SAN DIEGO — In a 21st century world, where travelers easily move in and out of countries around the globe, emergencies, whether natural disasters or acts of man, can put all nations at risk, both rich and poor.
So said Gerald Kost, MD, PhD, of the University of California Davis, in discussing "Diagnostic and Healthcare Strategies for Critical Care and Diagnostic Readiness" at the American Association for Clinical Chemistry (AACC; Washington) annual meeting and Clinical Lab Expo just concluded at the San Diego Convention Center.
"There are so many people in a crowded world," that when an emergency happens, it is typically very fast and very pronounced. One has only to think of the threat of another flu pandemic to see the potential for crisis worldwide (or perhaps only one sick person — such as a globe-trotting, TB-infected patient flying from one nation to another).
The "reality," Kost said, is that we are not well-prepared for such events.
While most crises have the characteristic of being unexpected, obvious lessons can be learned from previous disasters that should put the healthcare industry on alert in advance of the next catastrophe, such as another Katrina or a huge tsnunami striking Asia.
Kost said that when the huge tsunami swept across Thailand, one hospital, described as a "sophisticated, regional" facility, had only one blood gas analyzer. And another community hospital had only one physician on duty and no blood gas or electrolyte monitoring devices.
Kost said that the type of catastrophe in which emergency healthcare strategy tends to fall short is as an event in which the devastating aftermath remains "long-term."
In the days following Katrina, mobile labs deployed to the New Orleans area were "late to arrive," Kost said, and flooding hindered rescue teams that could have been equipped with point-of-care (POC) testing equipment
Kost said that Katrina was, or should have been, the "turning point" for a new awareness and understanding of the role of POC capabilities and that countries worldwide need to be much better equipped with POC systems to provide successful healthcare delivery following disasters.
"Point-of-care may represent the only diagnostic available" in such cases, he said.
He noted that most community hospitals In Thailand have no microbiology labs to measure such things as sepsis, a common consequence of lacerations. And, based on what he termed personal testimony, he said that the "lack of standardized equipment" hindered healthcare delivery following Katrina.
"Standardization is necessary" for POC instruments for first responders, he said, so that they immediately can operate the equipment of different suppliers in an emergency situation.
He also said that for certain disaster response teams that are set up to care for 250 people in an emergency, and composed of up to 35 first-responders, these teams have no lab or POC personnel.
"This needs to change," Kost said.
Another broad need is advanced connectivity for medical systems and devices, he said, noting that in the wake of Katrina, cell phone towers failed.
Expanded telemedicine facilities and connections also factor into Kost's vision of a better state of emergency preparedness.
He issued a call to the business community, specifically those companies involved in the development and manufacturing of POC tests, to join in the research effort to find better solutions for more illnesses that can withstand extreme climates, such as extremes of temperature and moisture, to function adequately in the field.
Asking the rhetorical question of what changes have happened with healthcare delivery in Thailand following the tsunami disaster, Kost's answer was: "In short, not many."
In related news from the AACC meeting:
Magellan Biosciences (Chelmsford, Massachusetts) said it is attempting to facilitate access to its POC lead testing system in areas affected by Katrina but said it is facing reimbursement challenges due to government regulations dictating how lead testing is to be funded.
The company said that money for such testing is allocated through the Centers for Disease Control and Prevention (Atlanta) and that seeking reimbursement through the federal government becomes redundant.
Instead, the company is having to deal with each state's regulatory process, since federal money also is given to each state for such things as lead-based testing and the states manage the testing and dispersal of the reimbursement money.
Thus, Robert Rosenthal, CEO of Magellan, termed the whole process "counter-intuitive."
Rosenthal told Diagnostics & Imaging Week that high levels of both lead and arsenic have emerged in areas hit by Katrina following the disaster.
The CLIA-waived LeadCare II POC blood/lead analyzer received that designation in September 2006. It provides results in three minutes.
In a statement issued by the company, Rosenthal said that Magellan has been "hearing many success stories" from community health practitioners who work to identify children with high lead levels, as well as industrial programs to check employees for lead levels.
Magellan, through its ESA Biosciences business, is also taking this platform one step further to develop a lead testing device that can be used in hospital laboratories, called LeadLab.
The device, which can process six samples simultaneously, can process about 75 samples in an hour and is compatible with lab's information technology systems. The device has not yet been cleared by the FDA.