Ten Questions You Always Wanted to Ask a Poison Control Phone Operator

"We’ve [had people call about] sex toys that were accidentally swallowed and continued to vibrate in somebody’s stomach."
July 19, 2018, 5:47pm
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In the post-WWII era, long before child-proof lids and Mr. Yuk stickers, all sorts of wondrous new chemicals and medications were making their ways into households. It didn’t take long before kids—nature’s idiots—began ingesting these bright, alluring, and oftentimes tasty new poisons. Faced with a prospective health crisis, governments around the world began allocating resources to establish call centers to field the torrents of worried parents reaching out for help. In 1958 the American Association of Poison Control Centers (AAPCC) was formed to coalesce the centers from around the states into one standardized operation. Decades later, despite the rise of the internet, poison control centers remain one of America’s few free public health services, their call center staffers still a point of first contact for many emergencies around the country. With a 2012 study showing $13.39 in saved costs for every dollar of funding put into poison control, it’s no wonder this analog bastion has survived well into the digital age. To learn more about this still somewhat mysterious public service, I spoke with Dr. Bruce Ruck and Dr. Richard Casas, two New Jersey Poison Information and Education System employees with almost half a century of call center experience between them.


This interview has been edited for clarity and length. VICE: What are the most common types of poisonings and remedies for them?
Dr. Ruck: It’s usually drugs, medication, plants, or household chemical products.

Dr. Casas: Most things don’t really have a remedy. If you’re looking for something like “you drink some milk and you’re fine,” that’s not really the way it works. But, for most of the calls, depending on what’s going on, we try to give them the information they need to handle it at home. There are cases that do need to be referred to the hospital, depending on what’s going on.

Are there any common household things that people call in about that are actually harmless? Dr. Casas: There’s really no one common thing, but the most common calls have to do with children who have gotten into something at home. There’s not really anything that we can just say is harmless because everyone is different and we need to get all the information about that particular individual to determine whether there is an issue or not. Dr. Ruck: Let’s say a child takes drug A, and that drug should cause minimal to no side effects in that child based upon the child’s age, weight, and medical history. We won’t send them to the hospital. But with that same kid, same age, same weight, but where the kid has an underlying medical condition, we would send them in. What are some things you think people aren’t calling in enough about?
Dr. Ruck: Children will often taste a chemical around the home or take one pill of an over-the-counter product or one pill of Grandma’s medication and [their parents] will think it’s no big deal. But they need to call us any time a child puts any medication that’s not theirs into their mouth. And they should call us any time a child puts anything in their mouth that doesn’t belong there, such as cleaning products or chemicals from the garden, lawn, pool, etc. One thing that people often miss and don’t think about are button batteries. That’s a typical household item that could be deadly in a child. What’s the craziest thing someone has swallowed and called about?
Dr. Casas: That’s the $100,000 question, because almost every day someone calls in with something wild. Dr. Ruck: It really depends upon the age group. We’ve had people cook turkey for Thanksgiving and leave the plastic on and want to know if the chemicals from that will poison their family. We’ve also had some “objects”—and you can use your own imagination—but they were sex toys that were accidentally swallowed and continued to vibrate in somebody’s stomach. Did anyone ever call you guys about eating Tide pods during that craze or do you think that story was a bit overblown in the press?
Dr. Ruck: You have to separate the Tide pod challenge from general ingestion of laundry products by little children. The challenge was very real for the older teens, but what we see mostly is the little kids getting into them. We haven’t gotten any "challenge" calls, lately, but we did get a call on the board the other night when a young child bit into one and swallowed some. Dr. Casas: Tide pods, when you look at it, really almost do look like a little candy, so little children obviously are going to pick those up and put them in their mouths. What do you do when people call in because they’re high on a drug? Do you have to narc on them? Are there different protocols for different drugs?
Dr. Ruck: If somebody’s high or under the influence, we try to get them to go into an emergency room to be evaluated. Dr. Casas: If they’re calling us, they’re clearly not feeling well, so the last thing we want to do is leave them at home. I want somebody to look at them to determine what’s going on and see if they need further care. Have you ever encountered obstinate callers who didn’t believe you or want to take your advice, perhaps due to religious beliefs fear of perceived medical costs?
Dr. Casas: An individual might call and say their child got into X product, and the parent gives you the information and you explain to the parent why you think the child should go to the hospital and the parent will say “I’m not going to the hospital. I can take care of it myself.” Or they’ll say “I have a brother who’s an LPN and he says I don’t have to go.” At that point all we can do is give them the information and tell them that based on the product and its potentiality for harm, we’re suggesting the child go to the hospital and these are the reasons why. The decision’s ultimately theirs. Dr. Ruck: Depending upon the situation, if we feel somebody is in danger and they’re refusing to go into an emergency room, if we can somehow get their address or do a reverse look up—and this is in rare situations—we would send a rescue squad to the home. It’s the suicidal patients that all have to go in, and the patient or child we believe is in harm that we send in. Dr. Casas: In many cases we’ll keep them at home and then call back and check in to see how the poor person’s doing and reassess what’s going on.

How has Google affected your job? Has the internet age caused a dip in calls?
Dr. Casas: Sometimes people think they know better than us but they’re misreading or looking at incorrect information. Sometimes we end up having to play catch up on things they’ve done because of what they read. The internet can be misleading. Another thing, because of access to the internet, there’s more information out there that you might not want getting into the hands of teenagers. We run into problems because of that. Dr. Ruck: Right. It’s not just teenagers trying to get high. It’s younger and younger age groups trying to kill themselves. Ten years ago, I got almost no calls about 11 and 12-year-olds. Now I’m getting those calls about them trying to kill themselves. How many calls do you get in a given shift?
Dr. Ruck: We get approximately between 130-160 calls in a 24-hour period. Over that 24-hour period, we’ll have four or five, maybe six people covering all shifts. Not at one time, but throughout the day. What’s the methodology for fielding each call and assessing that poison’s threat? Are there programs and databases you reference?
Dr. Ruck: There are several reference sources that all the poison centers use. They’re very expensive programs. We can spend anywhere upwards of $50,000-$100,000 per year on these subscriptions. But the key here is that, in the hands of somebody who doesn’t know what they’re doing, these could be very dangerous. What qualifications and training does one need to become an operator and what made you personally choose to do this?
Dr. Ruck: The staff here are all taught how to use those references and they don’t pick up a phone for months until they’re fully trained on how to handle these calls. They’re gradually brought into the fold. Dr. Casas: As a baseline, everyone we train to be an operator has to be a pharmacist, nurse, or physician. But I chose to do this because it’s interesting. It’s a job where you’re constantly on the front end of a lot of new information about new drugs, treatments, and we’re here helping individuals every day.

You can call the national poison help hotline at 1-800-222-1222 or text POISON to 797979 to save the number in your phone.

If you or someone around you is exhibiting suicidal tendencies or self-harm please reach out to the National Suicide Prevention Lifeline.

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