Background: There was an outbreak of botulism in a district in Nan Province in upper northern Thailand. The outbreak occurred after the villagers took bamboo shoots preserved in a sealed bucket under anaerobic conditions (home-canned bamboo shoots). There were 209 people at risk, of whom 119 (56.9%) were hospitalized. Among the 119 cases, 42 (35.3%) needed ventilators. Of the 42 cases, 25 (59.5%) were transferred to another hospital.
Objective: Describe and review transferal processes of the 25 cases and document lessons learned for medical services response from a public health aspect.
Material and Method: Review of records and reports.
Results: All 25 cases were successfully transferred with no mishaps. The duration of transferal was less than 3 hours.
Conclusion: Preparedness of local capacity to cope with botulism outbreak of this scale is important. However, it is also necessary to develop a good system for medical referral of severe cases, to be started early in the course of medical care.

Keywords: Lessons learned, Botulism outbreak, Referral