Poison Center's medical director explains agency's work, his research
Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. My guest today is the medical director of the Upstate New York Poison Center. Dr. Vincent Calleo is also an assistant professor of emergency medicine and also of pediatrics. Thank you for making time for this interview, Dr. Calleo.
Vincent Calleo, MD: It's my pleasure to be here, Amber. Thanks so much for having me on this morning.
Host Amber Smith: Well, I know you did your undergraduate work at Binghamton university and then medical school here at Upstate. And you then did an emergency medicine residency followed by a pediatric emergency medicine fellowship at Upstate. And you also spent the last two years as a medical toxicology fellow. Can you tell us what drew you to medicine to begin with, in general? And then why did you decide to focus on emergency medicine and toxicology?
Vincent Calleo, MD: Yeah, boy, that's a long story, but I'll try to keep it relatively short for you. So, going back, back into my high school years, I always was really drawn to, the sciences, biology and chemistry in particular.
Vincent Calleo, MD: And I really, I really liked to see how they interacted with human physiology. So when I was an undergrad, I started to do a little bit more work and take some anatomy classes, physiology, etcetera. And I really liked the way that, you know, I was able to apply the basic sciences to help, learn more about the the human body and conditions that hopefully we can help to cure. And that kind of brought me through to to medical school and in terms of what kind of kept me at Upstate and in the Upstate New York region, I'm a native from the Binghamton area. So I come from a pretty large family, and everyone's pretty much pretty much centered in the Binghamton area. And I was actually the the outlier of the family, went an entire hour north to Syracuse. And it's been great to be up here. And so I think, I was always really drawn to Upstate for its academics from the medical school end. And that's really what drew me here, but what's kept me here all this time has been the phenomenal people that I've had the pleasure and the the opportunity to work with and learn from in the emergency department. And that's really what drew me to residency here and subsequently with my pediatric emergency medicine followed by my toxicology fellowship. You know, I always tell people it's the location that got me here, and it's been the people that have kept me.
Host Amber Smith: What are your days as poison center medical director like?
Vincent Calleo, MD: It varies from day to day. I feel like there are some days where a lot of it tends to be more administrative work going ahead and helping to develop different guidelines, to try to help manage various complaints that, we get brought to us from different healthcare providers, via the emergency medicine setting be it from inpatient or even sometimes from home callers. One of the roles that I perform is helping to streamline and come up with ways to help guide the management of these cases. I do a pretty good number of administrative meetings as well to try to help grow the poison center. And in addition to that, I get the pleasure of interacting with our poison specialists and our educators here who really provide a lot of the direct outreach to the community, either from, helping to educate them, to prevent poisonings or to help deal with them when they, when they arise. So those tend to be the majority of the days. And, depending on the times during you know, during the week very commonly, I, or a number of my other clinical or medical toxicology colleagues, we'll go ahead and we also see patients at Upstate University Hospital and you know, do direct rounding and patient care in that setting as well.
Host Amber Smith: I was going to ask if you ever see patients, like, face to face?
Vincent Calleo, MD: Yep. We do pretty commonly, so I, I'm really lucky to be in a group of some great toxicologists. And there are about four to five of us that routinely will, go ahead and trade services as we're going through. And round on the patients in the hospital. And we also do a lot of education with a number of different medical students from Upstate mainly as well as a number of different pharmacy students medical residents from the emergency medicine department from internal medicine, pediatrics. We do a lot of different interaction and teaching both at the bedside and didactics with simulations, journal clubs, and things of that sort to try to help to you know, get people to recognize some of the subtleties with toxicology that frankly, we may not get taught all that much about in medical school or in typical residency. So I'm really lucky to be a, to be able to do those things.
Host Amber Smith: Well, I know the poison center is a 24 hour operation. What percent of your calls happen outside of regular business hours?
Vincent Calleo, MD: If I'm defining normal business hours, as we'll say nine to five, I would say probably at least 60% of them are happening outside of business hours with a good majority occurring, probably I'd say between the hours of maybe 12 in the afternoon, right up through 10 or 11 o'clock at night. Those tend to be more of our peak hours in terms of when the volumes are highest. Though it certainly as you know, can fluctuate from day to day with some of them coming, much more heavily in the morning, early morning hours, or even the late night hours. So we, we do get that fluctuation, but I'd say in general, our peaks tend to be in the you know, in the later afternoon to to evening.
Host Amber Smith: And I know the poison center serves the whole Central New York region from the Canadian border to the Pennsylvania border. Do you have an idea of where the calls are coming from?
Vincent Calleo, MD: Yeah you know, we do serve a very wide geographic area covering 54 counties for the Upstate New York Poison Center. And I'd say that in general, the highest number of calls we get, tend to come from the areas where the populations are the most dense, and those tend to be some of the bigger cities. In terms of some of the ones geographically, we get a lot of calls from the Onondaga county area. And I think that's partially because we have the poison center physically located here, and people are much more aware of the services that we have available, but we also do get a lot of calls from areas like Rochester and Buffalo and the surrounding counties in that area. A number of the other areas we serve are a lot smaller. So it's just, based on the sheer numbers. We're going to probably hear less from them because they don't have as many patients coming in as a whole. But there are a lot of times we hear from some of these smaller outlying hospitals with really sick patients that do come in as well. So it's great that we have the ability to help provide guidance to them. When those calls come into us.
Host Amber Smith: How many of the calls relate to children, versus how many relate to adults?
Vincent Calleo, MD: So I'd say in terms of the overall number, I'd say maybe roughly 50 to 60% are probably related to children. If I'm defining that age range as, 19 year olds or younger for the pediatric population. And it's a pretty large percentage. Now with that being said, I think it's important to recognize that a good number of the calls that we get that are related to pediatric exposure, fortunately, are ones that we are able to provide guidance for the families too, and help them manage at home, thus avoiding, an ED (emergency department) visit or stay, particularly now when ED wait times across the state and really across the country are so high, given the number of COVID cases, staffing, shortages, bed shortages. So it's great when we're able to provide that for families. I'd say in terms of the overall number of calls we get for people that are hospitalized or really sick, the number tends to be more skewed toward adults where intentional ingestions are more common than they are for the accidental pediatric exposures we commonly get called about. But in terms of absolute number of calls, I'd say that it actually skews a little bit more towards the pediatric population where kids may accidentally get exposed to, one or two pills or substances, or even even some plants or other things that we can, in some cases help provide safe guidance at home.
Host Amber Smith: What would you say are the top sources for unintentional poisonings among children?
Vincent Calleo, MD: I feel like it's pretty consistent from year to year, if you look at both our data, as well as some of the national data that we have. With the majority of the the highest numbers of exposures being with over-the-counter medications, and some of the ones that we see most commonly are going to be things like ibuprofen (Motrin) and acetomenophen (Tylenol) simply because they are very readily available, and it's not uncommon for a parent to turn their head, even for a millisecond, and then the small child decides they're going to go snag a bottle and, get into a pill or two or have a sip of, liquid formulations too.
Host Amber Smith: You're listening to The Informed Patient podcast from Upstate Medical University in Syracuse, New York. I'm your host, Amber Smith. I'm talking with Dr. Vincent Calleo, who is the medical director of the Upstate New York Poison Center. And before I ask you anything else, I want to make sure listeners know the number for the poison center: 1 800 222 1222. Now you've written about quite a few cases for the medical literature. So I wanted to ask you about some of the topics you've delved into. Can you tell us about the work you've done on Naloxone administration by untrained community members?
Vincent Calleo, MD: Yeah, sure. So this was something that I did with with one of my, well now, now colleagues, but former attendings Dr. Willie Eggleston, who is a brilliant toxicologist. One of the things that we found in the medical literature is that in terms of Naloxone administration, we found that people who have been trained -- even if they're lay people without a significant amount of medical training -- are able to adequately and safely deliver Naloxone. But in terms of things going forward one of the questions that we had was whether or not participants could administer different types of Naloxone more successfully than others. There are several different things that people can use to administer this on the market, including some different nasal sprays or atomizer kits. And there's also an intramuscular form that you can give to. And so one thing that we wanted to figure out was are people able to give these different types without training, and if so is one type more successful than another? So we ended up going to the State Fair a few years ago -- This was a pre COVID time -- and just administer, having people recruited into the study to try to get a sense of which one is more easily available to someone without training. And what we found at least in our study was that we found that the nasal sprays and the intramuscular injections were more successfully administered within a certain time period we defined than the atomizer kit. And I think a lot of it just had to do with the kit took a little bit longer to put together and had a couple more pieces to the puzzle, so to speak. So that's the experience we found with that. But yeah, it was a great way to look at that, to help guide what may happen, going forward in terms of the different ways that people can get trained in, or different things people can use to help try to save a life.
Host Amber Smith: And correct me if I'm wrong, but the opioid situation is still a big concern in this community, right?
Vincent Calleo, MD: Yeah. You know, it's both in our community, locally and nationally the opioid crisis is still raging. I feel like we don't hear about it as much as we did, pre pandemic, simply because we have other things on the radar now too. But, we do have a good number of opioid deaths both locally as well as nationally. And I think the last statistic I looked at nationally, I want to say in 2021, had about 75,000 deaths nationally from, from opioids.I might be slightly off with those numbers, but I think I'm probably pretty close. So it's a, it's still quite a systemic problem. And, hopefully administration of Naloxone can help to reduce that number.
Host Amber Smith: Have you seen Naloxone save someone's life?
Vincent Calleo, MD: I certainly have. And so in terms of my emergency medicine background, it's a medication that we give not infrequently in the emergency department, very commonly for people that come in who have signs of an overdose. We frequently will give it to help people restore their breathing. And in many cases, if they have a significant change in their mental status and can't protect their airway, if they were to vomit, those are a couple of the times we will give it, but there have been many times I've had patients come in, completely blue, not breathing at all. We've given themthe medication, and it's helped to save a life, certainly, in those cases, too.
Host Amber Smith: Now you've also helped develop training for how to treat overdoses of anti-diabetic medication. Why is that important?
Vincent Calleo, MD: So there are a number of different antidiabetic medications out there on the market right now. And one of the ones that we do see exposures to, and sometimes in the pediatric population are going to be a class of medicines called sulphonylureas. And essentially what they do is they increase the amount of insulin that your body has available or releasing from the pancreas and can cause your blood sugar to drop very, very low. I think that's a really important topic for me, particularly with my interest in toxicology and pediatric emergency medicine, simply because if a patient like this comes in and is profoundly hypoglycemic, and you're concerned that, they may have some bad outcomes from that, knowing how to properly treat that is going to be really important. And in fact I went ahead and created a simulation for our rotators here to kind of go through that helps to mimic that and helps them to recognize what medications and what treatments they need to do to help reverse the the effects of some of these medicines, how long to watch them for and and how to manage them throughout the course of their time in the hospital.
Host Amber Smith: Are you seeing more cases of children, particularly, overdosing on these medications? Because I know there's been an increase in recent years in the number of kids with type 2 diabetes.
Vincent Calleo, MD: That's a number I don't have off the top of my head there. I will say that as a general rule, the number of cases of diabetes nationally has been continuing to rise. And as such, it stands to reason there are more anti-diabetics out on the market now. So I think that, in terms of the absolute numbers, while I may not have them there, one concern I do have is that as medications become more readily available, there are certainly a lot more potential for kids in particular, to get exposed to these medicines and potentially have a bad outcome. So increasing awareness in terms of how to manage these cases when they occur, I think, is really important. So that's one of the, one of the big reasons I wanted to develop something like that.
Host Amber Smith: Well, I want to ask you about one other paper that has your name on it. What can you tell us about camel bites and how they compare to dog bites?
Vincent Calleo, MD: Sure. This was a case that I actually had when I was an emergency medicine resident a few years ago. And you would think you may not see a camel bite in Upstate New York, which for the most part is very true. So that's part of the reason I found this to be such an interesting one. But there was a case we had locally. In terms of camel bites versus dog bites, there can be a lot of differences between the two. One of the things that's different is that camels have a different set of teeth, compared to dogs, obviously. And they have very, very strong jaws, which I didn't recognize at the time. So there are a lot of cases in the literature where, know, camel bites can cause significant problems in terms of both the soft tissue injuries, but sometimes even causing injuries to the bones too. It's not uncommon to have fractures that occur from camel bites, as well as these, penetrating injuries from the bite itself. And in addition to that, there are a number of different bacteria that are within a camel's mouth that make it very potentially dangerous in terms of some of the different infections that can cause now a lot of these bacteria are similar to those that are in a dog's mouth, but I think it's really important to recognize that these patients who have, these camel bites really need to have aggressive decontamination and cleaning, as well as strongly considering putting them on some special antibiotics. It can really help to decrease the likelihood of them developing, systemic infections or even those localized bone infections, too. So while it was something I wasn't terribly familiar with at the time, it was one that I certainly learned a lot about when writing that paper.
Host Amber Smith: Well, getting back to the poison center, do you have ideas about how it may evolve in the coming years? Are there new types of services that you are seeing an increase in demand for?
Vincent Calleo, MD: In terms of things going forward, I always tell people I'm really bad at predicting the future because my crystal ball broke. But with that being said, I think one thing that we've been trying to do looking forward is increasing the amount of public health outreach that. What we do here is provide invaluable services for managing people after they've been exposed to medications or substances, either recreationally, occupationally, or in a number of other ways. But one thing that we really are trying to look to do is increase our public health outreach. And fortunately we have a wonderful public education team and a great leadership team here as we're trying to work through that. So we're really hoping that we can increase our presence within the areas that we serve and really help to be proactive rather than reactive for a lot of things. And that's always been a mission of the poison center, but that's certainly one thing that we're going to try to continue to work on and grow going forward is trying to increase that public outreach presence. And we are trying to look at doing additional different types of research both within our poison center and collaborating with our counterpart down in New York City, as well as some of the other poison centers nationally to try and establish really good trends for different types of exposures and different things that we may need to go ahead and keep an eye out for as we go forward. So I think those are a couple of the biggest things that I see, as we're looking into the future for trying to do and certainly continuing to provide. A lot of high-quality care for in particular these sick cases, because what we found over the last few years is that the acuity of the cases we've been seeing really has been going up. We do see a lot of really sick patients or hear about a lot of really sick patients when we're taking calls. And fortunately, we have a team of very highly trained poison specialists that will take those initial calls and help to provide guidance and reach out to the toxicology attending group, if they have any questions for things that may be a little bit more complex, but fortunately we have a really highly trained, specialized group that is great at fielding those calls and helping to provide great recommendations in the meantime. So we're going to continue to try to keep that up in the meantime and provide greater outreach.
Host Amber Smith: Well, thank you. My guest has been Dr. Vincent Calleo, an assistant professor of emergency medicine and pediatrics at Upstate, and also the medical director of the Upstate New York Poison Center. The Informed Patient is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York. I'm your host, Amber Smith, thanking you for listening.