Puffer Fish Poison Prevention Project

State: FL Type: Model Practice Year: 2006

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In March of 2002, 5 cases of saxitoxin, a poison associated with paralytic shellfish poisoning, were reported to a division of the National Poison Control Center. The common link between these cases was the consumption of Puffer Fish from the Indian River Lagoon in Brevard County, Florida. Unlike the poison tetrodotoxin, commonly associated with several species of Puffer Fish, saxitoxin was found throughout the organs and flesh of the fish. It could not be cleaned from the meat or detoxified by cooking, boiling or freezing. This case was unprecedented.

Although a temporary ban on puffer fish harvesting was issued, more cases of accidental saxitoxin poisoning continued to be reported. One of the core values of public health is the prevention of disease transmission. The response to an unprecedented exposure risk from the southern Puffer Fish was critical to the health and safety of the general public, and specifically, persons with the mistaken notion that puffer fish could be a delicacy if properly cleaned. Through the spring of 2002, twelve more cases were identified. An interagency partnership along with local agencies was formed, a target audience was identified, an implementation plan was developed to address the goal of reducing the incidence of saxitoxin poisoning from the Southern Puffer fish to zero. Objectives included: meeting current need to change behaviors and reduce incidence to zero; inform and re-educate the public at large; and sustain the program to serve as a continuous form of information and warning on this topic. The principle target audience was anyone fishing at the northern portion of the Indian River Lagoon. Because the saxitoxin was found south of this area, the general fishing population throughout the Indian River Lagoon, encompassing Brevard, as well as other counties, to the south.

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Brevard County Health Department
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Puffer Fish Poison Prevention Project
In March of 2002, 5 cases of saxitoxin, a poison associated with paralytic shellfish poisoning, were reported to a division of the National Poison Control Center. The common link between these cases was the consumption of Puffer Fish from the Indian River Lagoon in Brevard County, Florida. Unlike the poison tetrodotoxin, commonly associated with several species of Puffer Fish, saxitoxin was found throughout the organs and flesh of the fish. It could not be cleaned from the meat or detoxified by cooking, boiling or freezing. This case was unprecedented. Although a temporary ban on puffer fish harvesting was issued, more cases of accidental saxitoxin poisoning continued to be reported. One of the core values of public health is the prevention of disease transmission. The response to an unprecedented exposure risk from the southern Puffer Fish was critical to the health and safety of the general public, and specifically, persons with the mistaken notion that puffer fish could be a delicacy if properly cleaned. Through the spring of 2002, twelve more cases were identified. An interagency partnership along with local agencies was formed, a target audience was identified, an implementation plan was developed to address the goal of reducing the incidence of saxitoxin poisoning from the Southern Puffer fish to zero. Objectives included: meeting current need to change behaviors and reduce incidence to zero; inform and re-educate the public at large; and sustain the program to serve as a continuous form of information and warning on this topic. The principle target audience was anyone fishing at the northern portion of the Indian River Lagoon. Because the saxitoxin was found south of this area, the general fishing population throughout the Indian River Lagoon, encompassing Brevard, as well as other counties, to the south.
In March of 2002, five cases of saxitoxin, a poison associated with paralytic shellfish, poisoning were reported to a division of the National Poison Control Center. The common link between these cases was the consumption of puffer fish from the Indian River Lagoon in Brevard County, Florida. Through the spring of 2002, twelve more cases were identified. Unlike the poison tetrodotoxin, more commonly associated with puffer fish, saxitoxin was found throughout the organs and flesh of the fish. It could not be cleaned from the meat or detoxified by cooking, boiling or freezing. This case was unprecedented.Although a public health alert was issued, continued reports of puffer fish poisoning revealed that the targeted population was not receiving the message, or simply not adhering to the warning. Although it is not new to use the media to communicate an essential public health message to the public, the innovation is the partnership between the health department and public broadcasting to provide a sustained message of vital importance to the viewers over months and years. For a significant public health message to become rooted in the community, that message must be delivered repeatedly and over an extended timeframe. Public health studies in the areas of physical activity and tobacco also show that repetitive, film-based media has a better chance of changing behavior than other methods. The video is shown on SCGTV which is carried on the local cable provider to approximately 180,000 homes in Brevard. In a study done in 2000, the estimated viewer-ship was approximately 6% of cable subscribers or 10,800. Because SCGTV primarily carries city and county government meetings, its viewer-ship is primarily older adult. It is this group that the Puffer Fish prevention message is targeted.
Agency Community RolesInitially, the health department responded in a traditional manner to reports of toxin poisoning and worked in collaboration with other governmental partners to respond to the primary threat. The Florida Department of Health (FDOH), Florida Fish and Wildlife Conservation Commission (FFWCC) and the Brevard County Health Department (BCHD) each had a direct and pre-determined role and worked closely to initiate the primary response. When it was determined that the primary response was not completely successful at stopping cases of puffer fish poisoning, a revised effort was initiated.  Costs and ExpendituresFunding was absorbed by partnering agencies, thus, costs were primarily in-kind expenditures of personnel and supplies. Specifically, five team members spent a total of approximately 40 hours to develop and produce the program. Supply costs included cost of printing flyer and reproducing the DVDs. Prior to the puffer fish poisoning, a relationship with the SCGTV had already been established and several projects have already been completed, such as: Food for Thought which provides information to the public about food safety, and, a video highlighting the essentials of public health during Public Health Week. Previous projects demonstrated the commitment of SCGTV as a community partner that is ready and willing to contribute their unique services and effectively assist in the mission of public health. FFWCC, FDOH and BCHD collaborated on curriculum development, concepts and script development. SCGTV was then consulted to provide expertise and serve as a technical resource for filming, editing, and eventually, airing of the video. SCGTV continues to air time the puffer fish video one to two times per week.  ImplementationThe project team decided to try another new approach to ensure accurate and continuous education to correct old thinking and achieve the goal of totally eliminating cases of saxitoxin poisoning. Through the development of an informative and entertaining film, as well as, partnering with the local government access channel, a complete reoccurring message and total re-education of the entire community could be achieved. As demonstrated within studies that assess the effectiveness of community-based media, it was recognized that this approach would reach a wider range of people and a larger segment of the target population on a repetitive basis. An assessment of learner needs was performed to address level of comprehension and diversity issues. Curriculum development, modalities, and formats for media coverage were discussed and devised. Scripts and posters were developed to meet comprehension levels. The production was scheduled through the Brevard County Space Coast Government Television (SCGTV). Production and editing took place within several weeks and the video was completed and ready for air on SCGTV on a rotating basis between televised county government, municipality and special governmental meetings. Over a period of two to three months, the video was researched, planned, filmed, edited, and produced. SCGTV aired the program and copies of the program were distributed to other counties for their use as well. A news show format was selected, and featured, two remotes with experts from the FDOH and FFWCC in the field. The first broadcast was in October of 2004. The video continues to be shown on SCGTV at a frequency of about two times a week. The partnership with SCGTV proved to be a key factor in disseminating the information over a protracted interval and sustains the message to the current and future public.
The addition of the local broadcasting channel, SCGTV, as a partner to provide media expertise and distribute the public health message was pivotal to the final success of the project. Each partner brought resources and talents to the program. Over the last two years, the Puffer Fish Prevention Project has delivered exceptional results. Outcomes that truly demonstrate the success of this program are as follows: Saxitoxin poisonings have stopped after implementation. Not a single outbreak of saxitoxin poisoning related to the Southern Puffer Fish has occurred in Brevard or surrounding counties. The video is shown on SCGTV which is carried on the local cable provider to approximately 180,000 homes in Brevard. In a study done in 2000, the estimated viewer-ship was approximately 6% of cable subscribers or 10,800. Because SCGTV primarily carries city and county government meetings, its viewer-ship is primarily older adult. It is this group that the Puffer Fish prevention message is targeted. The Puffer Fish Prevention video continues to be shown 1-2 times per week over SCGTV. Widespread distribution of the prevention message through viewer communication (word-of-mouth) to family, friends and acquaintances. Immeasurable effect on lessening the impact of hospitalization on victim’s family, workplace and the community. Video program adopted by all counties bordering the Indian River. Video was included as part of a video produced by a multi-agency partnership named the Harmful Algae Bloom Task Force. Nominated for a Davis Productivity Award 2006 in recognition of a savings to community of $208,000. Partnership with SCGTV for video production saved approximately $5,000 to 7,000 in commercial production costs.
This project enjoys a high degree of sustainability due to minimal financial requirement and no recurring costs, a partnership that meets mutual goals, and positive outcomes that benefit the entire community. Puffer Fish Poison Prevention is a model example of a partnership with media to provide a rapid and continuous response to a public health problem that substantially increases knowledge and awareness levels and induces a positive behavior change among a targeted population. All costs were incurred during the planning and development stages, but once implemented, the program can continue without further financial investment, but continues to achieve the desired outcomes year after year. Prior to partnering on the issue of puffer fish poisoning, the relationship with local public broadcaster had already been established through several successful projects. SCGTV had demonstrated their commitment as a community partner that was ready and willing to contribute their unique services and effectively disseminate information to assist in the mission of public health. Outcomes were improved by the frequency and air time allotted. SCGTV provided frequent broadcasts at the time of implementation and continues to air time the video one to two times per week. As is often the case in successful partnerships, this partnership is mutually beneficial as it meets an important goal of the channel’s programming by providing essential information and specifically, “. . . to help residents (of Brevard County) gain a better knowledge about government actions and services through media, internet and television programming.” There is a firm commitment from SCGTV to continue this and other projects for as long as needed for the maximum benefit to the community.
 
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