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 For
Health Care Providers
Recognition
and Management
Dr.
Lynn Goldman, former Assistant Administrator of the Office of Prevention,
Pesticides and Toxic Substances of the U.S. Environmental Protection Agency,
has publicly acknowledged that “medical problems caused by pesticide
exposure are often overlooked or misdiagnosed by health care providers.”
Yet we use pesticides in our homes, workplaces, schools, communities and
on our food. This widespread use of pesticides requires health care providers
to be prepared to recognize, manage, report and prevent pesticide related
health problems.
Symptoms
The health
effects of pesticide exposure often mimic the symptoms of the common cold
or flu, including dizziness and/or nausea, sore throat, itchy eyes, nose
and throat, headache, rashes, excessive sweating or salivation, watery
eyes, and stomach cramps. Therefore, it is important to understand the
complexities of pesticide exposure. The Federal Environmental Protection
Agency has published Recognition
and Management of Pesticide Poisoning which
provides specific information on the health effects and treatments for
a variety of pesticides.
Another resource
for health care providers is Pesticides
and Human Health: A Resource for Health Care Providers, published
by Physicians for Social Responsibility (PSR).
McMaster
University in cooperation with the University of Toronto has developed
an Environmental Health
in Family Medicine module for health care providers, with the
following objectives:
1. To introduce
and provide practice in environmental exposure history through the use
of clinical cases.
2. To provide
diagnostic and treatment guidelines for the management of acute (short-term)
and chronic (long-term) pesticide exposures and the symptoms related to
exposure.
3. To provide
clinical cases and discussion material illustrating pesticide exposures
in three groups with specific biologic vulnerability: children, pregnant
women and the elderly.
4. To provide
selected references relevant to the health effects of pesticide exposure
in these three groups.
Educating
Patients
According to the EPA “none of the medical procedures or drugs used
in treating poisonings is risk-free. In fact, many antidotes are toxic
in their own right, and such apparently simple procedures as gastric intubation
incur substantial risk.” Prevention is the best way to assure the
health and safety of patients. Therefore, it is imperative that health
care providers become more engaged in educating patients about the dangers
of pesticide use, the steps that can be taken to reduce exposure, and
the existence of reliable alternatives.
Exposure
Histories
The Environmental Protection Agency acknowledges that “Pesticide
poisonings may go unrecognized because of the failure to take a proper
exposure history.” Yet, many health care providers have not implemented
procedures for taking adequate exposure histories. EPA dedicates a section
of their book to Environmental
and Occupational History. Although a more detailed history may create
more paperwork, the tracking of possible pesticide illness is of great
importance.
The Agency
for Toxic Substances and Disease Registry also has a website for Case
Studies in Environmental Medicine Taking An Exposure History
Mandatory
Reporting
By law any “physician who knows, or has reasonable cause to believe,
that a patient has a pesticide-related illness must report that case to
the local health officer by telephone within 24 hours.” (Click here
to access a reporting form). Reporting of suspected pesticide exposures
is important because it is one of the strategies the state of California
uses to track potential problems with registered pesticides. The key to
reporting is that the physician does not have to be absolutely sure that
a pesticide exposure has occurred. If a physician even suspects a possible
exposure it should be reported. Once a report is filed, the County Agricultural
Commissioner and health officers may conduct an investigation on the possible
exposure.
A report
can either be filed by the physician themselves or by calling the Poison
Control Center at (800) 876-4766. Regardless of the way a report gets
filed, physicians are strongly encouraged to contact their local County
Agricultural Commissioner to advise them of the suspected exposure.
Resources
The County
Agricultural Commissioner or County Health Officer is a resource for
health care providers with questions about potential pesticide exposure.
Specifically, the Commissioner’s Office can provide information on
what pesticides may have been applied to a certain farm, can provide Material
Safety Data Sheets and labels, and can help to determine if pesticides
were applied to public areas such as parks, schools and roadways. CCEHP
can also provide resources, information, medical videos and packets, and
medical trainings for interested parties.
See links
for more resources on pesticide issues.
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