Recommendations to Improve Rapid Medical Diagnosis during Disasters

CHICAGO (October 1, 2006)—Medical response teams should be better equipped with handheld point-of-care testing (POCT) devices, and airborne critical care testing and mobile medical units could improve triage during disasters such as Hurricane Katrina and the tsunami of 2004, a Fulbright Scholar and colleagues report in the October issue of the American Journal of Clinical Pathology, the journal of the American Society for Clinical Pathology.

Gerald J. Kost, MD, PhD, MS, FACB, Director of the Point-of-Care Testing Center (POCToCTR), Pathology and Laboratory Medicine, University of California Davis School of Medicine, led research teams that assessed availability of rapid diagnostic testing in Thailand after the tsunami and in the United States after the hurricane.

"Limited availability and poor organization severely limited POCT use," they wrote. "The medical failures in both countries should motivate new emergency strategies and public health plans."

The authors said that the White House's 2006 report, The Federal Response to Hurricane Katrina: Lessons Learned, "falls short of a vision for acute care or for assisting patients with chronic illnesses and does not mention crucial new diagnostic technologies, such as POCT, that can convert empiric diagnosis to evidence-based triage during directed rescue."

The researchers surveyed medical staff and administrators in 14 health care facilities administered by the Thai government and in 22 Louisiana hospitals. In Thailand, interviewees were asked to list needs and describe how they could have been better prepared. In the United States, researchers asked personnel about hospital size, number of staff, laboratory services, POCT availability, critical care testing, cardiac biomarkers, and disaster responses. They also identified the influence of environmental conditions such as temperature, humidity, and electricity. Through direct communications and web searches the researchers collected information on military, commercial, and civilian responses in Texas, Louisiana, and Mississippi.

In Thailand, community hospital staff listed numerous needs, including whole-blood analyzers, point-of-care cardiac biomarker testing, oxygen saturation monitoring, and infectious disease tests. Regional health systems need distributed mobile resources, uninterruptible wireless communications, shared responsibility, mutual preparedness, and improved rapid, sustainable care for mainland and island emergencies.

After the hurricane, "hospitals, evacuation sites, and local agencies were not prepared fully to assist quickly with POCT, which was used primarily on U.S. military ships and combat support units," the report states. "Donations of glucose meters proved valuable, but not fast enough or adequate for the large numbers of diabetic victims involved in the disaster."

The researchers said that stockpiles of point-of-care testing supplies tailored to the needs of the particular disaster should be made readily available.

"In terrorist actions involving isotopic contamination or infectious agents, POCT can detect pathogens and facilitate care of isolated or quarantined patients," they wrote. "Dedicated mobile medical units equipped with POCT instruments and intensive care unit modules can move to sites in need of help during the first week, as observed during Katrina."

In a related paper Kost coins the term, "newdemics," defined as "unexpected and disruptive problems that affect the health of large numbers of individuals in a crowded world," to describe events such as Hurricane Katrina, tsunamis, devastating earthquakes, and possibly, avian flu. Acutely in these situations, POCT may be the only diagnostic modality operational, and thus should be fully incorporated in rescue strategies and public health preparedness.

Kost received a Fulbright Scholar Award to Thailand, 2003-2004, and Pacific Rim grants from the University of California, 2004-2007, as well as additional support from the Point-of-Care-Testing Center and the Edward W. and Ora I. Kost Foundation, for this project. His POCT practice recommendations now appear also in the Thai and Bahasa Indonesia languages to help national preparedness in Southeast Asia.

Co-authors are Nam K. Tran of the POCT Center at UC Davis; Masarus Tuntideelert in the Dept. of Logistics Management, Chulalongkorn University, Bangkok, Thailand; and Shayanisawa Kulrattanamaneeporn, MA, and Narisara Peungposop, MA, in the College of Population Studies at Chulalongkorn University.