Background The increasing Indo-Pacific migration has affected the biodiversity of the Mediterranean Sea, and the prevalence of the puffer fish (Lagocephalus sceleratus), a well-known poisonous migrant, is increasing. The fish, which contains tetrodotoxin, is lethally poisonous when consumed. As its population increases it becomes more available in the markets of southern Turkey, but local people seem to be unaware of the danger. Probably because of the depressed stocks of the surrounding waters and demand on affordable seafood, local anglers are catching the fish. The situation constitutes an alert for the local emergency medicine organisation and is a public health issue.

Methods Local fishermen, fish sellers/dealers/brokers, buyers and emergency department physicians were interviewed about the fishery and consumption facts of the puffer fish in the region, the number of cases reported in the regional state run hospitals and the 112 Emergency Medical Response Service, and the knowledge and practice of the doctors in the emergency departments.

Results and conclusions General health organisations are unprepared for the serious health hazards caused by this fish, including fatalities. Health workers should have sufficient knowledge regarding the clinical manifestations, complications and management of puffer fish poisoning. Official authorities should make the public aware of the potential risk of consuming puffer fish.