title: Medical referral of patients with acute respiratory failure: lessons learned from a large outbreak of botulism in northern Thailand.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Services, Ministry of Public Health, Nonthaburi 11000, Thailand.
authors.forename: Sompop
authors.initials: S
authors.lastname: Pantukosit
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001904:Botulinum Antitoxin; D001906:Botulism / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D003014:Clostridium botulinum; D004189:Disaster Planning; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010360:Patient Transfer; D011635:Public Health Administration; D012017:Referral and Consultation; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D013785:Thailand / Q000453:epidemiology
chemical_list: D001904:Botulinum Antitoxin