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An algorithm for the evaluation and management of red, yellow, and green zone patients during a botulism mass casualty incident

Paul Rega MD, FACEP, Kelly Burkholder-Allen, RN, MSEd, Christopher Bork, PhD, PT, EMT-B, FASAHP


Botulinum toxin is one of the most toxic substances known to humankind. It is one among the six Category A agents in the CDC bioterrorism lexicon. This suggests that, while the possibility of a botulism mass casualty incident (MCI) is remote, its unique acute and long-term ramifications must be addressed and planned for. However, an in-depth knowledge of the disease and its tactical management in the acute MCI phase is inconsistent or superficial among healthcare personnel. Therefore, an algorithm has been developed to assist first receivers with the initial management of multiple probable and potential botulism patients when equipment resources are strained and when expert personnel are not readily available. The algorithm is specifically structured to assist with the identification and management of potential respiratory deterioration of suspected botulism patients.


botulism, botulism algorithm, botulism-induced MCI, mass casualty incident, botulism management

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