That the provision of an education program on management of self poisoning with supply of essential antidote stock will improve management of self poisoning when compared with the provision of guidelines alone. Specifically in patients presenting with poisoning to primary hospitals there will be: 1. Reduction of forced emesis 2. Reduction of gastric lavage 3. An increased use of activated charcoal 4. An increased use of pralidoxime in organophosphate poisoning 5. An increased use of oral methionine or n-acetylcysteine for paracetamol poisoning which will result in reduced inter-hospital transfers 6. A decrease in mortality

We will do a three arm clustered randomised trial of educational interventions in 106 primary rural hospitals in three non-contiguous provinces in Sri Lanka (North Western Province, North Central and Southern Province) The primary hospitals will be randomised (in a 1:1:1 ratio) to receive one of the following interventions: Control: Supply of new copies of National Poison Treatment Guidelines Book (Management of Poisoning, Prof Ravindra Fernando, published by the National Poisons Information Centre) only. Primary Intervention 1- Direct Primary Hospital Practice Intervention: A half-day interactive teaching session using a lecture/workshop format delivered by an expert (consultant physician) in the primary hospital to medical and other hospital staff. The distribution of posters describing treatment algorithms derived from National Poison Treatment Guidelines Book plus distribution of promotional items with reminder messages (folders for patient’s inpatient notes, whiteboards for the wards and pens; all with prompts to look-up the National Poison Guidelines). This would be followed up one year later with a refresher session in a similar format. Primary Intervention 2 - Centralised Further Education & Training Intervention: The delivery of a full day educational intervention to available primary care doctors and nursing staff from a number of health institutions in a central location. This will include a component of ‘training the trainer’ to provide them with teaching materials so they could run a small session to train other staff at their institution. To assist them with becoming local ‘clinical champions’ of change, additional distance learning material will be supplied to these participants. The distance learning material will consist of a short course comprising case vignettes and case-based reading material. This will come from the distance learning course in Clinical Toxicology from the Post-Graduate Medical Institute of Sri Lanka & Colombo University. Completion of the material will be recognised as part of continuing medical education where appropriate. The promotional items described in Primary Intervention 1 will also be distributed to these hospitals.

All primary rural hospitals with inpatient treatment facilitie

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