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Enhancing crisis standards of care using innovative point-of-care testing

Gerald J. Kost, MD, PhD, MS, FACB, Ann Sakaguchi, MPH, PhD, Corbin Curtis, Nam K. Tran, PhD, MS, Pratheep Katip, BS, MT, Richard F. Louie, PhD

Abstract


Objective: To identify strategies with tactics that enable point-of-care (POC) testing (medical testing at or near the site of care) to effectively improve outcomes in emergencies, disasters, and public health crises, especially where community infrastructure is compromised.
Design: Logic model-critical path-feedback identified needs for improving practices. Reverse stress analysis showed POC should be integrated, responders should be properly trained, and devices should be staged in small-world networks (SWNs). First responder POC resources were summarized, test clusters were strategized, assay environmental vulnerabilities were assessed, and tactics useful for SWNs, alternate care facilities, shelters, point-of-distribution centers, and community hospitals were designed.
Participants and environment: Emergencydisaster needs assessment survey respondents and Center experience.
Outcomes: Important tactics are as follows: a) develop training/education courses and “just-in-time” on-line web resources to ensure the competency of POC coordinators and high-quality testing performance; b) protect equipment from environmental extremes by sealing reagents, by controlling temperature and humidity to which they are exposed, and by establishing nearpatient testing in defined environments that operate within current Food and Drug Administration licensing claims (illustrated with human immunodeficiency virus-1/2 tests); c) position testing in defined sites within SWNs and other environments; d) harden POC devices and reagents to withstand wider ranges of environmental extremes in field applications; e) promote new POC technologies for pathogen detection and other assays, per needs assessment results; and f) select tests according to mission objectives and value propositions.
Conclusions: Careful implementation of POC testing will facilitate evidence-based triage, diagnosis, treatment, and monitoring of victims and patients, while advancing standards of care in emergencies and disasters, as well as public health crises.


Keywords


alternate care facility, bedside testing, critical path, emergency medical system, environmental stress, near-patient testing, needs assessment, point of distribution, reverse stress analysis, therapeutic turnaround time, triage, small-world network, shel

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References


Kost GJ (ed.): Principles and Practice of Point-of-Care Testing. Philadelphia, PA: Lippincott Williams and Wilkins, 2002.

Price CP, St John A, Kricka LL (eds.): Point-of-Care Testing: Needs, Opportunity, and Innovation.Washington, DC: AACC Press, 2010.

Piggott W: National Disaster Medical System presentation 2007. Available at http://www.azdhs.gov/phs/edc/edrp/es/pdf/ndms_piggott.pdf. Accessed October 17, 2011.

Texas Health Resources Field Surge Program presentation: Available at http://www.ehcca.com/presentations/emsummit2/cannefax_pc2.pdf. Accessed October 17, 2011.

Toledo, Ohio Disaster Medical Assistance Team support Web site. Available at http://mediccom.org/public/tadmat/training/NDMS/Part_V.pdf. Accessed October 17, 2011.

Missouri State Disaster Medical Assistance Team inventory Web site. Available at http://mo1dmat.org/logistics/DMAT%20Basic%20Load%20(Rev%2021-Gen-II)%20(2-6-08).xls. Accessed October 17, 2011.

Sonosite Web site.Available at http://www.sonosite.org/healthcareprofessions/ems/testimonials/. Accessed October 17, 2011.

California Emergency Medical Services inventory document. Available at http://intranasal.net/EMS%20training%20materials/Fresno%20CA%20EMS%20pediatric%20seizure%20protocol%20(dose%20too%20low).pdf. Accessed October 17, 2011.

El Dorado County Emergency Medical Services alert notice for glucose meters, issued December 28, 2010. El Dorado County Web site. Available at http://www.edcgov.us/DeptBlock.aspx?menuid=142&titleid=166&id=4175&terms=Glucose+EMS. Accessed October 17, 2011.

Oregon Health & Science University Precision Xceed Pro Guidelines. Available at http://www.ohsu.edu/pathology/POC/procedures/glucosexceedpro.pdf. Accessed October 17, 2011.

Kost GJ: The hybrid laboratory, therapeutic turnaround time, critical limits, performance maps, and Knowledge Optimization.® In Kost GJ (ed.): Principles and Practice of Point-of-Care Testing. Philadelphia, PA: Lippincott Williams and Wilkins, 2002: 13-25.

Julian DA: The utilization of the logic model as a system level planning and evaluation device. Eval Program Plann. 1997; 20: 251-257.

Torghele K, Buyum A, Dubruiel N, et al.: Logic model use in developing a survey instrument for program evaluation: Emergency preparedness summits for schools of nursing in Georgia. Public Health Nurs. 2007; 24(5): 472-479.

MacPhee M: Developing a practice-academic partnership logic model. Nurs Outlook. 2009; 57: 143-147.

Watson DE, Broemeling A-M, Wong ST: A results-based logic model for primary healthcare: A conceptual foundation for population- based information systems. Healthcare Policy. 2009; 5: 33-46.

Sitaker M, Jernigan J, Ladd S, et al.: Adapting logic models over time: The Washington State Heart Disease Stroke Prevention Program experience. Prev Chronic Dis. 2008; 5(2): A60.

Kost GJ, Hale KN, Brock TK, et al.: Point-of-care testing for disasters: Needs assessment, strategic planning, and future design. Clin Lab Med. 2009; 29: 583-605.

Brock TK, Mecozzi DM, Sumner SL, et al.: Evidence-based pointof- care test cluster and device design for disaster preparedness. Am J Disaster Med. 2010; 5: 285-294.

Mecozzi DM, Brock TK, Tran NK, et al.: Evidence-based point-ofcare device design for emergency and disaster care. Point Care. 2010; 9: 65-69.

Basel Committee on Banking Supervision (ed.): Principles for Sound Stress Testing Practices and Supervision. Basel, Switzerland: Bank for International Settlements, 2009.

Kawai T,Tatsumi N: POCT for earthquakes and disaster preparedness. In Kost GJ (ed.): Principles and Practice of Point-of-Care Testing. Philadelphia, PA: Lippincott Williams and Wilkins, 2002: 407-408.

Kost GJ, Tran NK, Tuntideelert M, et al.: Katrina, the tsunami, and point-of-care testing: Optimizing rapid response diagnosis in disasters. Am J Clin Pathol. 2006; 126: 513-520.

Ceflau WT, Smith SR, Blonde L, et al.: The Hurricane Katrina aftermath and its impact on diabetes care. Diabetes Care. 2006; 29: 158-160.

Louie RF, Sumner SL, Belcher S, et al.: Thermal stress and point-of-care testing performance: Suitability of glucose test strips and blood gas cartridges for disaster response. Disaster Med Public Health Prep. 2009; 3: 13-17.

Ferguson WJ, Louie RF, Yu JN, et al.: Dynamic temperature and humidity profiles for assessing the suitability of point-of-care testing during emergencies and disasters. Paper presented at the Proceedings of the American Association for Clinical Chemistry Annual National Meeting, Atlanta, Georgia, July 24-28, 2011; D-20: A155 [Best Abstract Award].

Infectious Diseases page. Acon Laboratories Web site. Available at http://www.aconlabs.com/infect.html. Accessed October 17, 2011.

Infectious Disease Tests page. Brochure. Ameritek Web site. Available at http://www.ameritek.org/images/Infectious-brochure.jpg. Accessed October 17, 2011.

BIONOR HIV-1&2 Kit, BIONOR HIV-1&2 Confirmatory Test. Brochures. BIONOR Web site.Available at http://www.bionor.no/hiv.htm. Accessed October 17, 2011.

Genie III HIV-1/HIV-2 Assay, Genie Fast HIV 1/2 Assay. Bio-Rad Web site. Available at http://www3.bio-rad.com. Accessed October 17, 2011.

Aware™ HIV-1/2 BSP,Aware™ HIV-1/2 OMT,Aware™ HIV-1/2 U. Product inserts. Calypte Biomedical Corporation Web site.Available at http://www.calypte.com/products.asp. Accessed October 17, 2011.

Rapid Test page. Core HIV 1&2, Core Combo HIV-HBsAg-HCV Kit. Product inserts. Core Diagnostics Web site. Available at http://www.corediag.com/rapidtest.html. Accessed October 17, 2011.

SERODIA® Series page. Fujirebio Diagnostics Web site. Available at http://www.fujirebio.co.jp/english/product/serodia.html#02. Accessed October 17, 2011.

Products/HIV page. Hema Diagnostics Systems Web site. Available at http://www.rapid123.com/products_hiv.html. Accessed October 17, 2011.

Rational Pharmaceutical Management Plus: In Johnson A (ed.): HIV Test Kits Listed in the USAID Source and Origin Waiver: Procurement Information Document. 5th ed. Submitted to the US Agency for International Development by the Rational Pharmaceutical Management Plus Program. Arlington,VA: Management Sciences for Health, 2009.

Clearview® COMPLETE HIV 1/2: Clearview® COMPLETE HIV 1/2 STAT-PAK. Inverness Medical Web site.Available at http://www.invernessmedicalpd.com/default.aspx. Accessed October 17, 2011.

Determine® HIV 1/2, HIV-1/2 Ag/Ab Combo. Product specifications pages. Determine Web site. Available at http://www.determinetest.com/default.aspx. Accessed October 17, 2011.

OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test. Custom Letter and Package Insert-English. OraSure Technologies Web site. Available at http://www.orasure.com/products-infectious/productsinfectious-oraquick.asp. Accessed October 17, 2011.

DoubleCheck™ II HIV 1&2, DoubleCheckGold™ HIV 1&2 Whole Blood, ImmunoComb® II HIV 1&2 BiSpot, ImmunoComb® II HIV 1&2 CombFirm, ImmunoComb® HIV 1&2 TriSpot Ag-Ab, PointCare™ HIV, RapidSignal™ HIV 1&2 Serum/Plasma Cassette, RapidSignal™ HIV 1&2 Whole Blood/Serum/Plasma Cassette. Product inserts. Orgenics Web site.Available at http://www.orgenics.com. Accessed October 17, 2011.

Products: BioSign® Infectious Disease Tests page. Princeton BioMeditech Corporation Web site. Available at http://www.pbmc.com/products/infectious.shtm. Accessed October 17, 2011.

First Response® HIV 1-2-0 Human Immmunodeficiency Virus Rapid Test Strip (Serum/Plasma/Whole Blood), First Response® HIV 1-2.O Card Test Rapid HIV Card Test Whole Blood/ Serum/Plasma.Package inserts. Premier Medical Corporation Web site. Available at http://www.premiermedcorp.com/infectiousdiseases.html. Accessed July 11, 2011.

Vijayakumar T, David S, Selvaraj, et al.: Performance of a rapid immunochromatographic screening test for detection of antibodies to Human Immunodeficiency Virus Type 1 (HIV-1) and HIV-2: Experience at a tertiary care hospital in South India. J Clin Microb. 2005; 43: 4194-4196.

Uni-Gold™ HIV, Uni-Gold™ Recombigen® HIV pages. Trinity Biotech Web site. Available at http://www.trinitybiotech.com/PointOfCare/Pages/PointOfCare.aspx. Accessed October 17, 2011.

Moore CC, Jacob ST, Pinkerton R, et al.: Point-of-care lactate testing predicts mortality of sepsis in a predominantly HIV type 1-infected patient population in Uganda. Clin Infect Dis. 2008; 46: 215-222.

Riviello ED, Letchford S, Achieng L, et al.: Critical care in resource-poor settings: Lessons learned and future directions. Crit Care Med. 2011; 39: 860-867.

Vanholder R, Borniche D, Claus S, et al.: When the Earth trembles in the Americas: The experience of Haiti and Chili 2010. Nephron Clin Pract. 2011; 117: 184-197.

Kubota M, Ishida H, Kojima Y, et al.: Impact of mobile clinical analysers on disaster medicine: A lesson from crush syndrome in the 1995 Hanshin-Awaji earthquake. Biomed Instrum Technol. 2003; 37: 259-262.

Lam C,Waldhorn R, Toner E, et al.: The prospect of using alternative medical care facilities in an influenza pandemic. Biosecur Bioterror. 2006; 4: 384-390.

Cantrill S, Pons PT, Bonnett CJ, et al. (eds.): Disaster Alternate Care Facilities: Selection and Operation. Rockville, MD: Agency for Healthcare Research and Quality, 2009.

Altegovt BM, Stroud C, Nadig L, et al. (eds.): Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events. Medical Surge Capacity. Workshop Summary.Washington, DC: National Academies Press, 2010.

Glassman ES, Parrillo SJ: Use of alternate healthcare facilities as alternate transport destinations during a mass-casualty incident. Prehosp Disaster Med. 2010; 25: 178-182.

Kost GJ, Kost L, Suwanyangyuen A, et al.: Emergency cardiac biomarkers and point-of-care testing: Optimizing acute coronary syndrome care using small-world networks in rural settings. Point Care. 2010: 9: 53-64.

Altevogt BM, Stroud C, Hanson SL, et al. (eds.): Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report.Washington, DC: The National Academies Press, 2009.

Stroud C, Altevogt BM, Nadig L, et al. (eds.): Crisis Standards of Care: Summary of a Workshop Series.Washington, DC: The National Academies Press, 2010.

Food and Drug Administration: Emergency Use Authorization of Medical Products. Available at http://www.fda.gov/RegulatoryInformation/Guidances/ucm125127.htm. Accessed October 17, 2011.

Pope TM, Palazzo MF: Legal briefing: Crisis standards of care and legal protections during disasters and emergencies. J Clin Ethics. 2010; 21: 358-367.

Hodge JG, Courtney B: Assessing the legal standard of care in public health emergencies. JAMA. 2010; 303: 361-362.

Annas GJ: Standard of care—In sickness and in health and in emergencies. N Engl J Med. 2010; 362: 2126-2131.

Kost GJ: Newdemics, public health, small-world networks, and point-of-care testing. Point Care. 2006: 5: 138-144.

Kost GJ: The hybrid laboratory: Shifting the focus to the point of care. Med Lab Obs. 1992; 24(9 Supplement): 17-28.

Grissom TE, Farmer JC: The provision of sophisticated critical care beyond the hospital: Lessons from physiology and military experiences that apply to civil disaster medical response. Crit Care Med. 2005; 33: S13-S21.

Department of Homeland Security (ed.): Target Capabilities List. A Companion to the National Preparedness Guidelines.Washington, DC: Homeland Security, 2007.

Yu JN, Brock TK, Mecozzi DM, et al.: Future connectivity for disaster and emergency point of care. Point Care. 2010; 9: 185-192.

Rodwig FR: Emergency preparedness essential: A pathologist’s stance on POCT. Med Lab Obs. 2006; 38: 18, 20.

Point-of-Care Technologies Center: Disaster Point of Care: Noninvasive Monitoring. Available at http://www.youtube.com/POCTCTR#p/u/1/9ELSR7z0U4w. Accessed October 17, 2011.

Venticinque SG, Grathwohl KW: Critical care in the austere environment: Providing exceptional care in unusual places. Crit Care Med. 2008; 36: S284-S292.




DOI: https://doi.org/10.5055/ajdm.2011.0074

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