A pruno party gone awry

Botulism as a mass casualty incident has unique features from both patient management and logistical perspectives. The discussion that is presented here may even have application in other mass casualty events. This chapter discusses botulism poisoning at a state prison resulting from the ingestion of home-brewed alcohol. Ten inmates are affected. Botulism is not a disease entity that is well known by many in the healthcare profession, so just-in-time training for the ED staff is appropriate. Botulism can cause death acutely from two complications: (1) aspiration due to a dysfunctional swallowing mechanism and (2) respiratory failure due to paresis and paralysis of the intercostal muscles and diaphragm. The author explains what to do when the poisoned patients arrive at the ED and how triage should function in these circumstances, how to assess the criticality of each patient quickly, how to manage each patient's care acutely, and how to work with infection control, local public health, state public health and CDC regarding the expeditious release of botulism antitoxin.