Disasters require POC technology.
During disasters, emergency medical responders deploy to disaster sites. (1) They carry point-of-care testing (POCT) devices, such as oxygen-saturation monitors (pulse oximeters), blood-glucose meters, and other small hand-held devices. (1) Disaster medical-assistance teams (DMATs), international medical-surgical response teams (IMSuRTs), and other first responders typically encounter harsh environmental conditions, temperature extremes, and high humidity. In a recent study conducted by Dr. Louie and colleagues at our center at the University of California-Davis, results indicated, however, that glucose test strips and blood-gas cartridges may not be able to withstand harsh environment conditions often encountered at disaster sites and noted, "The performance of glucose meter test strips and blood-gas analyzer cartridges was affected adversely and, sometimes inconsistently, by thermal stresses." (2) Without durable and robust POCT equipment, diagnosis and treatment of victims at disaster sites becomes increasingly complicated. The article further urges, "DMATs and emergency medical responders should be aware of the potential risks of inaccurate results from POCT when operated in adverse conditions." (2)
Additionally, the need for robust POC devices and reagents was clearly evident in the 2004 tsunami in Southeast Asia and Hurricane Katrina in the United States. The tsunami claimed more than 310,000 lives, with Thailand suffering a loss of nearly $1 billion. (1) Similar losses were observed with Hurricane Katrina. In the United States, an estimated 1,577 lives were lost, thousands were left homeless, and billions of dollars in damages resulted. (1)
Regional catastrophes like these "newdemics" (3), (4) lead to sequential magnified setbacks; and, typically, communities lack the POCT resources to effectively handle the respective disaster situations. (1), (3) These disasters highlight the need for new sturdy, hand-held, and robust POC technologies capable of effectively operating in disaster situations. Soon, the National Institute of Biomedical Imaging and Bioengineering (NIBIB) aided by the National Institutes of Health (NIH) will provide a solution to this gap in POCT resources. (5) Better prepared first responders will carry reliable diagnostics to the point of care, wherever it might be.
The potential for POCT--testing done at or near the site of the patient--to positively impact the manner in which healthcare is delivered in the United States was the result of a workshop sponsored by NIBIB in 2006. (5) The workshop recommended the formation of multidisciplinary research collaborations to facilitate clinical testing early in the developmental process. (5) In September 2007, the NIBIB established and funded four centers through the NIH cooperation agreement funding mechanism known as U54. (5) Each research center focuses on a specific healthcare-delivery theme (see Table 1). (5)
Table 1. The NIBIB point-of-care technologies research centers Principal Center location Theme investigator Fred Beyette University of Emerging Cincinnati neurotechnologies Charlotte Gaydos Johns Hopkins STDs University Gerald Kost UC-Davis-Lawrence Rapid muItipathogen Livermore National Detection for POCT Laboratory ILLNL] and national disaster readiness Bernhard Weigl PATH, Seattle and the POC diagnostics for University of global health Washington
The goal of the POCT centers is to address unmet clinical needs in POCT by utilizing the creation and collaboration of the multidisciplinary partnerships to build expertise in the development of integrated systems. (5) The centers work independently to achieve their particular research goals and collectively as part of a national network to allow coordinated development, clinical evaluations, and reduction to practice of new POC devices. (5)
Five core functions organize the center's activities. Core One focuses on conducting in-house clinical testing of prototype POC devices. (5) Core Two utilizes the collaboration with physical scientists, biochemical scientists, computational scientists, and bioengineers on exploratory projects. (5) Core Three addresses clinical needs assessment in areas anticipated to advance the field of POCT and disseminating this information to the community via education. (5) Core Four provides training to technology developers on clinical issues related to the development of POC devices. (5) Finally, Core Five outlines the administrative structure in order to ensure that each of the POCT centers achieves both individual and shared goals. (5)
POCT serves as a critical component of acute disaster response and follow-up recovery; but, at present, POCT devices available in the consumer market and for routine use do not meet adequate standards for disaster conditions. Our POCT center at UC Davis-LLNL specifically focuses on pathogen detection and development of devices capable of withstanding harsh disaster conditions. In addition, we utilize clinical needs assessment as an effective tool for gathering information on POC devices, test clusters, and pathogens considered critical for diagnosis at a specific disaster site.
To facilitate our development of rapid pathogen detection, a Clinical Needs Assessment Survey based on what we call "visual logistics" has been developed and is available by teleconference, in print upon request, and online through Survey Monkey (see Table 2). Responses serve as a guide to specifically identify pathogens that clinicians, several of whom are disaster experts, believe are vital to diagnosing and treating a patient effectively, given each disaster scenario. Through Clinical Needs Assessment, our center plans to develop a pathogen detection device that will give fast, rapid diagnosis and enable better patient care at a disaster site. Our Clinical Needs Assessment Survey asks questions covering the spectrum from device design to pathogen test clusters in the differential diagnosis.
Go to www.mlo-online.com for four figures that give more detail about the survey. Figure 1 asks the interviewee about test cassette sampling methods, specifically whether the sampling needle needs to be on the test cartridge or on a standard vacutainer. Figure 2 inquires about who should be trained in POCT for disasters. Figure 3 evaluates a pathogen test cluster design for Staphylococcus aureus. The interviewee must consider whether to detect coagulase negative Staphylococcus when ruling out methicillin-resistant Staphylococcus aureus (MRSA).
In addition, the pathogens for consideration are ranked in order of importance when diagnosing MRSA (Figure 3). Figure 4 evaluates which type of device would be preferred in various settings (i.e., disaster, urgent-care, or emergency-room settings). The knowledge gained by our POCT center from the survey directly guides the development of pathogen detection devices.
Participation in the survey gives MLO readers the opportunity to join our center in an effort to raise the standards of patient care available at any disaster site. The global problem of disaster response and preparedness affects everybody, including laboratory professionals and supervisors, who often are seasoned experts in the tests performed by POCT.
The survey is available online (Table 2 provides instructions) and can be completed in about 30 minutes; the hyperlink directs you to the online survey. Please take our survey and help bring adequate and effective care to the site of patient regardless of where disasters may strike.
Table 2. Survey Monkey instructions
Please go to www.surveymonkey.com/s.aspx?sm=9SYx6nymRDH4ed9EO_2b_2bl1w_3d_3d.
Follow the instructions on the screen to complete the survey. Note: Your progress will be saved after pressing the "next" button at the end of each page. Please note, your progress online is managed through your web browser cookies, and your identity is maintained using your IP address. For this reason, please try to complete the survey on the same computer and do not delete the cookies on your web browser prior to completion of the online survery.
Thank you for your time and input on the survey! Please contact, Keith Brock, Research Specialist, at 530-753-4702, e-mail email@example.com, for any comments or questions to better facilitate your participation in the Clinical Needs Assessment Survey.
POCT devices need to be suitable for response site environmental conditions beyond equipment storage and operating limits. (2) POCT devices carried by first responders need to endure these environmental stresses to avoid producing inaccurate test results. (2) Patient care available at these sites represents a top priority. Each of the POCT centers individually and collectively continues striving to bring POCT technologies to the frontline in order to make global health a world reality. (5)
Correctly utilized and executed, POCT allows for fast on-site testing that facilitates evidence-based decisions. (3), (4) POCT developed poorly, not explored fully, or not deployed proactively to meet challenges at disaster sites, such as Hurricane Katrina or the tsunami in Thailand, (1-4) detracts from on-site care. In order to prevent this from occurring, the devices taken to any of these respective field sites have to be able to withstand environmental conditions encountered and must be tailored for specific use by personnel working in these conditions. (3), (4)
Some POCT devices, however, may be able to effectively handle adverse environmental conditions. Preliminary results from thermal stress testing of a point-of-care hemoglobin-measurement system show promising results. (6) The potential to revolutionize the current POCT field is here. Join us to take disaster response and preparedness to a heightened level by participating in our survey. Collectively, we can assure that patient care will be available at disaster sites, that is, at the point of need.
Kristin N. Hale, BS, BA, is a graduate student researcher and currently in the graduate program for Comparative Pathology at the University of California-Davis (UC-D) with her undergraduate degrees awarded there. T. Keith Brock, BS, is a UC-D graduate and research specialist there. Gerald J. Kost, MD, PhD, MS, FACB, is the director of the Point-of-Care Testing Center for Teaching and Research (POCT * CTR), and is a colleague of Hale and Brock.
(1.) 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.
(2.) 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 Preparedness. 2009;3:13-17.
(3.) Kost GJ, Minear M, Siegel PM, et al. Knowledge, education, mind connectivity: using telemedicine to achieve a global vision for point-of-care testing. Point of Care. 2008;7(2):69-71.
(4.) Kost GJ. Newdemics, public health, small-world networks, and point-of-care testing. Point of Care. 2006;5:138-144.
(5.) Kost GJ, Korte B, Beyette FR, et al. The NIBIB point of care technologies research network center themes and opportunities for exploratory POC projects. Point of Care. 2008;7:41.
(6.) Kraynov L, Brock T, Louie R, et al. Effects of thermal stress on reagent test strips and test cuvettes for point-of-care glucose, hemoglobin, and white blood cell measurements. 20th Annual Undergraduate Research, Scholarship, and Creative Activities Conference at UC Davis. Davis, CA. March 2009.
The project described was supported by Award Number U54EB007959 (Dr. Kost, PI) from the National Institute of Biomedical Imaging and Bioengineering. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Biomedical Imaging and Bioengineering or the National Institutes of Health. Table and figures provided courtesy and permission of knowledge optimization,[R] Davis, CA.
NOTE: Figures 1 through 4 are available on the MLO website at www.mlo-online.com with this article.
By Kristin N. Hale, BS, BAT. Keith Brock, BS; and Gerald J. Kost, MD, PhD, MS, FACB