The Utah Poison Control Center (UPCC) has layers of expertise built into the operations, starting with the Specialists in Poison Information (SPI) who are on the front lines taking calls and interacting with the community. The SPIs are pharmacists thoroughly trained to advise callers on a myriad of issues. They are supported by several expert medical toxicologists, who are on site or on call at the UPCC 24/7. The medical toxicologist leadership is guided by Michael Moss, Medical Director, and Ally Dorey, Assistant Medical Director.
MM: A lot of the day to day of being a medical toxicologist is serving as backup for when the SPIs need help managing unusual cases. And when health care professionals around the state call the UPCC with questions, we are always available to help provide answers.
AD: Ruling in and out serious toxicity is one of our most important assignments. We help triage who needs to go to the emergency department and who doesn’t. Once a patient is admitted, we help manage the specific toxicity.
MM: In general, one of us is holding rounds with the team every morning, reviewing all the currently admitted patients in the state that the poison center is following. On most days there’s also an educational component like a lecture or a case presentation. Mike and Ally were both wired for toxicology from a young age and realized it during medical school.
AD: As I was going through my emergency medicine residency at UC Davis, I saw that many of the faculty members had gone through the medical toxicology fellowship. I found toxicology fascinating and was so impressed with my instructors who were so deliberate in their thinking and more meticulous than others.
MM: I always wanted to know how and why things worked, but as an undergraduate physiology major, I became disillusioned with doing research in a lab—so I went to medical school. As I was training in emergency medicine at Virginia Commonwealth University, I did a toxicology rotation and realized, “Wow! This is what I’ve been missing.”
AD: Emergency medicine is tough because you have to know a little bit about everything. Diving into toxicology was really nice for the part of my brain that wants to be really facile with something specialized—and toxicology is uber-specialized.
MM: I think emergency training is helpful at a poison control center because you have to make decisions quickly and with confidence—often with little information to go on. At the same time, you have to keep a vast trove of factoids in your brain about all the substances that exist on earth and how they could affect or kill somebody. Having expert medical toxicologists is crucial to the success of the UPCC, though Mike and Ally say the center’s highly trained and tight knit staff is what makes the UPCC so effective. They also both tout the UPCC’s specific knowledge of local issues.
MM: Our focus and expertise is local to Utah. We know which Utah hospitals can take care of children and which ones have advanced capabilities for extra life support. Many of the doctors, pharmacists, and nurses in Utah visited or had a learning rotation at the poison center, so we have a personal relationship with health care providers across the state. They know us and trust us because they’ve been here and seen us in action.
AD: The poison center also plays a key role in public health crises, including mass exposure events like the harmful algal blooms we’ve seen in some Utah lakes. And of course, we helped the health department set up the COVID Information Line, which was crucial to the state’s response to the pandemic.
MM: We also do a lot of data collection and share the information with the state health department. Our interaction with the public keeps us abreast of what’s going on in Utah with things like opioid overdoses. And we know all about Utah’s snakes, spiders, and scorpions, so I know how to use the correct anti-venoms to treat bites. But if you ask me about those things in a different state, I might not be as confident. There’s a lot of local knowledge that goes into what we do.
The UPCC receives over 40,000 cases a year—that’s over 100 cases per day—so it’s no surprise that during the interview for this profile, Mike received a call about a patient who was just rushed to the ED after taking some street drugs. He stepped aside and calmly counseled the SPI on how to advise the medical facility to treat the patient, while Ally continued with the interview, pointing toward Mike as she spoke.
AD: You can see why medical toxicologists need to have an ongoing commitment to continuing education. No one has more information on the current trends in street drugs as Mike. Of course, having a huge amount of information readily accessible is crucial to our job. We have to know what resources are available or where to quickly find information if we don’t know the answer off the top of our heads. After Mike finished his call, he returned to the interview.
MM: A lot of people are scared in the moments when they call the poison center. Maybe it’s because they took something by accident or they just realized their child was exposed to something. Or maybe it’s a doctor at a hospital taking care of a patient who has taken something they don’t deal with very often. Here at the UPCC, we have the tools and the know-how to deal with anything from the most common exposures to cleaners and chemicals to unusual plants or even a new street drug. It’s what we do day in and day out.