Mass Casualty of Scombroid Fish Poisoning among Factory Workers in Obour City

On the first of January 2013 one hundred and seventy five workers in one of El Obour factories were complaining of nausea, vomiting, abdominal cramps and diarrhea after eating a mackerel fish lunch meal served to them at their work at 1 P.M. They were rushed first to emergency department “ED” of El Salam general hospital where they were diagnosed as food poisoning and advised to be transported to the poison control center “PCC” of Ain Shams University “ASU.” The faculty dean and PCC director alerted the preventive control unit in ministry of health about suspected scombroid food poisoning. An emergencymanagement plan for mass casualty was established. The patients were triaged under  supervision  of two clinical toxicologist teams and grouped  according to triage colored  tags into yellow  tag cases (Group I)  ;they included  65 cases with  mild clinical manifestations. Green tag cases (Group II); they included 100 cases with moderate manifestations and red tag cases (Group III); they included10cases presented withsevere clinical manifestations. Demographic data showed that 60% were males and 40% were females .There was non-significant statistical difference regarding delay time between the three studied groups. The clinical assessment results revealed highly significant statistical difference between the studied groups regarding gastrointestinal manifestations (in the form of diarrhea, abdominal colic, and tingling and burning peppery taste sensation), and cardiopulmonary manifestations (in the form of hypotension, tachycardia, bronchospasm, positive Trendelenberg´s position). Neurological manifestations in the form of headache were highly significant in the studied groups and significant syncope only in group III. The skin manifestations among the studied groups showed highly statistical significant facial flushing, sweating and itching. Microbiological examination of biological samples (stool and gastric aspirate) and fish samples (fried and raw mackerel fish) revealed positive Bacillus cereus and Staphylococcus aureus. Chemical examination of fish samples revealed highly significant increase in histamine levels in fried and raw mackerel fish samples when compared with their permissible levels according to food and drug administration values. There was highly significant statistically difference between the studied groups of patients with acute scombroid fish poisoning as regards the percentage of different lines of treatment received at emergency room and inpatient wards of both PCC and ED ASU hospitals. The outcome showed complete cure with fully discharged   cases with no morbidities or mortalities. In conclusion mass casualty of scombroid fish poisoning incident could pass safely if the emergency management plan was successfully established.  The study recommends the necessity of increasing the number of available beds in PCC to enlarge its capabilities of facing mass casualty incidents. Also the study recommends the necessity of   strict preservation of fish especially those belonging to scombroidea family (mackerel and tuna) in cool temperature to avoid bacterial contamination and the increase in histamine level.