8/14/2019 Pasakorn

1/17

Botulism

A) Isolated or sporadic occurrence - this

type is result from the main assumption

that consumption of local preparation of

food and canned bamboo shoot remained

largely the same.

8/14/2019 Pasakorn

2/17

Botulism

B) Large outbreak - group exposure, could be

small to large cluster or mass exposure (similar

to Nan's events)

350

143 42 respiratory insufficiency40 1

8/14/2019 Pasakorn

3/17

8/14/2019 Pasakorn

4/17

Botulism

D) Poisoning, Intentional poisoning

So far no report in this category - could be

specific/single or mass(in case of bioterrorism)

E) Other,

8/14/2019 Pasakorn

5/17

Events in Nan at the time of crisis Sudden early unknown event and "Progressive unfolding................,

information, scattering pieces information .......

Early information = Large outbreak of food poisoning >>>>>>>observation of neurological complication ............. suspect botulism

# Typical case , female aged around 23-25 year old ......requirerespirator support >>>> experienced doctor ...............made diagnosis.

Wave of ill persons overwhelming the hospital at Ban Luang and Nan

Hosp. It was Friday afternoon There was some information sent to central level .............request help

20 persons with severe illness, need assisted ventilation

Documented Massive, Large botulism outbreak

8/14/2019 Pasakorn

6/17

Engage with TUC

Got the information .............................

(Late Friday afternoon ...............Dr. JT

Decision of the leader(Dr. JT) - lead from

the front

Assess the trigger event, essential support

Initial verification of information / Loop of Contact (KN-SM-JT-Psk + others)

8/14/2019 Pasakorn

7/17

Understanding Needs

Receive request from DDC (verbal)

.......specific request ()

Ask if CDC can provide Anti toxin for

treatment

Decision Process >>>> Teleconference,

(credit to JT)

? Other loop (WHO/CDC ATL) interaction

8/14/2019 Pasakorn

8/17

Decision at Far Side

Emergency Center Information

Decision to support

Activation of Emergency plan Coordination DOD/CDC federal level

Authorization, stockpile, transportation,

personnel Deployment of personnel, anti-toxin

8/14/2019 Pasakorn

9/17

Complex decision process (US side)

Deployment Decision

Decision to deployment of Expert (Dr.Christopher Braden)

Request Airplane transportation and TDY

of CB, coordination of US/CDC to get

stockpile (at LA and San Jose)

Green light

8/14/2019 Pasakorn

10/17

Strategic objective

How to get anti-toxin as quick as possible

and no delay in transportation

(when arrive) if anti-toxin is critical

tools how to use if effectively, maximize

the benefit of antitoxin

How to use the expertise of expert in this

event in compliment to Thai and local

staffs

8/14/2019 Pasakorn

11/17

Logistic & Report to Thai Authority

Logistic and supply chains (from

US>Taiwan>Bkk> Nan

Custom issue and FDA exemption

Transport (competitive seat, PB air,

coordination with supplies from Japan

Through FETP Thailand contact.

Report CB to Minister of Public Health and

Assistant (Patchara Panachet)

8/14/2019 Pasakorn

12/17

Define our role in/amongCrisis management (part of operation)

Role of Dr. CB (discussion with Psk) >>> whatis our role in the outbreak response

as clinical expert, PH subject matter expert and

Decision to use antitoxin and how (makedecision with Thai doctors, collective decision)

Engage in other emergency decision support (ie.Work load, chain of refer, screening, district

hospital visit, Transportation to BKK) Understanding the situation and apply public

health measure

8/14/2019 Pasakorn

13/17

crime or

bioterrorismNAd) Poisoning, Intentional poisoning - so far

no report in this category - could be specific/

single or mass (in case of bioteerorism)

Focal Outbreak

Local event -detect and

remove

exposure

Food borne

disease

c) Accidental exposure - food, consumption

of commercial product or substandardproducts

deploymentPHER - emergency responsePublic Health

Emergency

NAb) Large outbreak - group exposure, couldbe small to large cluster or mass exposure (si

milar to Nan's events)

# early diagnosis ???Focal OutbreakLocal event -

detect and

remove

exposure

Food bornedisease

a) Isolated or sporadic occurrence - thistype is result from the main assumption that c

onsumption of local preparation of food and c

anned bamboo shoot remained largely the sa

me.

Botulism

Post eventDuringPre-eventScenario

Technical IssueEssential Actions, StrategyLikelihood or nature of event

8/14/2019 Pasakorn

14/17

Retrospective - ?

Can we do it better? "How will technology, invention,

knowledge do better if there will beanother outbreak

Preparedness and Response Plan = ?

Planning Approach & Methodology = ?

8/14/2019 Pasakorn

15/17

Panic Acute Unknown Outbreak ICU

Need for Emergency Medical Services

(All emergency care, ICU, ER, WARDS

Lab referral) Med team

3.

8/14/2019 Pasakorn

16/17

4. Hospital Service interrupt

5. Media miscommunication

6. uncoordinated response

8/14/2019 Pasakorn

17/17

7. Villager demand care,screening, check up

8. 9.

10. ?