By Anthony M Burda Rph, DABAT  aka the Man, the Myth, the Legend

Everyone has a tendency to remember where they were and what they were doing on the day something very significant happened in the world, for example, the day President John F. Kennedy was assassinated, the Challenger shuttle went down, or the terrorist attack of 9/11/01.  For those of us in the toxicology world, one incident that stands out is the Tylenol®-cyanide deaths which rattled Chicago and the entire nation back in September 1982.

I can recall the moment I first heard of several deaths being linked to Extra-Strength Tylenol® capsules.  It was during the 10:00 AM hour one seemingly uneventful morning when another specialist and I were listening to a news radio station and heard a newsflash which broke the story for the first time.  After listening in stunned silence, I said, “Holy s***, we’re going to get killed.”  And sure enough, within minutes, every line lit up in the poison center and stayed that way for the rest of the day and for many days following.

It was all we could do to keep up with the relentless calls just by passing on what dribs and drabs of information we could glean from news reports.  There was a lot of confusion surrounding the real facts of the incident.  I recall squeezing in a call to my family telling them not to use any Tylenol® products until further notice and listen to the news.

In 1982, our call volume usually averaged about 40-60 calls per 24 hours (taken by 1-3 staff members), but the day the story broke, our call volume approached 800 calls.  Usually we documented data such as caller name, county, etc. for statistics, but the call volume was so fast and furious that all we did was make hash marks on a sheet of paper to keep track of the number of phone calls per hour that we were handling.  The phone was so busy that you would literally hang it up, and it would ring again.  At that time, our phones could only take a maximum of four lines at a time with only 4-5 usable workstations, which really limited the number of calls that could get through to us.  It was difficult for callers with poisoning emergencies unrelated to the Tylenol® story to get through.

Most of our staff had no real experience in dealing with a true cyanide poisoning since cyanide poisonings are relatively rare occurrences.  So we dove into our toxicology references and became instant cyanide experts.  At that time, most of our information was provided by two microfilm readers, and believe it or not, 5 x 9 index cards provided by a now defunct organization called the National Poison Control Center Network.  In the metropolitan Chicago area and probably across the nation, hospital pharmacists scrambled to dust off their cyanide antidote kits or urgently ordered some if none were on-hand.  Everywhere, store managers clambered to move Tylenol® products off retail shelves.

Even though consumers were instructed to drop off bottles of unused Tylenol® at local pharmacies or police stations, dozens of people decided to drop them off at our poison center where we accumulated boxes of these containers.  Many of us were interviewed by reporters from local and national radio, print, and television news media.  Police cars moved up and down local streets blaring a message through their loudspeakers not to use Tylenol® products.

A   majority of the calls we received were managed by providing nothing more than calm reassurance that no cyanide poisoning had occurred.  For instance, a caller might have stated he had taken a couple of Tylenol® capsules two weeks prior to the call, and now had nausea, vomiting, and diarrhea.  Upon further questioning, it would be found that his symptoms were more likely related to his ingestion of a leftover mega burrito grande that had been sitting in his car for a few days.  The poison center supervisor would routinely reassure panicked callers that if he/she was “walkin’ and talkin’” and able to dial the telephone, they most likely were not poisoned by cyanide.

Following the well-publicized Tylenol® tampering, several “me too” product tamperings occurred in the following months, for example the placement of rat poison into over-the-counter decongestant capsules.  I have worked in the poison center during these and other product tamperings and recalls over the years, such as salmonella contaminated milk, asbestos in Twinkies®, E. coli in ground beef, etc., but nothing strikes fear into the hearts of people like the threat of cyanide-tainted drugs.

So, what’s happened with the poison center and what have we learned from this unique toxicological public health emergency? The Illinois Poison Center (IPC) is a nonprofit health service that provides the people of Illinois with comprehensive and trusted information and treatment advice on potentially harmful substances via a free, confidential 24-hour helpline staffed by specially trained physicians, nurses and pharmacists. The IPC is a service of the Illinois Health and Hospital Association and covers the entire state of Illinois, averages 250-300 calls per day and employs 26 health care professionals specially trained in toxicology.  The IPC houses 15 onsite and 17 remote workstations, each equipped with up-to-date computerized data retrieval and record keeping software and a state of the art telephone system.  If a large scale public health emergency were to occur, the IPC now has the capability of activating 40 telephones and calling in extra full-time and part-time staff and volunteer healthcare professionals to man the phone bank on a 24/7 basis.  Working through crises like the Tylenol®-cyanide tampering have helped us to plan and prepare for any current or future wide-scale public health disaster or mass casualty event.  Our expertise in this area was recognized when officials from the state of Illinois approached the IPC in the fall of 2009 to serve as the focal point for dissemination of information via operation of an ongoing state-wide H1N1 influenza hotline.

I truly hope and pray that another crazy psychopath never unleashes another round of such senseless destruction of people’s lives here in Chicago or anywhere in the United States.  But if it happens,  a few grizzled veterans like me, and a larger number of younger, more energetic healthcare professionals are ready, willing, and able to step up to the public health challenges we may encounter.  Remember, save the IPC free Helpline to your phones: 800-222-1222 and request a free IPC safety packet (available in English and Spanish; includes: sticker, magnet and first aid tips for a poisoning).