Innovations in point-of-care testing for enhanced United States disaster caches
DOI:
https://doi.org/10.5055/ajdm.2013.0125Keywords:
analytical errors, cardiac troponin I, crisis standards of care, deployment logistics, disaster preparedness and response framework, preparedness, quality assurance, resiliencyAbstract
Objective: To describe, innovate, recommend, and foster the implementation of point-of-care (POC) testing in disaster caches to enhance crisis standards of care and to improve triage, diagnosis, monitoring, treatment, and management of victims and volunteers in complex emergencies and disasters.
Design and settings: The authors compared POC testing in United States disaster caches to commercially available POC testing to enhance the caches and to reflect current state-of-the-art diagnostic capabilities. The authors also provided recommendations based on literature review and knowledge from newly developed POC technologies from the UC Davis Pointof-Care Technologies Center.
Results: Presently, US POC testing caches comprise chemistry/electrolytes, pregnancy, hemoglobin, cardiac biomarkers, hematology, fecal occult blood, drugs of abuse, liver function, blood gases, and limited infectious diseases. Deficiencies with existing POC tests for cardiac biomarkers, hematology, and infectious diseases should be eliminated. POC resources can be customized for pandemics, complex emergencies, or disasters based on geographic location and potential infectious diseases. Additionally, a new thermally stabilized container can help alleviate environmental stresses that reduce test quality.
Conclusions: Innovations in POC technologies can improve response preparedness with enhanced diagnostic capabilities. Several innovations, such as the i-STAT® Wireless, OraQuick ADVANCE® HIV-1/2, VereTrop™ Lab-on-a-Chip, and new compact hematology analyzers will improve test clusters that facilitate evidence-based decision making and crisis standards of care during US national disaster responses. Additionally, strategic resources and operator training should be globally harmonized to improve the efficiency of international responses.
References
Apple FS: A new season for cardiac troponin assays: It’s time to keep a scorecard. Clin Chem. 2009; 55: 1303-1306.
Apple FS, Ler R, Murakami MM: Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem. 2012; 58: 1574-1581.
Apple FS, Collison PO: Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem. 2012; 58: 54-61.
Venge P, Johnston N, Lindahl B, et al.: Normal plasma levels of cardiac troponin I measured by the high-sensitivity cardiac troponin I Access Prototype Assay and the impact on the diagnosis of myocardial ischemia. J Am Coll Cardiol. 2009; 54: 1165-1172.
Kost GJ: Goals, guidelines, and principles for point-of-care testing. In Kost GJ (ed.): Principles and Practice of Point-of-Care Testing. Philadelphia, PA: Lippincott Williams & Wilkins, 2002: 3-12.
Curtis CM,Kost GJ, Louie RF, et al.: Point-of-care hematology and coagulation testing in primary, rural emergency, and disaster care scenarios. Point Care. 2012; 11: 140-145.
Welsh J: NDMS Laboratory Services Laboratory Cache. Washington, DC: NDMS/HHS Logistics. Available at www.usphs.gov/corpslinks/pharmacy/documents/labcache.pdf. Accessed August 5, 2013.
Louie RF, Sumner SL, Belcher S, et al.: Thermal stress and pointof- care testing performance: Suitability of glucose test strips and blood gas cartridges for disaster response. Disaster Med Public Health Prep. 2009; 3: 13-17.
Louie RF, Ferguson WJ, Sumner SL, et al.: Effects of dynamic temperature and humidity stresses on point-of-care glucose testing in disaster care. Disaster Med Public Health Prep. 2012; 6: 232-240.
Ferguson WJ, Vy J, Louie RF, et al.: Preliminary evaluation of a point-of-care blood gas-electrolyte analyzer potentially robust in cold during emergencies and disasters: Evidence from evaluation of reagents in stress testing chambers. Point Care. 2012; 11(3): 152-156.
Tang CS, Ferguson WJ, Louie RF, et al.: Ensuring quality control of point-of-care technologies: Effects of dynamic temperature and humidity stresses on glucose quality control solutions. Point Care. 2012; 11(3): 145-151.
Rust MJ, Carlson NA, Nichols JH: A thermo-modulating container for transport and storage of glucose meters in a cold weather environment. Point Care. 2012; 11(3): 157-160.
Thygesen K, Alpert JS, Jaffe AS, et al.: Third universal definition of myocardial infarction. Circulation. 2012; 126(16): 2020-2035.
Newby LK, Jesse RL, Babb JD, et al.: ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: A report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2012; 60(23): 2427-2463.
IFCC Working Group-TnI: Table 1. Analytical characteristics of commercial and research cardiac troponin I and T assays declared by the manufacturer. 2010. Available at http://www.ifcc.org/media/102202/IFCC_Troponin_Table_vDec_2010_FINAL_ug_L_28Jan11.pdf. Accessed August 5, 2013.
Mahajan VS, Jarolim P: How to interpret elevated cardiac troponin levels. Circulation. 2011; 124(21): 2350-2354.
Brown SM, Andrews D: After the disaster: Sustaining quality point-of-care testing in a resource-poor environment. Point Care. 2013; 12: 23-26.
Jorgensen MB, Levine RA,Wardlaw SC: Potential utility of a novel automated point-of-care image-based hematology analyzer for the diagnosis of malaria as part of a routine CBC. Presented at the 2013 AACC Annual Meeting Abstracts. B-103.
Wardlaw SC, Levine RA, Unfricht DW, et al.: Measurement of RBC indices in an image-based whole blood analyzer. Presented at the 2013 AACC Annual Meeting Abstracts. A-517.
Unfricht DW, Olson DR, Xie M, et al.: The use of quantitative, multispectral imaging to measure hematology parameters in whole blood preparations. Presented at the 2013 AACC Annual Meeting Abstracts. A-518.
Ports B, Unfricht D, Mitsis P, et al.: Disposable analysis chamber for a novel imaging-based hematology instrument. Presented at the 2013 AACC Annual Meeting Abstracts. A-519.
Unfricht D, Olson D, Xie M, et al.: Quantitative imaging of whole blood smears for measuring hematology parameters. Presented at the XXVIth International Symposium on Technological Innovations in Laboratory Hematology, May 10-12, 2013. Poster #72.
Karon BS, McBane RD II, Chaudhry R, et al.: Accuracy of capillary whole blood international normalized ratio on the CoaguChek S, CoaguChek XS, and i-STAT 1 point-of-care analyzers. Am J Clin Pathol. 2008; 130: 88-92.
Orasure Technologies, Inc.: OraQuick ADVANCE® Rapid HIV- 1/2 Antibody Test [package insert]. Bethlehem, PA: Orasure Technologies, Inc., 2012.
Oden M, Mirabal Y, Epstein M, et al.: Engaging undergraduates to solve global health challenges: A new approach based on bioengineering design. Ann Biomed Eng. 2010; 38: 3031-3041.
Federal Emergency Management Agency: Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, and Related Authorities, 2007. Available at http://www.fema.gov/pdf/about/stafford_act.pdf. Accessed August 5, 2013.
Kost GJ, Mecozzi DM, Brock TK, et al.: Assessing point-of-care device specifications and needs for pathogen detection in emergencies and disasters. Point Care. 2012; 11: 119-125.
Kost GJ, Katip P, Curtis CM: Strategic point-of-care requirements of hospitals and public health for preparedness in regions at risk. Point Care. 2012; 11: 114-118.
Kost GJ, Katip P, Chuchart V: Diagnostic testing strategies for healthcare delivery during the Great Bankok Flood and other weather disasters. Point Care. 2012; 11: 191-199.
Weigl BH, Gaydos CA, Kost GJ, et al.: The value of clinical needs assessments for point-of-care diagnostics. Point Care. 2012; 11: 108-113.
Kost GJ, Katip P, Kulrattanamaneeporn S, et al.: Point-of-care testing value proposition for disaster preparedness in small-world networks: Post-tsunami Phang Nga Province, coastal Thailand. Point Care. 2013; 12: 9-22.
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.
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.
Olea S: Most Challenging Lab Standards 2012. The Joint Commission Accreditation Laboratory. Available at http://www.jointcommission.org/assets/1/18/April_26_Teleconference_Slides_Most_challenging_lab_standards_2012.pdf. Accessed August 5, 2013.
Centers for Medicare & Medicaid Service: What do I need to do to assess personnel competency? September 2012. Available at http://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/CLIA_CompBrochure_508.pdf. Accessed August 5, 2013.
Kost GJ, Tran NK, Abad VJ, et al.: Evaluation of point-of-care glucose testing accuracy using locally-smoothed median absolute difference curves. Clin Chim Acta. 2008; 389: 31-39.
Kost GJ, Tran NK, Sifontes JR, et al.: Locally-smoothed median absolute difference curves and the First Global Performance Cooperative: Relevance to glycemic variability and underserved populations. Point Care. 2009; 8: 45-52.
Kost GJ, Tran NK, Singh H: Mapping point-of-care performance using locally-smoothed median and maximum absolute difference curves. Clin Chem Lab Med. 2011; 49: 1637-1646.
Maon F, Lindgreen A,Vanhamme J: Developing supply chains in disaster relief operations through cross-sector socially oriented collaborations: A theoretical model. Supply Chain Manag: Int J. 2009; 14(2): 149-164.
Stewart GT, Kolluru R, Smith M: Leveraging public-private partnerships to improve community resilience in times of disaster. Int J Phys Distrib Logist Manag. 2009; 39(5): 343-364.
Ferguson WJ, Louie RF, Tang CS, et al.: Geographic information systems can enhance crisis standards of care during complex emergencies and disasters: A strategy for global positioning systemtracked, H2 fuel cell-powered, and knowledge-optimized point-of-care medical intelligence. Point Care. 2012; 11: 184-190.
Sinha B: A public health tool for population resilience. Disaster Med Public Health Prep. 2012; 6: 197.
Army Combat Service Support Automated Information Systems Interface (CAISI): Portable, weatherproof WLAN components extending your network to remote locations.Available at http://images.telos.com/files/external/CAISI_Slick.pdf. Accessed August 5, 2013.
Louie RF, Kitano T, Brock TK, et al.: Point-of-care testing for pandemic influenza and biothreats. Disaster Med Public Health Prep. 2009; 3(suppl 2): S193-S202.
ST Microelectronics: Press Release: A*STAR and Veredus Laboratories create market’s first Lab-on-Chip for the detection of multiple tropical infectious diseases. April 24, 2013. Available at http://www.st.com/web/en/press/t3420. Accessed August 5, 2013.
Mazur SM, Rippey J: Transport and use of point-of-care ultrasound by a disaster medical assistance team. Prehosp Disaster Med. 2009; 24: 140-144.
Kost GJ, Sakaguchi A, Curtis CM, et al.: Enhancing crisis standards of care using innovative point-of-care testing. Am J Disaster Med. 2011; 6: 351-368.
Kost GJ, Curtis CM: Disaster point of care testing: Fundamental concepts to enhance crisis standards of care. Whitehat Communications, Charlottesville, VA, Live Webinar. March 13 and May 9, 2013. Available at http://www.whitehatcom.com/POCWebMtgs/Slides/Disaster_POCT_G_Kost_050913.pdf. Accessed August 5, 2013.
Kost GJ, Curtis CM, Ferguson WJ, et al.: The role of point-of-care testing in complex emergency and disaster resilience. In Raskovic B, Mrdja S (eds.): Natural Disasters: Prevention, Risk Factors and Management. Hauppauge,NY: Nova Science Publishers, 2013: 73-110.
Craw P, Balachandran W: Isothermal nucleic acid amplification technologies for point-of-care diagnostics: A critical review. Lab Chip. 2012; 12: 2469-2486.
Castro AR, Mody HC, Parab SY, et al.: An immunofiltration device for the simultaneous detection of non-treponemal and treponemal antibodies in patients with syphilis. Sex Transm Infect. 2010; 86: 532-536.
Castro AR, Esfandiari J, Kumar S, et al.: Novel point-of-care test for simultaneous detection of nontreponemal and troponemal antibodies in patients with syphilis. J Clin Microbiol. 2010; 48: 4615-4619.
Alere: Alere Determine™ HIV-1/2 Ag/Ab Combo. Available http://www.alere.com/za/en/productdetails/ determine-1-2-ag-abcombo.html. Accessed August 27, 2013.
Centers for Disease Control and Prevention: Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Planning Workgroup. MMWR Recomm Rep. 2000; 49(RR-4): 1-14.
Institute of Medicine (US) Forum on Emerging Infections; Knobler SL, Mahmoud AAF, Pray LA (eds.): Biological Threats and Terrorism: Assessing The Science and Response Capabilities: Workshop Summary.Washington, DC: National Academies Press, 2002.
Kost GJ: Emergency response and medical POC caches: Future global harmonization. Presented at the 11th Annual POINT-OFCARE Coordinators Forum. AACC Critical and Point-of-Care Testing Division. August 1, 2013.
Published
How to Cite
Issue
Section
License
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved
