Globally, poisoning is an under-recognized and under-reported major public health concern. While the World Health Organization (WHO) recommends that all countries establish and strengthen poisons centres, fewer than half of WHO Member States have one.
Ramathibodi Poison Center in Bangkok, Thailand, is one example of how a poisons centre can positively impact the health system of not only a country but an entire region. Opened in 1996, Ramathibodi advises and assists with the prevention, diagnosis and management of poisoning.
Medical professionals work at the call centre of the Ramathibodi Poison Center. © WHO / Amanda Mustard
Via a 24/7 hotline — 1367 — staff at the centre answer enquiries about potential poisoning from different sources, including consumer products, pharmaceuticals, substances of abuse, environmental chemicals, natural toxins, pesticides and industrial chemicals. They then provide an assessment of whether a particular exposure is hazardous, and information about the kind of treatment that should be given, if necessary.
Through sharing clinical guidance with health professionals from across the country, the centre empowers health professionals to provide the best management to poisoned patients. Such guidance is built upon many hundreds of thousands of cases and access to databases and images from poisons centres around the world.
Various sources of poisoning are documented and stored as specimen samples at the Ramathibodi Poison Center. Such samples can be used to confirm cases of poisoning, particularly when the patient or family may only have empty or broken packaging or information in foreign languages. © WHO / Amanda Mustard
In 2020, Ramathibodi consulted on more than 29 000 unique cases. More than half were related to drug and pesticide poisonings.
When he was 7 years old, Krittithee was referred to Ramathibodi after high levels of lead were found in his blood, a result of being accidentally shot in the leg with a lead bullet. Lead poisoning can occur from a number of different sources, including some household paints and contaminated soils, and is a particular concern for children’s long-term health.
Yingluck Thongtwein, 38, and her son Krittithee, 13, consult with Dr Satariya Trakulsrichai at the Ramathibodi Poison Center. © WHO / Amanda Mustard
“After the accident, I wondered if my life would ever go back to normal,” Krittithee said. “But it takes time.”
Timely access to information and treatment are key to surviving and recovering from poisoning. Access to antidotes or antivenoms that can counteract the poisoning is often life-saving.
Krittithee underwent several years of treatment at the centre. Prompt clinical diagnosis and laboratory analysis helped to confirm his need for specialized antidotes to counter the effects of lead poisoning.
“Today, he is able to walk again and handle his daily activities, living life as normal. He can go back to school. He can dream. He said he wants to be an accountant when he grows up. He gets to be an ordinary child again,” Dr Trakulsrichai said.
Dr Satariya Trakulsrichai at the Ramathibodi Poison Center. © WHO / Amanda Mustard
When the centre opened, access to antidotes in Thailand was a challenge. However, in 2010, the National Health Security Board in Thailand established a national antidote programme, and now both antidotes and antivenoms are more readily available.
Ramathibodi also coordinates the procurement and improved distribution of antidotes in the WHO South-East Asia region through an initiative to improve availability of these essential medicines. The initiative also encourages shared learning of technical expertise. Poisoning treatment guidelines may not be commonly published and can be very specific, hence, this mentoring is of critical importance.
Director of the Ramathibodi Poison Center Dr Winai Wananukul, Charuwan Sriapha, Puangpak Promrungsri and Achara Tongpoo meet in the main office of the centre. Regular review of calls referred to the centre helps to spot trends in cases and optimize the advice given. © WHO / Amanda Mustard
Charuwan Sriapha, a data scientist at the centre, recalls having sent antidotes to several countries, including Myanmar, India and once all the way to Nigeria.
Sriapha said, “I am proud to be part of Ramathibodi, which helps health workers save and improve the quality of their patients’ lives.”
Dr Satariya Trakulsrichai consults with patients at the Ramathibodi Poison Center. © WHO / Amanda Mustard
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Ramathibodi Poison Center is a WHO Collaborating Centre for the Prevention and Control of Poisoning and networks with other poisons centres around the world.
View the world directory of poisons centres.
Read the Delhi Declaration that aims to improve access to essential medical products in South-East Asia and more about the regional initiative.
Read recently published WHO guidelines for establishing a poisons centre, led by the WHO Collaborating Centre for the Public Health Management of Chemical Exposures, based at Public Health England.