Botulism Treatment The only known antidote is trivalent botulinum antitoxin, made from horse serum. Each case requires three injections: upon learning of exposure and then at two and twelve weeks after the first injection. There is a 9 percent allergic reaction rate, but doctors can manage that with antihistamines. Additionally, the availability of this lifesaving substance is limited to state health departments and the Centers for Disease Control and Prevention. The only manufacturer in North America that I could find on the Internet is Aventis Pasteur Limited, in Ontario, Canada. Furthermore, even a small-scale aerosol attack infecting three or four thousand people would cause an acute public health dilemma because virtually every victim, to stay alive, would require an intensive care bed and a respirator for eight to twelve weeks, even after receiving an injection of antitoxin. In New York City, there are approximately six thousand intensive care beds that are usually about 85 percent occupied at all times. That would leave only nine hundred beds (give or take a few dozen) available for an onslaught of several thousand patients with paralytic respiratory failure.   Consequently, your hospital's new disaster plan must have a contingency for alternative makeshift intensive care sites. The health-care providers can utilize any empty warehouse, convention hall, National Guard armory, or other such building with large open space. The plan should also identify inventories of the following items: hospital beds hospital linens mechanical ventilators crash carts with emergency drugs, syringes, and needles defibrillators cardiac monitors blood pressure monitors oxygen blood saturation monitors electrical generators suction machines suction catheters bladder catheters and drainage systems portable x-ray machines portable laboratory equipment ambulance transport with life-support capabilities Finally, the hospital's new disaster plan should contain procedures for collecting specimens for laboratory diagnosis. In case of attack, the Federal Bureau of-Investigation (FBI) is supposed to coordinate the collection and transport of b1ohazard materials to designated laboratories for diagnostic confirmation. During such an event, public health workers would test only random samplings of victims within various groups. It would not be feasible to test everyone.