Core 3 - Rapid Multipathogen Detection For POCT and Natioal Disaster Readiness

核心3。临床需求评估和传播

CORE 3. CLINICAL NEEDS ASSESSMENT AND DISSEMINATION Leadership in POCT Education and Dissemination. Our overall theme is criticalemergencv- disaster care. We will perform needs assessment of POCT with this theme as the unifying concept. In parallel, we will implement an interactive website to disseminate information effectively to technology developers, scientists, engineers, clinicians, rescue services, and DMATs (Disaster Medical Assistance Teams). Modern existing digital information systems, such as telemedicine, podcasting, online discussion sites, and live streaming video for web casting at the new UCDMC Education Building, which has state-of-the-art teaching suites, will allow us to accomplish these goals effectively with immediate start-up in the first year. The POCT*CTR and Its Role in Critical-Emergency-Disaster Care. POCT is defined as diagnostic testing at or near the site of patient care (Kost 2002A). POCT evolved during the 1970's. Early key concepts of POCT were developed by Dr. Kost (Kost 1999, Kost 2002A). During the 1980's, Dr. Kost conducted extensive invited talks and educational speaking tours on POCT in the United States, followed by presentations and workshops in Europe. Next, he was invited to speak, educate, and train in Asia as smaller and less expensive technologies became available worldwide (Tran 2006). Presentations focused on national development of key POCT concepts and included multimedia products such as educational PowerPoint programs, video, and country- and language-specific monographs (Kost 2003C, Kost 2006H, Kost 2006I). Over the past decade alone, the POCT¿CTR has conducted more than twenty translational studies. These studies generated forty-nine peer-reviewed journal publications and book chapters, many of them dealing with critical and emergency care. An additional set established the national standard of care for critical values for diagnostic tests. In 2006 alone, the POCT¿CTR produced seventeen publications on POCT, public health, and disaster readiness. Included was an original article in the American Journal of Clinical Pathology on how POCT was used during Hurricane Katrina and the tsunami (Kost 2006E). Those disasters proved, in a limited fashion, the feasibility of using POCT and identified key needs for future deployment of on-site testing in field rescue. However, Hurricane Katrina also proved that current generations of POC technologies are not able to withstand the harsh conditions encountered (see Core 2) in a disaster. Needs Assessment Following Hurricane Katrina and the 2004 Tsunami. We are already experienced at needs assessment for POCT. Dr. Kost's US and Thai research teams conducted field surveys, personal interviews, and data analyses shortly following these two disasters (Kost 2006E). Although countries differed greatly in their demographics and resources, results showed similar substantial deficiencies including lack of availability of POCT instruments for triage in community hospitals and in field sites where victims first appeared. Typically, there were no devices for rapid pathogen detection (see Core 1) in either the US or SE Asia. Even in the US, of the 100,000 diabetics who were without access to glucose meters and test strips during Hurricane Katrina, Cefalu et al. (2006) reported that uncontrolled hyperglycemia and hypoglycemia may have contributed to excess deaths. Despite the response to Katrina by US civilian and military organizations, we discovered a significant absence of fieldrobust POCT instruments. Although the military were equipped with handheld whole-blood analyzers, for the most part used on ships and in stable temporary environments, these devices would not have worked properly under the field conditions observed in Thailand or New Orleans. We have simulated these conditions in the research report by Sumner et al. (2007). We describe preliminary results in Core 2. Needs Assessment for Critical-Emergency-Disaster-Care¿DMATs. We will survey personnel from fifty National Disaster Medical Assistant Teams (DMATs) in the US in our needs assessment plan. We will determine the geographic distribution, medical resources, and capabilities of DMATs. These teams must be assessed because they represent professional medical personnel trained to provide care when existing healthcare infrastructure is overwhelmed by disasters or terrorism (NDMS website). They support the local healthcare infrastructure. We will contact the DMAT personnel directly by telephone and personal interview, similar to survey techniques Dr. Kost has used in several studies of critical limits (critical values) in the US. Direct contacts assure high response rate. We also will use email and web-based survey tools We plan to assess the needs of DMATs because properly equipped teams with environmentally robust POCT will be better prepared to practice evidence-based medicine during field rescues. DMATs are designed to provide rapid response that supplements local medical care until other federal or contracted resources can be mobilized. For example, two DMATs at UCDMC responded to Hurricane Katrina. Typically, our teams plan for three days of field service, but may stay one week. The teams carry two ordinary handheld blood gas analyzers with limited test menus, but no other POCT equipment. Storage and transport are routine like other supplies. There are no special devices, reagents, quality control, or containers that will endure environmental extremes of heat, cold, humidity, shock, altitude, or other factors. Nonetheless, team members we interviewed recognize the need for accurate diagnostic data on site during field rescues. Hence, DMATs would benefit from small, portable, and environmentally robust POC devices. We will conduct the survey starting with seven DMATs in the State of California, followed by remaining teams distributed across the US. Our goal is to achieve at least a 70% response rate from all DMATs identified in the US through official registries. DMATs are required to register and establish communication networking in order to be called to emergencies. The current contingency of DMATs in the United States is thought to provide geographical and statistical representation of population distributions. Hence, survey sampling will reflect similar demographic features. However, we recognize that some areas in the US may be deficient in these disaster response resources. Therefore, when we identify such deficiencies, we will survey regional healthcare resources to determine if they have incorporated POCT in disaster planning. We are working on the survey questionnaire currently. Below are examples of survey questions¿