Who does this guideline apply to?

This guideline applies to adults, children and infants.

Who is the audience for this guideline?

This guideline is for use by bystanders, first aiders and first aid training providers.

Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) make the following recommendations for managing those that have or may have been exposed to poison:

1. Take active steps at home and in the workplace to prevent exposure to poisons. [Good Practice Statement]
2. Recognise potential risks and send for an ambulance early. [Good Practice Statement]

1. Remove the person who has been poisoned from the source or remove the source from the person if it is safe to do so. [Good Practice Statement]
2. If the person is not responding and is not breathing normally, commence resuscitation if safe to do so, following the ANZCOR Basic Life Support Flowchart [Refer to ANZCOR Guideline 8].
3. If the person is unresponsive and breathing normally, position them in a lateral, side-lying recovery (lateral recumbent) position ([Refer to ANZCOR Guideline 3 ].
4. Contact the National Poisons Centre for specific advice (available 24 hours)

1. Australian Poisons Information Centre call 13 11 26
2. New Zealand Poisons Centre call 0800 764 766 (0800 POISON)

1. Decontaminate only if it is safe to do so. [Good Practice Statement]
2. Ensure the poison is secured and ambulance personnel are advised of any information on poison. [Good Practice Statement]

Abbreviations

A poison is a substance (other than an infectious substance) that is harmful if ingested, inhaled, injected, or absorbed through the skin. Substances that have no effect or may be therapeutic at low levels (for example, medicines and herbal remedies) may be poisonous at higher concentrations. Toxins are poisons that are produced by living organisms. Venoms are toxins that are injected by an organism. For information on Bites and Stings go to ANZCOR Guideline 9.4.3 - First Aid Management of Envenomation from Tick Bites and Bee, Wasp and Ant Stings.

Poisoning is a common problem with many events reported in Australia and New Zealand. Most cases are unintentional and one third are children aged 1 to 4 years.¹ The best treatment for poisoning is constantly evolving. Advice you may have received in the past may no longer be the recommended treatment, hence the advice to call the Poisons Information Centre in your country.

• Many poisons are substances that also have a useful purpose. Poisoning is particularly common in children and vulnerable adults so ensuring poisons are only accessible to those who need and know how to use them reduces their risk of harm.
• It is useful to make a survey of the home or workplace and identify all poisonous substances.
• The amount of poisonous substances stored in a home should be kept to a minimum.
• Unwanted poisons or medicines should be removed. Chemicals should be disposed of safely using the accompanying directions for guidance. Medicines should be returned to a pharmacy for safe and environmentally friendly disposal. The National Poisons Information Centre can also advise on methods of safe disposal.
• Poisonous substances must be stored in their original containers in locked or child-resistant cupboards or containers out of reach of children. Medicines should not be stored in the refrigerator unless advised to do so by a pharmacist.
• Non-poisonous cleaning products and insecticides should be used where possible.
• When possible, choose substances available in child-resistant packaging. However, do not rely on child-resistant packaging to prevent a child’s access to a poison, because child-resistant containers are not completely child proof.
• Closely supervise children around the home. 
• Don't call medicines 'lollies' when giving medicine to children 
• Do NOT decant chemicals into drink bottles 
• Read medicine labels and use according to the directions. When medicines are taken ensure the right:
  • medication
  • person
  • dose
  • route of administration
  • reason for administration
  • time and frequency of administration
• The recommended personal protective equipment (PPE) should be used when using toxic or caustic chemicals, for example spraying, painting, or oven cleaning. For industrial or commercial products this information can be found in the Safety Data Sheet for the product. For many non-commercial consumer products, the labeling may contain first aid instructions and safety directions, including recommended PPE.

• Eating and drinking should be avoided near poisons.

• Poisons can cause harm by a wide range of mechanisms and can cause a wide range of symptoms including reduced levels of responsiveness, difficulty breathing, cardiac arrest, nausea, vomiting, burning pain in the mouth or throat, headache, blurred vision, seizures and burns to skin, eyes, mouth, nose and throat.
• The circumstances of the incident may give an indication that poisoning has occurred. A person may complain of physical symptoms without realising these are due to a poison. Alternatively, they may exhibit abnormal behaviour, which may be misinterpreted as confusion or mental health disturbance.
• Most medicines are poisonous in overdose. The point at which overdose becomes harmful is substance/medicine specific and varies greatly, but many medicines are lethal if less than a single pack is taken simultaneously.
• The speed of effect of a poison is determined by the chemical and physical properties of the toxic material, the concentration of the toxic material, the route of exposure (oral, skin, eyes, inhalation, injection), and the length of time of exposure. The effects may be rapid, but they may also be delayed.
• It is important to seek medical assessment after exposure to a poison, even if symptoms are initially mild or absent.
• Poisoning can mimic other conditions such as intoxication, seizures, stroke 
• If poisoning is suspected, look for clues – empty pill bottles/packets, scattered pills 
• With children, consider the possibility of swallowed button battery or medicinal patches (normally applied to the skin)

The principles of managing a person who has been poisoned are:

• Recognise Danger, maintain safety and prevent poisoning of the first aid provider.
• Send for an ambulance and possibly fire services for containment and decontamination where necessary
• Resuscitation and supportive care, using the ANZCOR Basic Life Support Flowchart (Guideline 8]. If unresponsive and breathing normally, position in a lateral, side-lying recovery (lateral recumbent) position and ensure airway is clear [Refer to ANZCOR Guideline 3]. If not responding and not breathing normally, commence resuscitation if safe to do so, following the ANZCOR Basic Life Support Flowchart [Refer to ANZCOR Guideline 8].
• Decontamination of the skin or eyes if they have been exposed to poison and if it is possible and safe to do so. (Refer to section 4.3 below)
• If possible, ascertain what poison or medicine has been taken, how much, and when.
• ANZCOR recommends specific management of particular poisons including antidotes, techniques to remove the poison from the body, and the treatment of complications of the poison which is most commonly undertaken in the hospital setting. [Good Practice Statement]

• ANZCOR Guideline 8 Cardiopulmonary Resuscitation
• ANZCOR Guidelines 9.4.1
• ANZCOR Guidelines 9.4.2
• ANZCOR Guidelines 9.4.3
• ARC Guidelines 9.4.5
• ARC Guidelines 9.4.6
• ARC Guidelines 9.4.7
• ARC Guidelines 9.4.8
• For information on specific poisons, consult the Australian Poisons Information Centre on
  13 11 26 or New Zealand poisons centre 0800 764 766 (0800 POISON)

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