Kost Gerald J, Sakaguchi Ann, Curtis Corbin, Tran Nam K, Katip Pratheep, Louie Richard F
University of California Davis Point-of-Care Technologies Center and the Point-of-Care Testing Center for Teaching and Research (POCT-CTR), Pathology and Laboratory Medicine, School of Medicine, University of California Davis, California, USA.
Am J Disaster Med. 2011 Nov-Dec;6(6):351-68. doi: 10.5055/ajdm.2011.0074.
To identify strategies with tactics that enable point-of-care (POC) testing (medical testing at or near the site of care) to effectively improve outcomes in emergencies, disasters, and public health crises, especially where community infrastructure is compromised.
Logic model-critical path-feedback identified needs for improving practices. Reverse stress analysis showed POC should be integrated, responders should be properly trained, and devices should be staged in small-world networks (SWNs). First responder POC resources were summarized, test clusters were strategized, assay environmental vulnerabilities were assessed, and tactics useful for SWNs, alternate care facilities, shelters, point-of-distribution centers, and community hospitals were designed. PARTICIPANTS AND ENVIRONMENT: Emergency-disaster needs assessment survey respondents and Center experience.
Important tactics are as follows: a) develop training/education courses and '"just-in-time" on-line web resources to ensure the competency of POC coordinators and high-quality testing performance; b) protect equipment from environmental extremes by sealing reagents, by controlling temperature and humidity to which they are exposed, and by establishing near-patient testing in defined environments that operate within current Food and Drug Administration licensing claims (illustrated with human immunodeficiency virus-1/2 tests); c) position testing in defined sites within SWNs and other environments; d) harden POC devices and reagents to withstand wider ranges of environmental extremes in field applications; e) promote new POC technologies for pathogen detection and other assays, per needs assessment results; and f) select tests according to mission objectives and value propositions.
Careful implementation of POC testing will facilitate evidence-based triage, diagnosis, treatment, and monitoring of victims and patients, while advancing standards of care in emergencies and disasters, as well as public health crises.
确定能够使即时检测（在护理现场或其附近进行的医学检测）有效改善紧急情况、灾难和公共卫生危机（尤其是社区基础设施受损的情况）中医疗结果的策略及战术。
逻辑模型-关键路径-反馈确定了改进实践的需求。逆向压力分析表明，即时检测应实现整合，应急人员应接受适当培训，设备应部署在小世界网络（SWN）中。总结了急救人员的即时检测资源，制定了检测集群策略，评估了检测环境的脆弱性，并设计了对小世界网络、替代护理设施、避难所、分发中心和社区医院有用的战术。
应急-灾难需求评估调查的受访者及中心经验。
重要战术如下：a）开发培训/教育课程和“即时”在线网络资源，以确保即时检测协调员具备能力并实现高质量检测性能；b）通过密封试剂、控制其暴露的温度和湿度以及在符合美国食品药品监督管理局当前许可要求的特定环境中建立床边检测（以人类免疫缺陷病毒1/2检测为例），保护设备免受极端环境影响；c）在小世界网络和其他环境中的特定地点进行检测；d）强化即时检测设备和试剂，使其能在野外应用中承受更广泛的极端环境；e）根据需求评估结果，推广用于病原体检测和其他检测的新型即时检测技术；f）根据任务目标和价值主张选择检测项目。
认真实施即时检测将有助于对受害者和患者进行循证分诊、诊断、治疗和监测，同时提高紧急情况、灾难以及公共卫生危机中的护理标准。
