If the term “catastrophe management” is not an oxymoron, the staff at Furness General Hospital in the north west of England are uniquely experienced in this area. In the summer of 2002 this 400 bed hospital was confronted with the UK’s largest ever outbreak of legionnaire’s disease.¹ The disease was confirmed microbiologically in over 170 people, with 498 suspected cases being admitted to the hospital over a 10 day period. The mortality rate was about 3%. This compares favourably with another large recent outbreak in the Netherlands, where at least 188 people were infected by a contaminated fountain at a flower show (mortality 13%)² and with sporadic cases in the UK (11% in 1998).³ We feel that this was due to prompt recognition and appropriate management rather than low virulence of the organism. The outbreak also provided an early—and very public—test for the nascent Health Protection Agency (HPA).

The trust was able to secure funding for a study reporting the hospital’s response to the incident and exploring the relation between the its major incident plan (drawn up in 1997 according to national guidance⁴) and what took place in practice. The study was reported in the Emergency Medicine Journal in April last year.⁵ The researchers interviewed in detail 15 managerial and clinical staff involved in the outbreak. In this editorial, inspired by that paper, some of the key players in the handling of the outbreak join the paper’s lead author to summarise the management of the outbreak and draw out some pointers for the future.

A case of legionnaire’s disease was identified in Barrow-in-Furness on 30 July. A second case was identified in east Lancashire two days later; this person had recently visited Barrow and an …