Emergency departments throughout the USA may have some familiarity with the management of envenomation from indigenous snake species such as Crotalinae (rattlesnakes) and Micrurus (coral snakes). However, venomous species may include exotic reptiles whose bites pose substantial treatment challenges due to both a lack of experience and the difficulty in obtaining antivenoms. Two pet cobra envenomation incidents illustrate the challenges that face emergency departments, especially in urban settings, that are confronted with these exposures. It is important for emergency departments to be aware of the large underground presence of exotic venomous reptile pets and to utilise the expertise of regional poison centres that will also assist in the procurement of exotic antivenoms.
The Moscow Toxicology Information and Advisory Center was created in 1993 as an institution of the Russian Federation Ministry of Health and Medical Industry. The Toxicology Information and Advisory Center is the first in a network of over 20 toxicology information centers to be created in different regions of Russia by 1998. At present the Toxicology Information and Advisory Center serves over 20 million people in the Moscow region with episodic inquiries from other areas. A prototype national bank of clinical and toxicological data on acute chemical poisoning and an information retrieval system POISON have been created. Work is underway to create computerized systems for data analysis of telephone inquiries on diagnosis and treatment protocols of acute poisoning.
Standardization of inpatient toxicological care is an urgent task to reduce mortality from acute chemical poisonings. Since 2005, health care standards and patient management protocols in poisonings with psychotropic and hypnotic agents, ethanol and other alcohols, and ethylene glycol have been developed and work is in progress on standards for intoxication with corrosive substances, soaps, detergents, carbon dioxide, other gases, smokes, and vapors. Major difficulties have been revealed. These are the lack of coincidence of the "Nomenclature of work and services in public health service" at the federal level with the similar regional documents; improper presentation of toxicological diagnostic and medical technologies; orientation of the Ministry of Health and Social Development of Russia towards only simple services; the "List of Essential and Most Important Drugs" that does not contain the heading "antidote agents" at all is to be completed.