Environmental Medicine Referral Service |Overview
September 2020
波士顿儿童健康医师announc(摘要)es a newly expanded clinical referral service in Environmental Medicine. The service is readily available to physicians, patients, and patients’ families who have clinical problems or unresolved questions potentially related to environmental issues or toxic exposures, such as to lead, mercury, solvents, toxic plants, mold, pesticides, and household cleansers. A specialized approach will sometimes uncover the diagnosis by recognizing a cluster of related signs, or “toxidrome”, that identify the likely agent. Conversely, a carefully taken environmental history may well unravel a confusing array of disparate symptoms and pinpoint an environmental hazard in the home or school.
Growing environmental awareness in the general public has brought greater insight among pediatricians that environmental factors can cause, trigger, or exacerbate disease. Despite today’s expanded focus on the environment, most physicians and nurses work in settings with only limited time to consider environmental etiologies of illness in their patients and evaluate possible environmental triggers. The need for pediatric environmental medicine referrals has been recognized by the American Academy of Pediatrics and Academic Pediatric Association.
Clinicians can now turn to BCHP’s Environmental Medicine Referral Service for advice regarding environmental health concerns, whether voiced by parents or suggested by clinical presentation. Among the issues to be encountered, identified, and managed are exposures to a variety of pollutants encountered in a variety of sources, including:
- House dust
- House paint
- 饮用水
- Indoor and outdoor air
- “Sick” building syndromes
- Industrial and vehicular emissions
- Processed and prepared foods
- Furnishings and window treatments
- Garden and backyard soil
- Home and locally-grown vegetables
- Climate and weather-related hazards including mold
How to Refer
Referrals can be made through NextGen (for BCHP clinicians) or initiated directly by telephone (see contact below) regarding suspected environmental exposures, confirmed exposures, nonspecific symptoms, and highly specific symptoms. Most initial assessments can begin promptly using telehealth visits augmented by chart review and direct communication with the referral source. Some cases may warrant an in-person evaluation or virtual home visit. In many instances, the referral service can save precious time and money by selecting only the most relevant biomarkers or biometric tests and ensuring the most reliable methods of collection and shipment of any needed lab specimens.
BCHP’s Environmental Medicine Referral Serviceis housed in the Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, led by Allen Dozor, MD, chief, in collaboration with Robert W. Amler, MD, and professional staff of the Children's Environmental Health Center of the Hudson Valley (CEHCHV). CEHCHV is a founding member of the statewide network, New York State Children’s Environmental Health Centers. For more information about our children's environmental health center,visit our website.
Contact:
Jennifer_Luchetta@BCHPhysicians.org, (914) 594-2358
Allen J. Dozor, MDis interim vice president at Boston Children’s Health Physicians and chief of the Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, one of the largest such divisions in the nation. He is Director of the Children’s Environmental Health Center of the Hudson Valley (CEHCHV), Associate Physician-in-Chief of the Maria Fareri Children's Hospital at Westchester Medical Center, and Director of the CF Foundation’s Therapeutic Development Center at the Armond V. Mascia, MD Cystic Fibrosis Center. Dr. Dozor is a Professor of Pediatrics and Clinical Public Health at New York Medical College (NYMC). He recently served on the Children’s Health Protection Advisory Committee (CHPAC) of the U.S. Environmental Protection Agency (EPA).
Robert W. Amler, MDis vice president for government affairs at NYMC, dean of the School of Health Sciences and Practice, and Institute of Public Health, and professor of public health, pediatrics, and environmental health science. Prior to NYMC, he was regional health administrator for the U.S. Department of Health and Human Services, chief medical officer at the Centers for Disease Control (CDC)’s Agency for Toxic Substances and Disease Registry (ATSDR), founder of the national network of Pediatric Environmental Health Specialty Units (PEHSU), senior advisor to the U.S. Surgeon General and EPA administrator, and committee chair for the President’s Task Force on Children’s Environmental Health Risks and Safety Risks.
Boston Children's Health Physicians (BCHP) is a large multi-specialty group with nearly 300 clinicians providing comprehensive care for newborns, children, and adolescents. BCHP offers a full range of care to families in over 60 locations throughout New York's metropolitan area, the Hudson Valley, and Connecticut.