On April 21, 2015, the Central Ohio Trauma System (COTS) Healthcare Incident Liaison (HIL) received a page from Fairfield Medical Center regarding an incident involving patients with possible exposure to Botulism from a local church potluck in Lancaster, Ohio (Fairfield County). The patients reporting to Fairfield Medical Center presented with signs of blurred vision, dropping eyelids and slurred speech. As of 12:45 p.m. on April 21, 2015 three patients were clinically confirmed with Botulism and seven were in the Fairfield Medical Center’s emergency department awaiting triage. The three patients admitted to Fairfield were in the Intensive Care Unit and required mechanical ventilation. Fairfield reported they had been in contact with the Ohio Department of Health and the Center for Disease Control and Prevention (CDC) for release of the Antitoxin from the Strategic National Stockpile (SNS). Fairfield requested that the COTS HIL notify Central Ohio Region Hospitals regarding the incident and assess the number of critical care beds available, as some of the patients would need to be transferred to Franklin County Hospitals for treatment. Franklin County Hospitals were already reporting a shortage critical care beds earlier in the week; therefore this posed a concern for the region.
By 1:15 p.m. the COTS HIL activated their Emergency Operations Center and notified the central region hospitals via a Telephone Emergency Notification System alert regarding the incident, and requested an update of the available critical care beds. The COTS HIL provided information sharing through the Central Ohio Healthcare Disaster Information Management website, gathered critical care bed numbers on SurgeNet, verified contact information and put the regional cache of portable ventilators on stand-by. Additionally, the COTS HIL contacted the Regional Healthcare Coordinators in the state via the Ohio Public Health Communication System to provide situational awareness and to put them on stand-by should additional cases present and the central Ohio region needed assistance. The RHCs reached out to their hospitals in the region to request them to update their critical care bed availability, should central Ohio hospitals become overwhelmed. Reports indicated that approximately 50-60 people were present at the church potluck and could possibly have been exposed. This number of patients could cause a major strain on the healthcare system in central Ohio.
As the incident continued to escalate over the next couple of days, additional patients reported to FMC for triage and possible treatment. FMC utilized the statewide patient tracking website OHTrac to record the patients and manage their location. Public Information Officers were established to provide uniform messages to the media. Throughout the extent of the incident the COTS HIL hosted conference calls to promote information sharing and ensure there were no resource needs in the region. Many of the conference calls and communications included the Central Ohio Healthcare Coalition (COHC), ODH, CDC and the COTS HIL. By the completion of the ten day incubation period of Botulism a total of 59 patients had been assessed or treated for Botulism.
Botulism is a serious bacterium toxin that attacks the nervous system, causing muscle paralysis. Symptoms of Botulism typically appear within 18-26 hours, but can occur as many as 10 days later (National Center for Emerging and Zoonotic Infectious Diseases , 2014). Some patients who are diagnosed with Botulism require mechanical ventilation for breathing and many months of recovery and therapy. There are different forms of Botulism and this incident appeared to be foodborne.
An incident of this magnitude provided a wealth of information and opportunities to improved preparedness processes in the region. This event proved how important regional planning is and how an event outside of Franklin County, at one of our rural hospitals, can greatly impact the larger hospitals in Franklin County. In all, 24 patients were admitted to hospitals in Franklin County and Fairfield Medical Center with twenty four doses of antitoxin given.
For more information about the Central Ohio Trauma System, click here.