In order to fulfill the requirements for fellowship training as specified by the American Board of Emergency Medicine, the Division of Pulmonary and Critical Care Medicine, and the Division of Emergency Medicine offer a two-year fellowship in medical toxicology.

The applicant must have completed an ACGME accredited residency program in Emergency Medicine, Internal Medicine, Pediatrics, or Preventive Medicine, and plan to sit for a Board exam in their specialty prior to completion of fellowship training.

The applicant will be required to work a minimum of 12 hours per week in their primary specialty in order to maintain their clinical skills.  The applicant must be acceptable to the department in which he/she plans to work in his/her primary field.

• Sacramento Division of the California Poison Control System
• Clinical Pharmacology Consult Service
• UC Davis Medical Center Emergency Department
• UC Davis Medical Center Intensive Care Unit
• UC Davis Pediatrics
• Acute hemodialysis service
• Hyperbaric oxygen unit (Travis Air Force Base)
• Graduate courses in pharmacology
• Forensic laboratory and procedures
• Department of Occupational and Environmental Medicine
• Sacramento Fire Department HAZMAT
• Research

This Division of the California Poison Control System (CPCS) is located on the UC Davis Medical Center campus.  It serves as the Poison Control Center for 26 counties in Northern California, and receives 70,000 telephone calls per year requesting information and assistance in poisoning matters.  The CPCS has received a five year accreditation from the American Association of Poison Control Centers.  The fellow will be on call for the CPCS for all calls from health care facilities, and as a resource to the poison information specialists who manage the daily phone calls.
The fellow will help in the teaching of medical students, residents, and Pharm.D. students while in the Poison Control Center.  There is a resident in Emergency Medicine on rotation 10 months a year.  Pediatric residents spend a half day a week in the CPCS on a rotating basis, and Internal Medicine residents and senior medical students frequently elect a two week rotation in toxicology.  Biweekly care management conferences are held electronically linking all 4 regional centers for education of all fellows.

Experience in the outpatient management of poisoning and exposures will be gained by handling many of the poison center telephone inquiries as well. The American Board of Emergency Medicine Toxicology section has established that the fellow personally handle 1500 calls per year. This is approximately 30 calls per week, an easily managed number given the CPCS call volume.

The CPCS also has an educational out-reach program with a full time Health Educator who makes presentations in schools on poison prevention. Approximately 73,000 school children in the greater Sacramento metropolitan area are reached every year through this educational forum. The Health Educator and attending staff are also called on frequently by the media to speak on poison and toxicology topics of newsworthy importance. The fellow will gain exposure to poison prevention, outreach education, and media interactions through these programs.

This service provides consultation for patients hospitalized at UCDMC. The fellow will participate in the management of poisoned and toxin-exposed patients. These patients will be managed in conjunction with the primary adult or pediatric admitting service. Board certified Toxicology attending staff will provide teaching and consultation with the fellow.

Therapeutic Drug monitoring is also a part of this consultative service. The fellow will assist the pharmacologists and attending Toxicologists in making recommendations on therapeutic drugs based on drug levels and halt-life calculations, and in those patients with liver or kidney dysfunction requiring special dosing regimens.

The UC Davis Medical Center is a Level I Trauma center and sees a large number of overdose and toxicology cases. The patient volume is 67,000 patients per year, and the acuity level is very high. Twenty five percent of all Emergency Department patients require hospital admission, and approximately three-quarters of all hospital admissions come from the Emergency Department.

The CPCS is notified of all cases of poisoning or exposure that arrive at the emergency department. The fellow will be called to assist the Emergency Medicine housestaff in the evaluation and management of these cases.  During most months a senior resident in Emergency Medicine is on call for the CPCS and the fellow will assist the resident in bedside evaluation and management.

An Academic Forum is held every Tuesday of the month, and a Journal Club once monthly. The fellow is expected to participate in these didactic sessions, and will be required six times a year to give presentations on a toxicology topic at either Grand Rounds, Morbidity and Mortality Case Conference, or Journal Club.

The fellow will be able to do 1 or 2 months in the medical intensive care unit (MICU). He or she will function at the level of a fellow in conjunction with the MICU fellow.  Most adult poisoned patients requiring monitoring or therapy are admitted to the MICU. Two toxicology faculty serve as attendings for the MICU as well.

The fellow with pediatric residency training will be expected to maintain his/her skills in pediatrics by working with the pediatric department 12 hours per week. The fellow who has had limited exposure to pediatrics in his/her primary training will be able to rotate for 1 or 2 months in the pediatric intensive care unit (PICU). Most pediatric poisoned patients requiring monitoring or therapy are admitted to the PICU. A large population is referred to this tertiary care center for specialty services as well.

The acute hemodialysis service of the Division of Nephrology does all emergent dialysis at UC Davis Medical Center. Approximately 100 cases of emergency hemodialysis are done in the emergency department each year. The fellow will do a one month rotation with the acute hemodialysis service and will be expected to assist with all acute emergency dialysis done for removal of toxins. Familiarity with the pharmacokinetics and toxicokinetics of both hemodialysis and hemoperfusion will be expected.

The hyperbaric oxygen unit is located at the David Grant Medical Center at Travis Air Force Base, 40 miles west of Sacramento. The hyperbaric unit houses the second largest hyperbaric chamber in the country. It is capable of diving 17 patients and two technicians simultaneously. The hyperbaric chamber is in use daily for 10 to 20 patients with difficult wounds and graft healing problems.
The hyperbaric unit is available to any patient who may require hyperbaric oxygen therapy for toxic gas exposure or for the treatment of decompression sickness. While the number of these types of patients are small, the fellow will have the opportunity to use the chamber and participate in the management of these patients, and may be required to assist in the air or ground transport of patients to Travis AFB.

Research opportunities exist for the fellow in conjunction with Dr. Penne-Casanova, the director of the hyperbaric unit. An expansive research facility with a small animal hyperbaric chamber is available at Travis AFB.

The fellow is expected to take 1 or 2 courses per semester at UC Davis. These graduate level courses cover topics in basic science in toxicology, toxicokinetics, and environmental medicine. Additional undergraduate or graduate courses can be taken by arrangement with the medical school, the veterinary school or the undergraduate department that offers the courses. The fellow is expected to maintain a B average for all coursework.

The fellow will gain experience in toxicology laboratory techniques through the toxicology lab of the Department of Pathology and by arrangements with the toxicology lab at the Sacramento County coroner's office.

Two of our faculty, certified in toxicology and occupational medicine, also attend in the emergency department. They will provide supervision in the occupational medicine aspects of toxicology.  An opportunity to participate in outpatient clinics and didactic programs in occupational medicine will be provided.  Research opportunities may be available through the Department of Epidemiology.

The CPCS is an integral part of the hazardous material response plan for Sacramento County. This state-of-the-art team is run by the Sacramento Fire Department and responds throughout the Sacramento valley region. Dr. Steve Tharratt, the associate director of the CPCS and medical director of the fire department, responds to all significant HAZMAT incidents with the HAZMAT team. The fellow will be expected to participate in field responses with Dr. Tharratt, and to assist with training and drills. There are 15 to 20 chemical spills each year in which high level HAZMAT assistance is requested.  Opportunities for the fellow to obtain hazardous Materials Specialist Certification exist.

The fellow will be expected to participate in research projects during the two year training program. Research opportunities include the CPCS, the emergency department, epidemiology and hyperbaric medicine. Some faculty have basic laboratory studies in progress, and animal lab techniques can be acquired through assistance with these studies. Individual interests of the fellow can be explored with advice from the program director and other faculty members. At least one research project must be of substantial quality to be submitted for publication in a peer review journal.

To apply, please fax the completed application form to (916) 734-7924 or e-mail Betty Boyd.

Director
Timothy Albertson, M.D.
Professor

Fellowship Coordinator
Betty Boyd
e-mail: bmboyd@ucdavis.edu
Telephone: (916) 734-3565
FAX: (916) 734-7924