments, and educational resource utilization, including use of India's national poison center hotline. 152 individuals responded to the survey. The most common poisonings encountered were organophosphates (79.4%), sedative/hypnotics (74.5%), household cleaning agents (58.8%), paracetamol (47.1%) and acid/alkali agents (44.4%). Use of poison specific antidotes was relatively low, reported by less than 50% of all respondents. Over 40% of respondents reported having no access to a poison center. Providers practicing in the Eastern (64.2%, 95% CI (45.4-83.2)) and Southern states (56.6%, 95% CI (45.7-67.5)) were much more likely to report no poison center access as compared to providers practicing in the Northern (0) or Western States 8.3%, 95% CI (-3.5-20.3). Most providers instead used hospital protocols, textbooks, or online resources to guide treatment and education efforts. Poisonings represent a major public health issue presenting to Indian EDs. Organophosphate ingestions are common, but these data suggest that medication overdoses are also common. Despite frequent presentations of potentially life threatening ingestions, often EDs have limited resources including lack of access to poison specific antidotes or poison center consultation. Although India has a 24-hour national poison center hotline, most providers in the South and East were unaware of this resource, suggesting an opportunity for better provider education.