Medical Referral of Patients with Acute Respiratory Failure: Lessons learned from a Large Outbreak of Botulism in Northern Thailand
Sompop Pantukosit MD, FICS*
Affiliation : * Department of Medical Services, Ministry of Public Health
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 hospi-
talized. 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.
Materials and Methods : 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. How-
ever, 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
