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The Rocky Mountain Poison Center is a model system for regionalization. Minimal cost is achieved by concentrating expensive equipment and information materials in the main center. Access to information is rapid because each subregional center has a POISINDEX and thus the capacity to provide standardized initial therapy as soon as contact is made. Full integration of professional activities from training to education is accomplished within the framework of Emergency Medical Services. Public education is uniform throughout the region so that medical interaction is consistent and the public receives maximum reinforcement. Funding is found through many sources and includes a cost-sharing program in which 18 Colorado hospitals participate. Institutions with similar regionalized programs, integrated with Emergency Medical Services and drug consultation, will provide cost effective programs well-tailored to the unique characteristics of each region.

The Massachusetts Poison Information Center has proved to be a good location for the teaching of clinical toxicology to physicians, pharmacists, and nurses at all periods of their training and professional development. With a continuous source of clinical problems, the availability of sophisticated information resources, and a wide array of clinical consultants, a center can become the setting for formal courses in toxicology, for fellowship training, and for continuing education. Review of clinical cases, discussion of management issues, literature reviews, bedside toxicology teaching, and formal weekly toxicology seminars are used to accomplish the educational goals of the program.

State and federal law provided the impetus to develop a coordinated statewide poison system in Massachusetts. To achieve this objective the Commissioner of the Department of Public Health established a Statewide Poison Committee, composed of poison control representatives, physicians, nurses, and pharmacists. After a year of regular meetings, a structure for a statewide poison system was developed, meetings, a structure for a statewide poison system was developed, and as January 1978 this System has been operational in Massachusetts. The structure is based on the Department of Public Health contracting with an incorporated institution to implement the Statewide System, which consists of one information center available to the public and professionals as well as a network of all 112 acute care hospitals in the State as "member institutions." Educational institutions" are further designated with a responsibility of professional and public education in various geographic areas throughout the State. The System is responsible for providing comprehensive poison information, treatment, public education, professional education, data collection, and research. A senior Advisory Board representing institutions with major contributions to the System as well as a Coordinating Committee representing diverse geographic and professional interests serve in an advisory capacity to the System. Funding is broad-based and includes federal, state, and private institutional support.

The delivery of consultation for treatment of acute intoxication encounters several obstacles. The physician must recognize the case with which he needs assistance; he must be aware that assistance is available; the help must be technically correct; the delivery system must maintain responsible professional continuity while providing consultation at the time and place where it is required. The consultation must be appropriate to the clinical problem at hand in that immediate life-threatening aspects are covered quickly while continuing care and principles are deferred. Availability of specialized equipment and drugs must be assured by some method of precrisis communication. A system for delivery of telephone consultation for the treatment of acute intoxication is described. The system is based on a collection of prepared tapes, providing consultation of 3 to 6 min duration, oriented toward specific topics such as etiologic substances, common clinical syndromes, and commonly encountered complications. The advantages and disadvantages of the program are discussed.

Since its inception in 1972, the San Diego Poison Center has made considerable progress towards achieving its goal of developing a poison care system which will decrease incidence, morbidity, and cost of poisonings. A systems approach has been developed to care for patients at all levels of severity. Subregional centers have been identified and linked to the poison center. Education of the region's emergency medical personnel and the public have been actively pursued. Calls to the center have increased from 6829 in 1972 to 25,949 in 1976. Eighty-five percent of poisoning calls in 1976 were managed at home over the telephone. A follow-up call at 24 hours for each case revealed that less than 1% sought additional medical care. The percent of all emergency department visits resulting from poisoning in a tracer group (children under age 12 leaving emergency department asymptomatic) dropped from 6.1% in 1971 to 1.9% in 1976. The percent of hospital admissions due to poisoning in children under 10 years also dropped by 40% between 1971 and 1974. Estimated cost savings to the community by preventing emergency department visits alone each year covers the cost of operation of the poison center itself.

The Clearinghouse was originally conceived to coordinate information flow among the then few Poison Control Centers. Services were to be provided through the state health departments where complete control over the individual state's poison centers was to reside. No authority to establish or regulate centers, or to set standards for staffing and operation of centers, or to designate regional centers was granted. However, growth in the numbers of centers, more sophistocation in the state of the art, more demands for product and human experience data, calls for research support, regionalization, standards setting, competency testing, and others has led to an increasing call for more and more Clearinghouse involvement in the entire poison control program. Though staffing and funding remains fairly constant, the Clearinghouse hopes to be as involved and to provide as great a service as possible to those involved in clinical toxicology and poison control.