Noel Stevenson Research Scholarship: Dr Colin Page

Grant ID: EMRF-001R22-2014

Project Summary

Dr Colin Page was awarded the Noel Stevenson Fellowship (in honour of eminent Queensland emergency medicine physician, Dr Noel Stevenson) to undertake a Doctorate of Philosophy (PHD). Dr Page is studying the antidotes and treatments that are commonly used by medical staff when looking after patients who are affected by drug toxicity. The PhD will be based at Princess Alexandra Hospital within the clinical toxicology unit with extension to other toxicology units/hospitals within Australia. It will be undertaken through the University of Newcastle (NSW) under the supervision of A/Prof Geoff Isbister and Prof Nicholas Buckley, who are both leaders in clinical toxicology research publications.

Dr Page has developed a clinical toxicology service at Princess Alexandra Hospital and Queensland through a locally run clinical toxicology unit and is the honorary medical director of the Queensland Poisons Information Centre. Clinical toxicology is the speciality that manages patients who are affected by drug toxicity either accidentally or in overdose. The project will primarily research antidotes and other treatments that are used in the management of toxicology patients. This will allow the introduction of safer treatments, new treatments and progressing the scientific basis behind treatments used in clinical toxicology.

Outcomes

1. Droperidol for use by paramedics
> An evaluation was completed looking at the effectiveness of Queensland Ambulance Service paramdedics using droperidol to sedate violent patients. The research team found the "use of droperidol for acute behavioral disturbance in the prehospital setting is associated with fewer adverse events, a shorter time to sedation, and fewer requirements for additional sedation." Dr Page was awarded the 2018 ACEM John Gilroy Potts award for best emergency medicine research publication (for his paper on 'A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance').

Sadly, Dr Page passed away in late 2018 before he could complete his PhD. Notwithstanding, his extraordinary research output stands testament to Dr Page's research acumen and achievements in the toxicology field.

Dissemination

Page, C.B., Parker, L.E., Rashford, S.J., Isoardi, K.Z. and Isbister, G.K., 2018. A prospective study of the safety and effectiveness of droperidol in children for prehospital acute behavioral disturbance. Prehospital Emergency Care.

Chiew, A.L., Isbister, G.K., Page, C.B., Kirby, K.A., Chan, B.S. and Buckley, N.A., 2018. Modified release paracetamol overdose: a prospective observational study (ATOM-3). Clinical Toxicology, 56(9), pp.810-819.

Page, C.B., Ryan, N.M. and Isbister, G.K., 2018. The safety of high-dose insulin euglycaemia therapy in toxin-induced cardiac toxicity. Clinical Toxicology, 56(6), pp.389-396.

Page, C.B., Parker, L.E., Rashford, S.J., Bosley, E., Isoardi, K.Z., Williamson, F.E. and Isbister, G.K., 2018. A prospective before and after study of droperidol for prehospital acute behavioral disturbance. Prehospital Emergency Care, 22(6), pp.713-721.

Isoardi, K.Z., Armitage, M.C., Harris, K. and Page, C.B., 2017. Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days. Emergency Medicine Australasia, 29(3), pp.310-314.

Chiew, A.L., Isbister, G.K., Kirby, K.A., Page, C.B., Chan, B.S. and Buckley, N.A., 2017. Massive paracetamol overdose: an observational study of the effect of activated charcoal and increased acetylcysteine dose (ATOM-2). Clinical Toxicology, 55(10), pp.1055-1065.

Pillans, PI., Page, CB., Ilango, S., Kashchuk,A., Isbister, GK,.'Self-poisioning in elderly Australians: a cohort study', Med J Aust 2017; 206 (4): 164-169

Isbister, G.K., Heppell, S.P., Page, C.B. and Ryan, N.M., 2017. Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity. Clinical Toxicology, 55(3), pp.187-192.

Isbister, G.K., Calver, L.A., Downes, M.A. and Page, C.B., 2016. Ketamine as rescue treatment for difficult-to-sedate severe acute behavioral disturbance in the emergency department. Annals of emergency medicine, 67(5), pp.581-587.

Page, C.B., Kruger, P.S., Dimeski, G. and Walsham, J., 2016. Severe toxicity with guanidine thiocyanate ingestion: a case report. Clinical Toxicology, 54(4), pp.495-495.

Armitage, M.C., Woolfield, K.I. and Page, C.B., 2016. Serotonin toxicity caused by the interaction of fentanyl and serotonergic medications. Emergency Medicine Australasia, 1(28), pp.119-120.

Page, C.B., Mostafa, A., Saiao, A., Grice, J.E., Roberts, M.S. and Isbister, G.K., 2016. Cardiovascular toxicity with levetiracetam overdose. Clinical Toxicology, 54(2), pp.152-154.

Isbister, G.K., Downes, M.A., Mcnamara, K., Berling, I., Whyte, I.M. and Page, C.B., 2016. A prospective observational study of a novel 2-phase infusion protocol for the administration of acetylcysteine in paracetamol poisoning. Clinical Toxicology, 54(2), pp.120-126.

Bateman, D.N. and Page, C.B., 2016. Antidotes to coumarins, isoniazid, methotrexate and thyroxine, toxins that work via metabolic processes. British journal of clinical pharmacology, 81(3), pp.437-445.

Calver, L., Page, C.B., Downes, M.A., Chan, B., Kinnear, F., Wheatley, L., Spain, D. and Isbister, G.K., 2015. The safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department. Annals of emergency medicine, 66(3), pp.230-238.

Isbister, G.K. and Page, C.B., 2015. Brown snake envenoming: Why are we left in the dark?. Clinical toxicology (Philadelphia, Pa.), 53(9), pp.925-925.

Calver, L., Drinkwater, V., Gupta, R., Page, C.B. and Isbister, G.K., 2015. Droperidol v. haloperidol for sedation of aggressive behaviour in acute mental health: randomised controlled trial. The British Journal of Psychiatry, 206(3), pp.223-228.

Isbister, G.K., Maduwage, K. and Page, C.B., 2014. Antivenom cross neutralisation in a suspected Asian pit viper envenoming causing severe coagulopathy. Toxicon, 90, pp.286-290.
Williams, M.M., Taylor, P.J., Page, C.B. and Martin, J.H., 2014. Clinical research in synthetic cannabinoids-do we need a national approach?. The Medical Journal of Australia, 201(6), pp.317-319.

Isbister GK, Page CB, Buckley NA, Fatovich DM, Pascu O, MacDonald SP, Calver LA, Brown SG, RAVE Investigators. Randomized controlled trial of intravenous antivenom versus placebo for latrodectism: the second Redback Antivenom Evaluation (RAVE-II) study. Annals of emergency medicine. 2014 Dec 1;64(6):620-8.

Poster Presentation:
- Chiew A.L., Isbister G.K., Page C.B., Chan B.S.N., Buckley N.A., 'Modified release paracetamol overdose: A prospective observational study', TAPNA toxicology meeting Melbourne April 2017
- Page C.B., Ryan N.M., Isbister G.K., 'The use and safety of high does insulin euglcycaemia therapy in toxin induced cardiac toxicity', TAPNA toxicology meeting Melbourne April 2017
- Wylie, C., Heffernan, A., Brown, J., Cairns, R., Lynch, AM., Robinson, J., Page, C. Electronic Cigarettes - Smoking Cessation Tool or Potential Poision. TAPNA toxicology meeting Melbourne 2017
- Chan, BS., Chiew, A., Page, C., Abdalla, A., Buckley, NA., Roberts, M., Isbister, G. Dihydropyridine CCB Toxicity (DTP) and the renin angiostensin axis. TAPNA toxicology meeting Melbourne 2017
- Chan, BS., Chiew, A., Page, C., O'Leary, M., Ibister, G., Buckley, NA. Acute Diagoxin Overdose and Response to Antibody (DORA study). TAPNA toxicology meeting Melbourne 2017
- Ayles, S., Finch, C., Isoardi, KZ., Page, C. Amphetamine Presentations to a Toxicology Unit: Management and Complications. QLD ACEM Autumn Symposium May 2017;
- Ayles, S., Finch, C., Isoardi, KZ., Page, C. Amphetamine Presentations to a Toxicology Unit: Management and Complications. TAPNA toxicology meeting Melbourne April, 2017
- Angela, L., Chiew, A., Page, CB., Clancey, D., Mostafa, A., Roberts, MS., Isbister, GK. BIN- DIE Ingestion: Too Hot to Handle, TAPNA toxicology meeting Melbourne 27-29 April 2017
- Chiew AL, Ibister GK, Page CB, Buckley NA,. Management of massive paracetamol overdose. An observational study. TAPNA Brisbane, May 2016
- Isoardi K, Armitage M, Harris K, Page CB. Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days. TAPNA Brisbane May 2016
- Roberts D, Xu T, Page CB. Effect of extracorporeal treatments in a patients with prolonges phenytoin toxicity. TAPNA Brisbane May 2016
- Logan H, Dean D, Soderstrom J, Page CB. Baby Bottle blues. A Case Report of Ethylene Glycol Poisoning. TAPNA Brisbane 2016
- Isbister GK, Heppell S, Page CB, Ryan N. Adult clonidine overdose: prolonged bradycardia and CNS depression but not severe toxicity. TAPNA Brisbane May 2016.
- Page CB, Ryan N, Ibister GK, HIE case series, EAPCCT Madrid, May 2016.
- Downes MA, Berling IL, Page CB, Whyte IM, Isbister GK. Use of an electronic device based database to measure the telephone consultation workload of a regional toxicology service in Australia. APAMT Perth December 2015