Tag Archives: safety

Botulism: A Measurement of Occurrence

 Botulism, caused by the Clostridium botulinum bacterium, is typically caused by poorly prepared, home-canned foods and can cause symptoms as simple as blurred or double vision to full body paralysis, sometimes causing death (Centers for Disease Control and Prevention [CDC], 1996). The incidence of botulism is said to be extremely low with only 126 reported cases in the United States in 2003; with only eight attributable to foodborne vectors, the predominant cause is accidental contamination (CDC, 2004).

One of the concerns regarding botulism is its toxicity. Botulinum toxin is the most potent toxin known to man (CDC, 2006). This potency lends to botulinum’s ability to be used as an agent of bioterrorism, though most of the known cases have been shown to be accidental in nature (CDC, 1996; CDC, 2006). Another concern is the accidental or negligent contamination of any food prepared for wide distribution, such as canned vegetables from a large manufacturer.

Surveillance is important to identify each and every case in order to have the most accuracy possible when considering increasing or decreasing trends of incidence and prevalence of the disease. The cause of any increase or decrease in incidence of botulism should always be investigated.

Any increase of incidence could identify a possible problem while a decreased incidence could foretell efficacy in the efforts of mitigation. More appropriately, though, as Friis and Sellers (2009) show, further identification should be made in order to focus on specific descriptive factors, such as affected populations, the geography of these populations, known vectors, and factors of time. This process will ensure that more accurate trends are observed.

For instance, the CDC (2004) has stated that in a typical year, such as 2004, the incidence of botulism is less than 200. With incidence reporting covering the entire United States, increases or decreases in this crude number serve only to identify general changes in frequency; whereas, further identification of certain characteristics of the disease pattern will help to further isolate affected individuals and etiologies (Friis et al., 2009). Within the CDC’s (2004) data, infant occurrence of botulism is identified as the major contributor to incidence, thereby isolating the remaining occurrences to adults. The CDC has gone further to separate the incidences of botulism into three groups, infant occurrence, foodborne infection, and wound infection. A separate group is reserved for other occurrences relating to the use of pharmacological botulin.

Using descriptive factoring of the 2003 CDC data (2004), further geographic isolation of occurrences show that infant occurring botulism is fairly wide-spread with a small number of incidences in each of twenty-two States, though California and Pennsylvania account for about half of the reported infant occurrences. Foodborne and wound occurrences of botulism were isolated to Alaska, California, Colorado, Oregon, Utah, and Washington. Texas had the only two reportable cases classified as “Other”. Theoretical assumptions can now be used to show that the problem in Texas is resolved but should continue to be monitored, and food safety education projects should focus on home-canning in the western regions of the United States.

In conclusion, epidemiology is an important means of understanding and identifying causation and etiology, as well as preparing for mitigation and outbreak response. In this example of botulism, I have identified localization of the disease, common pathways of infection, or vectors, and means of helping to mitigate future occurrences of the disease. Botulism numbers are quite low, but dealing with other diseases of larger scale, grouping the data into useful subsets will assist in following the progression of the disease from outbreak to outbreak and in consideration of mitigation techniques employed.


Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (1996). Botulism (Clostridium botulinum): 1996 case definition [CSTE Position Statement No. 09-ID-29]. Retrieved from http://www.cdc.gov/ncphi/disss/nndss/casedef/botulism_current.htm

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (2004). Surveillance for Outbreaks of Botulism [Summary of 2003 Data]. Retrieved from the Centers for Disease Control and Prevention website: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/Botulism_CSTE_2003.pdf

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (2006). History of Bioterrorism: Botulism. CDC Emergency Preparedness and You [Podcast]. Washington, DC: CDC Bioterrorism Preparedness and Response Program.

Friis, R. H., & Sellers, T. A. (2009). Epidemiology for public health practice (4th ed.). Sudbury, MA: Jones & Bartlett.

Relationships Among Health Services Organizations

 As a critical care paramedic, I am fortunate enough to experience our health care system as an active participant, caring for the sick and injured, and as a passive observer, following the pathways of the patients whom I have treated. The health care system in the United States is, admittedly, fractured (Kovner & Knickman, 2008), but there are components that serve to create harmony and efficiency within this system, and I will describe just a few of them.

The primary care physician is meant to be the coordinator of all care for his or her patients. The importance of this role cannot be overstated, as it is the keystone to “health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses” (American Academy of Family Physicians, 2010, para. 7). When appropriately utilized, the primary care physician can coordinate a patient’s care to ensure efficiency and efficacy of treatment while ensuring safe and comprehensive care (Kovner et al., 2008).

There is a growing number of specialties and sub-specialties within the practice of medicine today (Bureau of Labor Statistics, 2010b). Specialists focus on their chosen area of practice and are an asset to the general practitioner, or primary care physician, who can concentrate on the coordination of the patient’s care. The inclusion of specialists in medicine is an efficient and effective means of offering the patient a level of expertise not otherwise available. One of these specialties is emergency medicine.

Emergency departments are necessary entry points into the health care system for victims of acute trauma and illness, but often times, the emergency department is used as the primary portal for those who lack insurance or other means of accessing health care appropriately (Committee on the Future of Emergency Care, 2006; Kovner et al., 2008). These patients tend to utilize the emergency room for even minor ailments, distressing this important component of the system, causing a “nationwide epidemic of [emergency department] overcrowding, boarding, and ambulance diversion” (Committee on the Future of Emergency Care, 2006, p. 19).

Laboratories and radiology departments are great assets to providers, allowing technicians to perform tests at the behest of the physicians and only requiring the physician to interpret the results of the tests. This seems to be a cost-effective and efficient component of the system, so long as the tests are performed timely and accurately.

Pharmacists have been regarded as patient-focused consultants who can provide both patient-specific and general information regarding over-the-counter medications as well as prescription medications. In our health care system, pharmacists have a valuable role of safeguarding patients from over-medication, as well as under-medication, medication compatibility, and also educating patients to the possible side-effects of their prescribed medicines (Bureau of Labor Statistics, 2010a).

In conclusion, the safest and most efficient use of our health care system begins at primary care. Though, in emergency situations, there is certainly a need to seek immediate care by other means, patients can suffer financial challenges as well as safety issues by trying to remove the primary care physician from the health care paradigm. Not only is this unsafe for the patient seeking primary care elsewhere, but misuse of emergency departments cause unnecessary delays for truly emergent patients. The health care system in the United States is vast and can be confusing. The primary care physician can provide a safe and efficient pathway of care that will save a patient time, money, and, possibly, his or her life.


American Academy of Family Physicians. (2010). AAFP policy on primary care. Retrieved May 1, 2010, from http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html

Bureau of Labor Statistics, U. S. Department of Labor. (2010a). Pharmacists. Occupational outlook handbook (2010-11 ed.). Retrieved from http://www.bls.gov/oco/ocos079.htm

Bureau of Labor Statistics, U. S. Department of Labor. (2010b). Physicians and surgeons. Occupational outlook handbook (2010-11 ed.). Retrieved from http://www.bls.gov/oco/ ocos074.htm

Committee on the Future of Emergency Care in the United States Health System. (2006). Hospital-based emergency care : At the breaking point. Washington, DC: National Academies Press.

Kovner, A. R., & Knickman, J. R. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Improving Traffic Safety for Emergency Responders

The Emergency Medical Services (EMS) is an occupational field wrought with opportunities for workers to become ill, injured, or succumb to death while performing the functions of their job (Maguire, Hunting, Smith, & Levick, 2002). In the mid-1980’s, Iglewicz, Rosenman, Iglewicz, O’Leary, and Hockmeier (1984) were among the first to perform research into the occupational health of EMS workers by uncovering unhealthy carbon monoxide levels in the work area. This appears to have been the impetus for further research into uncovering some of the causes and contributing factors of illness and injury incidents, as well as safer alternatives to current work practices.

One of the more recent efforts to protect EMS workers relates to traffic-related injuries and fatalities of EMS workers while responding to calls and working on the scenes of traffic accidents. As important it is for the EMS workers to be able to get to the scene of an emergency and work without threat of injury, the safety of the community is important to consider. Solomon (1990) realized the need to improve safety in this area and recommended changing the paint color of emergency apparatus to more visible lime-green. Emergency workers were continuing to fall victim to “secondary incidents” at roadway scenes (Cumberland Valley Volunteer Firemen’s Association, 1999). An analysis of EMS worker fatalities between 1992 and 1997 reveals an occupational fatality rate that continues to exceed that of the general population (Maguire, Hunting, Smith, & Levick, 2002).

Across the pond, in the United Kingdom, efforts were also underway to improve the visibility of police vehicles by considering various paint design schemes, including the Battenburg design: alternating blocks of contrasting colour (Harrison, 2004). Harrison concluded that the half-Battenburg design showed promise as it increased visibility and recognition of police cars in the United Kingdom, and the United States National Institute of Justice was considering research on the efficacy of the Battenburg design here in the United States to promote officer safety. EMS administrations are known for paying special attention to the bandwagon, that is they frequently make changes based on inconclusive and sporadic evidence. This is the case with recent ambulance designs.

Many ambulances in the New England, as well as other parts of the country, are being designed with the half-Battenburg markings applied to the sides of the vehicles in attempts to improve the safety of EMS workers. Unfortunately, we may find that these markings might have an unintended effect of confusing other drivers and causing more problems. A recent study found that Harrison (2004) was correct in that the Battenburg design assisted British drivers in quickly identifying British police vehicles, but the “effectiveness of the ‘Battenburg’ pattern in the UK appears primarily related to its association with police vehicles in that country” (Federal Emergency Management Agency, Department of Homeland Security, 2009, p. 6) having little effect on the recognition potential of American drivers.

Perhaps with the evolving data, we can begin using an evidence-based approach at helping the EMS worker perform his or her job safely at traffic scenes.


Cumberland Valley Volunteer Firemen’s Association. (1999). Protecting Emergency Responders on the Highways: A White Paper. Emmitsburg, MD: United States Fire Administration.

Federal Emergency Management Agency, Department of Homeland Security. (2009). Emergency vehicle visibility and conspicuity study [Catalog No. FEMA FA-323]. Emmittsburg, MD: United States Fire Administration.

Harrison, P. (2004). High-conspicuity livery for police vehicles [Publication No. 14/04]. Hertfordshire, U.K.: Home Office, Police Scientific Development Branch. Retrieved from http://scienceandresearch.homeoffice.gov.uk/hosdb/publications/road-policing-publications/14-04-High-Conspicuity-Li12835.pdf

Iglewicz, R., Rosenman, K.D., Iglewicz, B., O’Leary, K., & Hockmeier, R. (1984). Elevated levels of carbon monoxide in the patient compartment of ambulances. American Journal of Public Health, 74(5).

Maguire, B.J., Hunting, K.L., Smith, G.S., and Levick, N.R. (2002). Occupational fatalities in emergency medical services: A hidden crisis. Annals of Emergency Medicine, 40(6), 625-632. doi: 10.1067/mem.2002.128681

Solomon, S.S. (1990). Lime-yellow color as related to reduction of serious fire apparatus accidents: The case for visibility in emergency vehicle accident avoidance. Journal of the American Optometric Association, 61, 827-831.