title: Out-of-hospital and emergency department management of epidemic scombroid poisoning.
abstract: OBJECTIVE
  To report two epidemic outbreaks of scombroid food poisoning and their emergency medical services (EMS) response and emergency department (ED) treatment, analyzing the impact of early physician involvement and on-line medical control.
  
  
  METHODS
  Retrospective case series of two multiple-casualty incidents (MCIs) involving scombroid food poisoning.
  
  
  RESULTS
  A total 57 patients were treated from two separate incidents, with 30 patients transported to area hospitals. One patient required treatment with a cardiac medication in the field and another patient eventually required hospital admission. On-scene medical control (incident 1) and early identification of the index case (incident 2) were instrumental to out-of-hospital care interventions and conservation of resources. Patient triage, field treatment, and hospital transport were expedited, with some patients treated and released from the scene.
  
  
  CONCLUSIONS
  Immediate diagnosis of a food-borne illness in the out-of-hospital setting allows rapid treatment at the scene and allows for the efficient transport of multiple patients to a single receiving facility. EMS medical directors should be able to immediately respond to such incidents to make presumptive diagnoses and accurately direct patient care. When this is not possible, early identification of the index case facilitates early diagnosis and treatment.
authors.affiliation: Los Angeles City Fire Department, Department of Emergency Medicine, University of Southern California School of Medicine, USA. eckstein@hsc.usc.edu
authors.forename: M
authors.initials: M
authors.lastname: Eckstein
authors.forename: M
authors.initials: M
authors.lastname: Serna
authors.forename: P
authors.initials: P
authors.lastname: DelaCruz
authors.forename: W K
authors.initials: WK
authors.lastname: Mallon
mesh_terms: D000328:Adult; D000818:Animals; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005396:Fish Products / Q000506:poisoning*; D005500:Follow-Up Studies; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014218:Triage; D014413:Tuna