Mobile POCT Labs and Disaster Preparedness
In response to my recent note entitled POCT and Mobile Labs (link here), Ellen Sullivan of the ASCP has called my attention to an article from the AJCP entitled Katrina, the Tsunami, and Point-of-Care Testing: Optimizing Rapid Response Diagnosis in Disasters by Kost, Tran, Tuntideelert, Kulrattanamaneeporn, and Peungposop (link here). The article discusses how point-of-care testing (POCT) can optimize diagnosis, triage, and patient monitoring during disasters. Here is a quote from the article:
Dedicated mobile medical units equipped with POCT instruments and ICU modules can move to sites in need of help during the first week, as observed during Katrina. POCT represents an established approach valuable in clinical practice. However, research is needed to develop field-worthy POCT devices robust enough to withstand extreme ranges of humidity, temperature, salinity, altitude, earthquake shock, and battery operation during rescue operations. Reagents, tests strips, and quality control materials must withstand the same harsh conditions or be transported in environmentally controlled containers (refrigerated or heated, depending on the circumstances) that meet manufacturers specifications. Better yet, manufacturers should improve durability and validate testing cycles under disaster field conditions, license instruments specifically for this purpose, and design modular POCT formats that can be converted easily and quickly for field use with flexible test clusters suitable for different types of disasters.
These goals established by Kost et al. are important and should be pursued by lab professionals in concert with device and reagent manufacturers. Let's assume that such a group were to design a mobile POCT lab that could be operated under disaster field conditions and could support the flexible test cluster concept described above. To my way of thinking, it would be a mistake to position such mobile labs around the country (or world) in dead storage, awaiting such periodic disasters as will definitely occur. It would make much more sense to deploy such mobile POCT labs in various medical centers around the world and place them in active daily use. The cost of such labs could be shared by both the health systems operating them and the various disaster support and relief organizations around the world such as FEMA in the U.S.
With such a dual-use approach, these mobile POCT labs would always be in good operating order, stocked with fresh reagents, and their functionality could be continuously enhanced by collaboration with the manufacturers. They could then be air-lifted to global emergency sites as needed. In fact, the skilled personnel managing such mobile labs on a day-to-day basis in hospitals could even accompany the mobile labs to the emergency sites so that trained teams would be immediately available to manage them.