Out-of-hospital and emergency department management of epidemic scombroid poisoning

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-l ine medical control. Methods: Retrospective case series of two multiple-cas ualty incidents (MCIs) involving scombroid food poisoning. Results: A total 57 patients were treated from two separate incidents, with 30 patients tra nsported to area hospitals. One patient required treatment with a cardiac m edication in the field and another patient eventually required hospital adm ission. On-scene medical control (incident 1) and early identification of t he index case (incident 2) were instrumental to out-of-hospital care interv entions 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 foodborne 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 fac ility. 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 facilita tes early diagnosis and treatment.