No C 294/10 Official Journal of the European Communities 22. 11. 89 
II 
(Preparatory Acts) 
COMMISSION 
Proposal for a Council resolution on improving the prevention and treatment of acute human 
poisoning 
COM(89) 505 final 
(Submitted by the Commission on 25 October 1989) 
(89/C 294/08) 
THE COUNCIL OF THE EUROPEAN COMMUNITIES, 
Having regard to the Treaty establishing the European 
Economic Community, 
Having regard to the draft resolution submitted by the 
Commission, 
Having regard to the opinion of the European 
Parliament, 
Having regard to the opinion of the Economic and 
Social Committee, 
Whereas, for a policy aimed at preventing the risks of 
acute poisoning in the population and, in particular, 
among workers, it is desirable to have the maximum 
amount of comparable data on clinical toxicology at 
Community level; 
Whereas each poison centre in the Community, by virtue 
of its informational, therapeutic and analytical functions, 
is one of the bodies in the best position to collect clinical 
toxicology data in its geographical area of activity and to 
process this information; 
Whereas a harmonization of the procedures for 
collecting clinical toxicology data for all the poison 
centres in the Community would facilitate the devel­
opment of a policy for toxic risk prevention; 
Whereas, by fostering the integration of clinical and 
analytical data, the Community wishes to achieve one of 
the main objectives of its programme of action on toxi­
cology for health protection ('), namely to help ensure 
the quality and comparability of data and encourage the exchange of experience and information in the field of 
clinical toxicology; 
Whereas harmonized annual reports will also be of value 
in the context of the Council Decision of 22 April 1986 
(86/138/EEC) (2) concerning a demonstration project 
with a view to introducing a Community system of infor­
mation on accidents involving consumer products, which 
stipulates in Annex I (sub-section 2, paragraph 3) that 
additional information may be obtained from poison 
centres to supplement the basic information obtained 
from the casualty departments of hospitals; 
Whereas, in the context of the free movement of persons 
and goods, it is important to improve the availability of 
antidotes by facilitating exchanges of information on 
their availability, in particular in areas adjacent to other 
Member States; 
Whereas this resolution should help to develop the use of 
clinical toxicology data in overall assessments of the 
impact of chemical products and preparations on the 
health of the public in general and, more particularly, of 
workers exposed to dangerous substances liable to cause 
acute poisoning: 
I 
EXPRESSES THE POLITICAL WILL to take the necessary 
steps to improve the prevention and treatment of acute 
human poisoning; 
II 
INVITES THE MEMBER STATES: 
— to designate a competent authority so that it may 
take the necessary measures to ensure that the 
collection of call data and the annual reports on the 
O OJ No C 184, 23. 7. 1986, p. 1. O OJ No L 109, 26. 4. 1986, p. 23. 
22. 11. 89 Official Journal of the European Communities No C 294/11 
work of the poison centres and the associated toxi­
cology services operating in the territory of the 
Member State concerned are based on the indications 
set out in Annexes 1 and 2; 
— to ensure that antidotes, i.e. the substances and prep­
arations used specifically in cases of acute poisoning, 
are available on the territory of the Member State 
concerned; 
— to increase the practical scope for using antidotes on 
the territory of the Member State concerned by 
requiring the competent authority to prepare and 
distribute a list, based on Annex 3, of available 
antidotes for treating acute poisoning cases and of 
sources of supply, so that the recipients have at their 
disposal the information required to obtain these 
antidotes within the period during which they can be 
administered effectively; 
—to provide better emergency services in areas 
adjacent to other Member States by arranging for the 
relevant competent authorities, in cooperation with 
the Commission, to set up between the poison centres 
a Community system of information and colla­
boration concerning the availability of antidotes; 
— to arrange for the competent authority to produce a 
summary of the harmonized annual reports of the 
poison centres and the associated toxicology services. This summary will deal in particular with records of 
poisoning, with a note on the measures taken or 
planned by the competent authority to improve the 
prevention of acute poisoning,, and shall be 
forwarded to the Commission before 31 March of 
the following year, together with a list of the poison 
centres operating on their territory showing the areas 
which they cover, and the list of available antidotes. 
The Commission may, where necessary, arrange for 
all or part of the harmonized annual reports to be 
forwarded to it; 
III 
INVITES THE COMMISSION to arrange for regular 
summary reports to be prepared for the Community indi­
cating, in particular, the measures required at 
Community level for the prevention of acute poisoning, 
and to expand on specific topics based on the infor­
mation received from the Member States on the 
prevention and treatment of acute poisoning; 
IV 
AGREES to review the provisions of this Resolution 
within a maximum period of five years following its 
adoption, on the basis of a report from the Commission. 
No C 294/12 Official Journal of the European Communities 22. 11. 89 
ANNEX 1 
Harmonized case data record sheet 
1. Centre code: 
2. Call registration number: 
Recall: ( ) 
3. 3.1. Date (mmdd): 
3.2. Time (hhmm): 
4. 4.1. Enquirer: 
Name: .... 
Address: 
Tel. number: 
4.2. Type of enquirer: 
4.2.1. Hospital: 
Accident and Emergency (Casualty) ( ) 
General Medical ( ) 
Intensive Care ( ) 
Paediatric ( ) 
Other ( ) 
Unknown ( ) 
Other Poisons Centres ( ) 
4.2.2. Outside hospital: 
Physicians ( ) 
Nurses ( ) 
Pharmacists ( ) 
Veterinary surgeons ( ) 
Occupational health services ( ) 
Industry/manufacturers ( ) 
Emergency Services ( ) 
General Public ( ) 
Mass Media ( ) 
Authorities ( ) 
Others ( ) 
Unknown ( ) 
5. Type of enquiry: 
Call related to a case ( ) Information only ( ) Other ( ) Unknown ( ) 
6. Patient: 
6.1. Multiple cases: Yes; Number: 
22. 11. 89 Official Journal of the European Communities No C 294/13 
6.2. Human: Name: 
6.2.1. Age (yymmdd): 
Unknown Child ( ) Unknown Adult 
6.2.2. Sex: Male ( ) Female ( ) 
6.2.3. Weight (kg): 
6.2.4. Pregnant: Duration (weeks): 
6.2.5. Lactating: yes ( ) 
6.3. Animal species: 
7. Agents: 
7.1. Name (given by caller): 
Composition of product: 
Manufacturer (if relevant): 
Quantity: 
— No: Vol.: 
— Unknown ( ) 
Exposure: 
— Acute ( ) Chronic ( ) 
Frequency: 
— Single ( ) Repeated ( ) 
7.2. Name (given by caller): 
Composition of product: 
Manufacturer (if relevant): 
Quantity: 
— No: Vol.: 
— Unknown ( ) 
Exposure: 
— Acute ( ) Chronic ( ) 
Frequency: 
— Single ( ) Repeated ( ) 
7.3. Name (given by caller): 
Composition of product: 
Manufacturer (if relevant): 
Quantity: 
— No: Vol.: 
— Unknown ( ) 
Exposure: 
— Acute ( ) Chronic ( ) 
Frequency: 
— Single ( ) Repeated ( ) ; if estimated ( ) 
( ) Unknown ( ) 
, if estimated ( ) 
Classification of product 
Annual Report Poisons Centre 
Wt.: , if estimated ( ) 
Wt.: , if estimated ( ) 
Wt.: , if estimated ( ) 
No C 294/14 Official Journal of the European Communities 22. 11. 89 
Classification of product 
Annual Report Poisons Centre 
7.4. Name (given by caller): 
Composition of product: 
Manufacturer (if relevant): 
Quantity: 
— No: Vol.: Wt.: , if estimated ( ) 
— Unknown ( ) 
Exposure: 
— Acute ( ) Chronic ( ) 
Frequency: 
— Single ( ) Repeated ( ) 
7.5. Name (given by caller): 
Composition of product: 
Manufacturer (if relevant): '. 
Quantity: 
— No: Vol.: Wt.: , if estimated ( ) 
— Unknown ( ) 
Exposure: 
— Acute ( ) Chronic ( ) 
Frequency: 
— Single ( ) Repeated ( ) 
7.6. Time since exposure: (ddhhmm) 
8. Location: 
8.1. Home and surroundings ( ) 
8.2. Workplace: 
— Factory/workshop ( ) Laboratory ( ) Agriculture/horticulture ( ) 
— Other ( ) 
8.3. Community: 
Nursery or primary school ( ) Other school, university, educational estab­
lishment ( ) Hospital, clinic, nursing home ( ) 
— Institution: prison, military, etc. ( ) Other ( ) 
8.4. Enclosed public spaces ( ) 
8.5. Open places ( ) 
8.6. Other ( ) 
8.7. Unknown ( ) 
22. 11. 89 Official Journal of the European Communities No C 294/15 
9. Circumstances: 
9.1. Accidental/Unintentional 
— General ( ) 
— Occupational ( ) 
— Environmental ( ) 
— Transport Accident ( ) 
— Fire ( ) 
— Therapeutic error ( ) 
— Misuse ( ) 
— Other ( ) 
— Unknown ( ) 
9.2. Intentional 
— Suicide ( ) 
— Misuse ( ) 
— Abuse ( ) 
— Malicious/criminal ( ) 
— Other ( ) 
— Unknown ( ) 
9.3. Adverse reaction: 
— Drug ( ) 
— Food ( ) 
— Other ( ) 
9.4. Unknown ( ) 
10. Route of exposure: 
10.1. Ingestion ( ) 
10.2. Inhalation ( ) 
10.3. Cutaneous ( ) 
10.4. Eye contact ( ) 
10.5. Bite ( ) 
10.6. Sting ( ) 
10.7. Injection: 
— Subcutaneous ( ) 
— Intramuscular ( ) 
— Intravenous ( ) 
— Intra-arterial ( ) 
10.8. Mucosal: 
— Buccal ( ) 
— Nasal ( ) 
— Rectal ( ) 
— Vaginal ( ) 
10.9. Placental ( ) 
10.10. Other ( ) 
10.11. Unknown ( ) 
No C 294/16 Official Journal of the European Communities 22. 11. 89 
11. Signs and symptoms: 
11.1. Signs and symptoms present 
11.2. Signs and symptoms not present 
11.3. Unknown 
Poisons Centre free text: 
Poisons Centre local symptom code: ... 
12. Toxicological analysis: 
yes ( ) 
13. Other investigations: 
yes ( ) 
14. Treatment: 
14.1. None 
Prevention of absorption: 
— Gastric emptying 
— Emesis 
— Lavage 
— Activated charcoal 
Symptomatic treatment 
Elimination 
Life support procedures 
Antidote therapy 
Other Treatment carried 
out before enquiry 
( ) 
( ) 
( ) 
( ) 
( ) 
( ) 
( ) 
( ) 
( ) 
( ) Treatment 
recommended 
by PC 
( 
( 
( 
( 
( 
( 
( 
( 
( 
( ) 
) 
) 
) 
) 
) 
) 
) 
) 
) 
14.2. Place of treatment: 
— Treatment at home or at place of incident, not by physician ( ) 
— Treatment outside hospital by a physician ( ) 
— Treatment in hospital ( ) Other ( ) 
15. Estimated risk: non-toxic ( ) 
— Probably non-toxic (low toxicity/minimal exposure) ( ) 
— Poisoning not excluded ( ) Predictable risk ( ) 
— Symptoms unrelated to exposure ( ) 
16. Outcome: 
Complete recovery ( ) sequelae ( ) death ( ) unknown ( ) 
Signature: 
22. 11. 89 Official Journal of the European Communities No C 294/17 
ANNEX 2 
LAYOUT OF THE HARMONIZED ANNUAL REPORTS 
1. Identification of the body drafting the report 
Name; full address (indicating country); telephone, telex and fax numbers (if any); name of person in 
charge of centre. 
2. Year 
The year covered by the annual report in question. 
3. Administrative information on the centre 
Description of staff at centre (medical and administrative personnel); a brief description of the centre's 
work; the size of the population served. 
4. Calls to the centre 
The total number of calls, their monthly variation, their distribution according to the person making 
the request, the way in which the call is made (telephone, letter, etc.), the reasons (actual or presumed 
poisoning, simple request for information, etc.). 
5. Poisoning cases 
— the number of cases and the frequency should be indicated for each category or sub-category; 
— if the centre has the necessary resources, it would be desirable to break down the data in terms of 
the classes of aetiological agents listed below. 
5.1. Cases involving human beings 
— males, females (including pregnant women, nursing mothers), unspecified 
— Age groups (in years): 
— < 1 
— 1-4 
— 5-9 
— 10-14 
— 15-19 
— 20-69 
— > 70 
— unknown 
— Aetiological agents: 
— non-pharmaceutical chemical substances (simple or compound, natural or synthetic): 
— industrial 
— pesticides 
— household products 
— others 
— pharmaceutical substances (human or veterinary) 
— animals as such (whether by their venom or through consumption of poisonous meat — 
e.g. ichthyosarcotoxism — where chemical products, bacteria or putrefaction are not the 
cause) 
— plants as such (including hallucinogenic or poisonous mushrooms) 
— others (including toxins of bacterial origin, e.g. botulism) 
— not identified 
— Location: 
— home and immediate surroundings 
— workplace: 
— industry 
— agriculture/horticulture 
— other 
No C 294/18 Official Journal of the European Communities 22. 11. 89 
— public establishments (e.g. schools or training centres, government offices, post offices, 
libraries, public transport — trains, buses, underground railways, etc.) 
— enclosed public places (e.g. bars, discotheques, restaurants, shopping centres, department 
stores, etc.) 
— open places (e.g. sports grounds, children's playgrounds, etc.) 
— other or unknown 
— Circumstances: 
— accidental acute poisoning 
— deliberate acute poisoning 
— side effect of drugs 
— accidental chronic poisoning 
— deliberate chronic poisoning 
— other or unknown 
— Initial evaluation: 
— non-toxic 
— probably non-toxic 
— poisoning not excluded 
— predictable risk 
— established poisoning 
— symptoms unrelated to the exposure 
— Treatment: 
— none 
— symptomatic only 
— specific (antidote therapy) 
— Outcome: 
— complete recovery 
— hospitalization (number of days) 
— sequelae 
— death 
— unknown 
5.2. Animals 
6. Record of poisoning cases 
Drawn up a list of the 15 most frequent causes of poisoning in decreasing order of frequency (indi­
cating the number of calls), with a breakdown by age group. 
7. Record of requests for information 
Draw up a list of the 15 products for which most requests for information are received. 
8. Record of toxicological analyses 
Draw up a list of the 15 toxicological analyses which are most frequently requested by the centre. 
9. Comments in free text 
On all treatment given and information provided; on particularly interesting cases which may have 
been encountered, on other activities (teaching, research, etc.) and on any other aspect not included 
elsewhere. 
10. Conclusions 
These are to deal mainly with the impact of the centre's activities on prevention. 
22. 11. 89 Official Journal of the European Communities No C 294/19 
ANNEX 3 
INDICATIVE LIST OF ANTIDOTES 
I. Specific antidotes 
Antidote 
Acetylcysteine 
Amyl nitrite 
Antivenins and 
antoxins 
Atropine 
Benzylpenicillin 
Calcium gluconate 
Calcium sodium edetate 
(EDTA) 
Dantrolene 
Deferoxamine 
Diazepam 
Dicobalt Edetate 
Digoxin specific antibody 
fragments 
(FAB) 
Dimercaprol (BAL) 
4-Dimethylaminophenol 
(4-DMAP) 
Diphenhydramine 
Ethanol Main indications 
Paracetamol 
Chloroform 
Carbon tetrachloride 
Acrylonitrile 
Cyanide 
Cholinergic syndrome 
Amatoxins 
Hydrofluoric acid 
Fluorides 
Oxalates 
Lead 
Malignant Hyperthermia 
Malignant Neuroleptic Syndrome 
Iron 
Aluminium 
Seizures 
Chloroquine 
Cyanide 
Digoxin 
Digitoxin 
Digitalis Glucosides 
Arsenic 
Gold, inorganic mercury 
Lead encephalopathy 
Cyanide 
Drug-induced dystonias 
Methanol 
Ethylene glycol Availability in terms 
of urgency of use in 
treatment 
B 
B 
B 
B 
A 
A-C 
A 
B 
A 
A 
A 
B 
A 
A 
B 
B 
A 
A 
A 
B 
B 
B 
B 
B 
B 
A 
A 
A 
A 
A: required to be immediately available (within 30 minutes); 
B: required to be available within two hours; 
C: required to be available within six hours. 
No C 294/20 Official Journal of the European Communities 22. 11. 89 
Antidote 
Etybenzatropine 
Flumazenil 
Folinic Acid 
Glucagon 
Hydroxocobalamin 
(Vit. B12 a) 
Methionine 
4-Methylpyrazole 
Methylthioninium chloride 
(Methylene blue) 
N-Acetyl penicillamine 
Naloxone 
Neostigmine 
Oximes 
Oxygen 
Oxygen hyperbaric 
D-Penicillamine 
Pentetic Acid (DTPA) 
(Diethylenetriamine pentaacetic 
acid) 
Phentolamine Main indications 
Drug-induced dystonias 
Benzodiazepines 
Folic Acid Antagonists 
-blockers 
Cyanide 
Paracetamol 
Ethylene glycol 
Methanol 
Methaemoglobinaemia 
Mercury (organic and 
metallic) 
Opiates 
Neuromuscular block (curare type) 
Peripheral anticholinergic 
poisoning 
Organophosphates 
Carbon monoxide 
Cyanide 
Hydrogen sulphide 
Carbon monoxide 
Cyanide 
Hydrogen sulphide 
Carbon tetrachloride 
Copper 
Gold, Lead, Mercury 
(elemental) Zinc 
Plutonium, actinides 
Alpha-adrenergic poisoning Availability in terms 
of urgency of use in 
treatment 
A 
B 
A 
A 
A 
B 
A 
A 
A 
C 
A 
A 
A 
B 
A 
A 
A 
C 
C c c 
c c c 
A 
A 
A: required to be immediately available (within 30 minutes); 
B: required to be available within two hours; 
C: required to be available within six hours. 
22. 11. 89 Official Journal of the European Communities No C 294/21 
Antidote 
Physostigmine 
Phytomenadione (Vit. Ki) 
Potassium ferric hexacya-
noferrate (Prussian Blue) 
Prenalterol 
Protamine sulphate 
Pyridoxine (Vit. B6) 
Silibinin 
Sodium nitrite 
Sodium thiosulphate 
Succimer (DMSA) (2,3 Dimer-
caprol succinic acid 
Tolonium Chloride 
(Toluidine blue) 
Trientine 
(Triethylene tetramine) 
Unitiol (DMPS) 
(2,3-Dimercapto-1 -propane-
sulphonic acid) Main indications 
Central anticholinergic syndrome from 
— atropine and derivatives 
— other drugs 
Coumarin and indanedione anticoagulants 
Thallium 
-blockers 
Heparin 
Isoniazid 
Crimidine 
Ethylene glycol 
Gyromitrin 
Hydrazines 
Amatoxins 
Cyanide 
Cyanide 
Lead 
Mercury (inorganic and organic) 
Arsenic 
Methaemoglobinaemia 
Copper 
Mercury (methyl- and inorganic) 
Lead Availability in terms 
of urgency of use in 
treatment 
A 
A 
B 
B 
A 
A 
A 
B 
B 
B 
B 
B 
A 
A 
B 
B 
B 
A 
B 
B 
B 
A: required to be immediately available (within 30 minutes); 
B: required to be available within two hours; 
C: required to be available within six hours. 
No C 294/22 Official Journal of the European Communities 22. 11. 89 
II. Agents to prevent absorption of toxic substances in the gastro-intestinal tract 
Antidote 
Activated charcoal 
Cholestyramine 
Fullers Earth 
Potassium ferrocyanide 
Sodium bicarbonate 
Sodium sulphate 
Starch Main indications 
(for most poisonings) 
Digitalis, Coumarin, Chlordecone 
Paraquat, Diquat 
Copper 
Iron 
Organophosphates 
Barium 
Iodine Availability in terms 
of urgency of use in 
treatment 
A 
B 
A 
A 
A 
A 
A 
A 
III. Agents to prevent absorption and/or damage on the skin 
Antidote 
Calcium gluconate gel 
Macrogol 400 (PEG) 
Copper sulphate, sodium bicar­
bonate, hydroxyethylcellulose Main indications 
Hydrofluoric acid 
Phenol 
White Phosphorus Availability in terms 
of urgency of use in 
treatment 
A 
A 
A 
IV. Emetics 
Antidote 
Apomorphine 
Ipecacuanha Main indications Availability in terms 
of urgency of use in 
treatment 
A 
A 
A: required to be immediately available (within 30 minutes); 
B: required to be available within two hours; 
C: required to be available within six hours. 
22. 11. 89 Official Journal of the European Communities No C 294/23 
V. Cathartics and solutions used for whole gut lavage 
Antidote 
Magnesium citrate 
Magnesium sulphate 
Mannitol 
Sodium sulphate 
Sorbitol 
Whole gut lavage fluids 
(Polyethylene glycol electrolyte 
lavage solution) Main indications Availability in terms 
of urgency of use in 
treatment 
B 
B 
B 
B 
B 
B 
VI. Agents to modify urinary pH 
Antidote 
Ammonium chloride 
Arginine hydrochloride 
Hydrochloric acid (0.1 N) 
Sodium bicarbonate Main indications Availability in terms 
of urgency of use in 
treatment 
B 
B 
B 
A 
A: required to be immediately available (within 30 minutes); 
B: required to be available within two hours; 
C: required to be available within six hours.