POCT & Disaster Preparedness

In the 13 years since 9/11, the lab community has realized their fundamental role in a hospital’s disaster plan.

It wasn’t always this way. As Kerstin Halverston, point of care coordinator in the lab at Children’s Hospitals & Clinics of Minnesota explained, hospitals were essentially considered “little black boxes where patients went to get better” and nobody fully understood how to get the appropriate resources in the event of a disaster.

By all measures, 9/11 served as a wake-up call that terror activity could occur on U.S. soil for the lab community as much as the general population. The city of Minneapolis escalated development of the Minnesota Metropolitan Medical Response System, encompassing 140 acute/chronic care hospitals, 10 community behavioral health hospitals and 7 regional treatment centers. Though it’s not legally binding, the collaboration is a “belief and commitment” by 30 hospitals to cooperate to meet patient needs, share staff and supplies in the event of a disaster. Similar groups have been established in Nebraska and the Pacific Northwest.

For perhaps the first time, the lab personnel became major players in the disaster initiative. In 2007, a sub-group, the Metro Lab Preparedness Group was formed, comprised mostly of lab safety officers, supervisors, microbiology staff and point of care coordinators at the 30 hospitals. The group essentially created a new lab-for emergency use only-with procedures, forms, lab positions, action statements, workflow, training and supply availability.

“We started in microbiology and studied bugs and organisms to watch out for,” recalled Halverston. “We branched into forming a group to develop an alternate care site for testing and started working through the specifics of doing testing in a disaster.”

Though no major catastrophe has occurred in the Twin Cities, many of the group’s action plans were implemented when a highway bridge collapsed in 2007 and during the GOP National Convention in 2008. Supply sharing has already come into play with PPE supplies during the H1N1 epidemic and with ventilators during the 2013 flu outbreak.

There have been no bioterrorism scares as of yet, but the group is prepared for that day. “Our precautions are different,” said Halverson. “The Department of Health will send out a white sample and leave it up to labs in the metro area to respond. Everyone’s aware of the protocols to follow if you suspect something.”

Instrument Selection
One of the group’s first challenges was deciding on a common instrument for testing patients and ramping up the supplies at area hospitals. The decision was more complicated than it first appeared.

“Everything’s temperature dependant,” said Halverston. “You can compromise results if you’re not testing in the prime temperature range.”

“We purchased 15 iSTATs with grant dollars,” explained Halverston. “It’s been around for 20 years and is the most common device among hospitals.”

The group decided the EC8+ cartridge, Creatinine, Glucose, Troponin and INR tests would be conducted at the alternative care site, along with urinalysis by dipstick and hCG qualitative. Any other tests would have to be treated as a send-out.

“At a disaster response site, you don’t want anything fancy,” said Halverston. “You want to do the most you can with the smallest amount of resources.”

Other supplies without expiration dates are stored at a local warehouse. Many are housed in wheeled black boxes typically used to transport band equipment.

Lab Positions & Workflow
Even with the supplies on hand, it was critically important for lab staff to work with the iSTATS so they could hit the ground running after a last minute training at the alternative care site or mobile medical unit.

The procedures are outlined in the ACS Lab Manual, of which three master copies are stored at the Department of Health and the two regional hospital resource centers. Additionally, 15 electronic copies are available on USB drives distributed to the Metro Compact hospitals.

Six staff positions were created for each pod in the ACS, with two each of rounding and static technologists, a pod clerk and a runner. Each position has a job action sheet with a list of duties and responsibilities.

The rounding technologists performs blood collections, iSTAT and glucometer testing, completes the result form with appropriate stickers if normal (yellow) or critical (red) and alerts nurses to critical results. Stationary technologists perform urine or blood collection, iSTAT testing and send-outs. Runners transport urine or blood for collection, send out specimens to off-site labs and get results. Clerks update patient charts.

“The beauty of this is you can staff up or staff down as necessary,” shared Halverston.

Time will tell if changes will be necessary for the staffing plan or workflow charts. One thing Halverston can say with certainty is that these plans will be enacted one day.

“Whether it’s a natural disaster or something terror related, I do think something will happen. How bad it is depends on your response,” she said.

Robin Hocevar is on staff at ADVANCE. Contact rhocevar@advanceweb.com

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