Division of EM Toxicology
"Medical toxicology is a subspecialty focusing on the diagnosis, management and prevention of poisoning, toxicity and other adverse health effects due to medications, chemicals, occupational and environmental toxins, and biological hazards. Toxicology is recognized as a medical subspecialty by the American Board of Medical Specialties." - American College of Medical Toxicology
To become a medical toxicologist, one has to obtain a medical degree, complete a residency in emergency medicine, pediatrics, or occupational medicine, and complete a two year fellowship in medical toxicology. The professional organizations of the specialty are the American College of Medical Toxicology and the American Academy of Clinical Toxicology. Toxicologists are trained to treat injuries and poisonings resulting from exposure to chemicals and biological agents including both legal and illegal drugs as well as environmental hazards.
The Division of EM Toxicology is directed by Jason Hack, MD, FACEP, a board-certified medical toxicologist. He is supported by Daniel Savitt, MD; James Linakis, MD; Bill Lewander, MD; and Angela Anderson, MD.
The mission of the Division of Medical Toxicology is dedication to education, research, innovation and outreach in the area of medical toxicology.
The Division runs a month-long rotation introducing emergency residents to the care of intoxicated or exposed patients, including recognizing toxidromes, appropriate use of laboratory testing, familiarity with antidotes, decontamination techniques, and disposition that is a required part of the Emergency Medicine Residency Program syllabus. We also train the pediatric emergency medicine fellows and the critical care fellows from The Miriam Hospital. The rotation includes frequent one-on-one lectures with toxicology faculty, an independent reading schedule, performance of educational consults at the bedside of patients with toxic issues, attending local poison center rounds, producing a section for the division's newsletter (the Toxic Matter) about their topic, and also presenting that topic in Tox Rounds at the Wednesday residency educational conference. Attendance at the monthly Tox Rounds is certified for one hour of category 1 CME credit for attending physicians.
Research and Innovation
The Toxicology Division is very active in medical/toxicologic research. The main research focus has been the examination of dogma or innovation to improve the management of acute poisonings or exposures.
Toxicology faculty has recently presented two platforms and two posters at American College of Medical Toxicology's March research meeting in Puerto Rico, two oral presentation at the New England Regional SAEM conference in April, and two oral presentations at SAEM's National conference in Atlanta in May—these research projects stem from novel work involving the exploration of Intralipid utility in treating exposures without effective antidotes. Our multidisciplinary research endeavors include collecting data on CO levels in average smokers with the Division of Disaster Medicine and doing preliminary work investigating real-time visualization of intralipid's effects with the Division of Cardiovascular Research.
Service and Outreach
The division has been very active as a source of information for local news sources on toxicologic matters and has participated in alcohol awareness campaigns at a local college. These include:
- Teen Binge Drinking and Brain Damage. Aug 2011 golocalprov.com/health/new-research-teen-binge-drinking-and-brain-damage1/; GoLocalProv. Spring Break Binge Drinking. March, 2012 golocalprov.com/health/spring-break-drinking-leads-to-brain-damage/
- Radio, WPRO. Dangers of Hand Sanitizer. April, 2012 630wpro.com/article.asp?id=2443911&spid=37719
- GoLocalProv. Underage Drinking. July, 2012. golocalprov.com/health/teen-underage-drinking-advice-for-parents/
- The Providence Journal. Fake Drugs, Real Danger. Dangers of Marijuana Substitutes. Providence Sunday Journal, November, 18, 2012;
- Channel 12 news on 12/13/12. Liquid Laundry Detergent Pods Danger. December, 13, 2012--Aired February 27, 2013 http://www.wpri.com/dpp/news/12_for_action/sweeps-laundry-detergent-pods?ref=scroller&categoryId=10011&status=true
We have also been active in education of members of the University on Toxicological issues: lecturing to both the Providence Center Mental Health professionals on "Bath Salts: History, Legal Path, Toxicity and Treatment;" and "Child Protective Services," on the same topic. Drs. Hack and Linakis also gave Grand Rounds at the University on "Pediatric Lead Poisoning, Revisiting an Old Nemesis," sponsored by the Department of Pediatrics and the Division of Medical Toxicology.
The division frequently publishes in peer-reviewed research journals. Recently submitted work includes: The HII Score as a Novel Assessment of Alcohol Impairment, Evaluation of a Tool; Hyperglycemia Emergencies, a Review; Unexpected Hypotension in an Intoxicated Trauma Patient Caused by Disulfiram: Intralipid's Interaction with Cocaine in an Animal Model: Intralipid's Interaction with Dabigatran in an Animal Model: Atropine dose in Sprague Dawley rat model.
Recently Published work includes:
- Hack JB, De Guzman J, Brewer K, Meggs, W, O’Rourke D. A Novel Localizing Circumferential Compression Device Delays onset of Systemic Toxicity after Eastern Coral Snake Torso Envenomations in Anesthetized Swine. J Emergency Medicine. May 25, 2010
- Hack JB, Orobegmi B, De Guzman, Brewer K, Meggs W, O’Rourke D. A Novel Localizing Circumferential Compression Device Delays onset of Systemic Toxicity after Eastern Diamondback Rattlesnake Torso Envenomations in Anesthetized Swine. J Med Toxicology. Mar 27 2010
- Meggs WJ, Wiley CN, Brewer KL, Hack JB. Efficacy of North American Antivenin Against the African viper Vitis Gabonica (Gaboon Viper). J Med Toxicol. 2010 Mar;6(1):12-4.
- Voskoboynik B, Babu K, Hack JB Cevimeline (Evoxac ®) Overdose. J Med Toxicol. 2010 Sept.
- Chai PR, Bastan W, Machan J, Hack JB, Babu KM. Levamisole exposure and hematologic indices in cocaine users. Acad Emerg Med. 2011 Nov;18(11):1141-7.
- Shaw K, Babu K, Hack JB. Methadone, Another Cause of Opioid Associated Hearing Loss: A Case Report. J Emerg Med. 2011 Dec;41(6):635-9
- Babu KM, Zuckerman MD, Cherkes JK, Hack JB. First-onset seizure after use of 5-hour ENERGY. Pediatr Emerg Care. 2011 Jun;27(6):539-40.
- Carreiro S, Blum J, Jay G, Hack JB. Intravenous Intravenous Lipid Emulsion Alters the Hemodynamic Response to Epinephrine in a Rat Model. J Med Tox. 2013 Feb, epub
Other recent publications include:
- Hack JB, Hoffman RS. General management of poisoned patients. In: Tintinalli JE, ed. Emergency Medicine: A Comprehensive Study Guide, 7th Ed. New York: McGraw-Hill; 2011:1187-1193.
- Hack JB, Cardioactive Steroids. In: Goldfrank LR et al ed. Goldfrank’s Toxicological Emergencies 9th Ed. Connecticut: McGraw-Hill; 2011: 963-945
- Babu KM and Hack JB, Cyanide and Other Chemical Agents, in Oxford American handbook of disaster medicine, Partridge RA, Proano L, Marcozzi D, et al., Editors. 2012, Oxford University Press: Oxford
- Hack JB, Hemolytic Anemias. In: Tintinalli's Emergency Medicine: Just the Facts, 3rd Ed. Cline D, Editor 2012, McGraw-Hill: New York
- Hack JB, Sickle Cell disease and Other Hereditary Hemolytic Anemias. In: Tintinalli's Emergency Medicine Manual, 7th Ed. New York: McGraw-Hill; 2012:622-626