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44 th Medical Command A Team of Teams Ready, Relevant, Reliable 1 st AML – First Team Out Area Medical Laboratory (AML) Capabilities and Applications LTC.

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Presentation on theme: "44 th Medical Command A Team of Teams Ready, Relevant, Reliable 1 st AML – First Team Out Area Medical Laboratory (AML) Capabilities and Applications LTC."— Presentation transcript:

1 44 th Medical Command A Team of Teams Ready, Relevant, Reliable 1 st AML – First Team Out Area Medical Laboratory (AML) Capabilities and Applications LTC Ken Pell, Jr., XO 1 st AML Office: 410-436-4156 robert.pell@us.army.mil

2 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Agenda 1st/9th Area Medical Laboratory  History  Mission  Operation  Personnel  Equipment/Capability Alternate configurations Planning considerations

3 44 th Medical Command A Team of Teams Ready, Relevant, Reliable History 520 th Theater Army Medical Laboratory (TAML) Deactivates in 2004 under Medical Re- engineering initiative (MRI) and is replaced by: 1 st Area Medical Laboratory (AML) 9 th Area Medical Laboratory (AML) 520 th TAML had a clinical mission. 1 st and 9 th AMLs do not.

4 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Area Medical Laboratory (AML) Mission Deploy world-wide as a unit or by task- organized teams to perform surveillance, confirmatory analytical laboratory testing and health hazard assessments of environmental, occupational, endemic and CBRNE threats in support of force protection and WMD missions.

5 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Application AMLs test air, water, soil, food, waste and vectors (insect, animal, blood) for a broad range of microbiological, radiological, chemical contaminants under two basic scenarios: 1) As a level 4 field laboratory in support of theater operations –When samples cannot be transported to a fixed facility in less than 24 hours or results are needed in less than 20 days. –Able to support multiple PM Detachments with surveillance oversight, sample management, and rapid laboratory analysis. 2) In contingency operations, for example after WMD use –Immediate hazard identification (presumptive or ‘field confirmatory’ laboratory analysis) in high risk environments with chemical or biological agent contamination, epidemic disease or industrial contamination. –In the initial stages of supporting energetics analysis

6 44 th Medical Command A Team of Teams Ready, Relevant, Reliable AML Organization Total: 19 Officers + 24 Enlisted = 43 Full Time: 6 Officers + 24 Enlisted = 30 COMMAND Analytical Chemistry Analytical Microbiology Environmental Surveillance HQ Staff

7 44 th Medical Command A Team of Teams Ready, Relevant, Reliable AML Process Definitive Analysis OEH Surveillance Oversight Screening Tests Portable assays Presumptive or “Field Confirmatory “ Analysis Identification; some quantification Routine Sample Input PM DET Sample Processing Air, Soil, Water, Food, Waste, Vectors Other Sample Input: 20 th SUPCOM*; customer complaints Field Drinking Water Testing Chemical Warfare Agents; Toxic Industrial Compounds; Toxic Industrial Materials Radiologic Materials Bio-Warfare Agents; Endemic/Epidemic Disease USACHPPM USAMRICD ECBC USACHPPM USAMRIID * 20 th SUPCOM: 22d Chem BN & 110 th Chem BN manage Technical Escort Unit (TEC Escort) for WMD agents/munitions

8 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Tailored Teams AML – PAX 43 25,000 ft 3 / 9 vehicles / 380,000 lbs Expeditionary AML – PAX 15 13,500 ft 3 / 4 vehicles / 178,000 lbs After PREPO vehicles, power, ECUs: 4,500 ft 3 / 67,000 lbs Section (heavy either C,B,R/N) – PAX 5-8 6,500 ft 3 / 3 vehicles / 65,000 lbs After PREPO vehicles, power, ECUs: 1,800 ft 3 / 20,000 lbs

9 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Chemistry Section * PROFIS Personnel Biochemist *O571B Biochemist *O471B Biochemist *O371B BiochemistO471B Medical Laboratory NCOE668K Medical Laboratory SergeantE568K Medical Laboratory SpecialistE468K Medical Laboratory SpecialistE368K Medical Laboratory SpecialistE368K

10 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Sample extraction to provide accurate screening and presumptive identification of unknown chemical contaminants (TICS/TIMS) using GC-MS, GC-ECD and GC-FPD. Thermal desorption of solid sorbent tubes (tenax or DAAMS) for the purpose of monitoring air with a Dynatherm ACEM 900 in combo with GC-MS. Focus on extremely low level (ppm-ppb) presence of chemical warfare agents G agents (nerve), V agents (nerve) and HD (blister). Chemistry Section Capabilities

11 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Determination of unknown bacteria utilizing gas chromatographic analysis (GC-FID) of cell membrane fatty acids following culture of the bacteria on blood/agar (MIDI). Evaluation of soldier exposure to nerve agent by analyzing for plasma cholinesterase inhibition using the Test-mate Kit from EQM Research. Chemistry Section Capabilities

12 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Selective and Sensitive Detection and Identification of Chemical contaminants in samples prepared using multiple extraction techniques. Presumptive level analysis based on matching derived spectra to those in spectral libraries. Gas Chromatograph with Mass Selective Detector Chemistry Section

13 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Extremely Sensitive Detection of chemical contaminants containing phosphorus or sulfur (ie. Nerve and/or blister agent) in samples prepared using multiple extraction techniques. Utilized as a screening technique; sample management tool. Gas Chromatograph with Flame Photometric Detector Chemistry Section

14 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Identification of unknown bacteria by analysis of cell membrane fatty acids. Complementary to techniques utilized by Endemic Disease Section (ie. PCR, ECL). Particularly helpful in identification of background bacterial flora. Can be used as a parallel system for identification of endemic disease agents. MIDI System Chemistry Section

15 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Determination of Soldier exposure to Nerve agent by measuring whether acetylcholinesterase levels are suppressed. Determined from finger stick. 5 min test. CAUTION. Nonspecific (exposure to organophosphate pesticides can lead to AChE inhibition). Only capable of screening small groups of soldiers. Test-mate Kit from EQM Research, Inc. Chemistry Section

16 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Microbiology Section Infectious Disease Officer*O461G Veterinary Pathologist*O464D Veterinary Microbiologist*O464E Microbiologist*O471A MicrobiologistO471A Medical Laboratory NCOE668K Medical Lab SergeantE568K Medical Lab SergeantE568K Medical Laboratory SpE468K Medical Laboratory SpE468K Medical Laboratory SpE368K * PROFIS Personnel

17 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Analytical Methods Nucleic Acid based assays  RAPIDS (Real-time PCR)  JBAIDS (Real-time PCR)  Gel based PCR Antibody based assays  Electrochemiluminescence (ECL)  Immunohistochemistry (IHC)  ELISA Bacterial culture  Bacterial identification  Antibiotic susceptibility (Microscan platform)  Gamma-phage (Bacillus anthracis) Microbiology Section

18 44 th Medical Command A Team of Teams Ready, Relevant, Reliable RAPID Analyzer Provides real-time PCR analysis 32 test capacity Screening analysis completed in 4-5 hours (includes specimen preparation and testing) Reagents come from USAMRIID and JPEO-CBD Critical Reagents Program Microbiology Section BW ANALYSIS (PCR)

19 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Microbiology Section Joint Biological Agent Identification and Diagnosis System (JBAIDS) Real-Time PCR analysis Machine pre-programmed with standard protocols for all analytical assays 32 test capacity Sample extraction kits provided for: blood, stool, soil, liquid, swipe, culture, tissue, vegetative matter, food Reagents come from Idaho Technology, Inc. BW ANALYSIS (PCR)

20 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Electrochemiluminescence (ECL) antigen detection 96 test capacity Run completed in about 1 hr Reagents come from USAMRIID and JPEO-CBD (Critical Reagents Program) BioVeris M1M Analyzer Microbiology Section BW ANALYSIS (ECL)

21 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Microbiology Section Frozen tissue sections for IHC Identification of BW agents Identification of endemic disease agents Supports Vet Pathology (animal pathology) Occ/Env Health (endemic disease surveillance) Cryostat (Leica CM1100) Immunohistochemistry (IHC)

22 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Microbiology Section Bacterial Identification and antibiotic susceptibilities – most Gram (-) – most Gram (+) Analysis total time ~24hrs from sample receipt, depending on isolate Microscan Analyzer

23 44 th Medical Command A Team of Teams Ready, Relevant, Reliable PROFIS Officers * PROFIS Nuclear Medicine Science Officer*O572A Preventive Medicine Officer*O560C Entomologist*O472B Sanitary Engineer*O472E Nuclear Medicine Science Officer*O372A Environmental Surveillance Section

24 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Environmental Surveillance Section Environmental Science OfficerO472D Preventive Med NCOE568S Preventive Med NCOE568S Food Inspection SGTE568R Health Physics NCOE568S N4 Health Physics NCOE568S N4 Preventive Med SpE468S Preventive Med SpE468S Assigned Personnel

25 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Ambient Air Monitoring Drinking Water Surveillance Toxic Industrial Compounds/Materials Entomological Services Occupational \ Industrial Hygiene Services Radiological Surveillance Food service inspection Core Capabilities Environmental Surveillance Section

26 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Environmental Surveillance Section Ambient Air Particulate Sampling Deployable Particulate Sampler (DPS) System  PM10 & PM 2.5 Volatile Sampling SKC pumps

27 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Drinking Water Bacteriological Testing Bact-T (CFU) Collilert (Presence / Absence) Requirements Incubator needs AC Power Replacement Media Environmental Surveillance Section

28 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Drinking Water Chemical Testing HACH DR4000  Portable spectrophotometer for analysis of metals and inorganics Chemetrics Colormetric Test Kits  Cyanide 0-1.0 ppm  Arsenic 0-10 ppb Hach Arsenic Test Kit  10 ppb or greater Environmental Surveillance Section

29 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Hazmat ID System Can be operated in a dirty environment Utilizes IR technology Capable of presumptively identifying  WMD - nerve and blister agents  WMD precursors  Toxic industrial chemicals  Forensic drugs  White powders  Explosives  Common chemicals  Pesticides TICs and TIMs Limitations Sample must have a covalent chemical bond Target must comprise > 10% of sample Can not definitively identify biological agents Environmental Surveillance Section

30 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Entomology Services Arthropod Surveillance and ID  Mosquitoes, ticks, filth flies, biting flies, fleas etc. Rodent and small animal trapping Handheld vector testing assays Environmental Surveillance Section

31 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Industrial Hygiene Air Analysis Tools Agilent GC-MS HAPSITE Portable GC/MS TMX 412 multi-gas monitor Miran SaphIRe Occupational Health Air Data Multimeter Quest Sound Level Meter WBGT Heat Stress Monitor Carbon monoxide monitor Environmental Surveillance Section

32 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Epidemiology DNBI Monitoring/Outbreak Investigation MC4 system Epidemiological Computing  CDC Statistical Surveillance Software Epi Info 2000  Microsoft package Environmental Surveillance Section

33 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Radiological Surveillance AN PDR 77 Radiac Set  Alpha, X-ray, beta and gamma radiation DART Multi channel analyzer  portable gamma-spectroscopy Identifinder  Portable handheld gamma spectrometer Liquid Scintillation Counter (wipe tests) TFIA Series High Volume Air Sampler  Radio-particulate characterization Environmental Surveillance Section

34 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Command/Staff * PROFIS Personnel CommanderO667B Chief Medical Laboratory NCOE968K Executive OfficerO571E Biomed Information Mgmt Officer *O370D Medical Operations OfficerO370H Medical Laboratory NCOE668K Medical Logistics SGTE568J Wheeled Vehicle MechanicE463B Personnel Admin SpecialistE442A CookE392G

35 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Expeditionary Laboratory Organization Lab Officer 71E O-5 Biomed Info Mgmt 70D O-3 Med Log SGT 68J ESO 72D O-4 Prev Med NCO 68S20 Hlth Phys NCO 68S20N4 Biochemist 71B O-4 Med Lab NCO 68K30 Med Lab NCO 68K20 Med Lab SPC 68K10 Microbiologist 71A O-4 Med Lab NCO 68K30 Med Lab NCO 68K20 Med Lab SPC 68K10 Headquarters MicrobiologyChemistry Environmental Surveillance 17 Personnel (5 Officers, 12 Enlisted)

36 44 th Medical Command A Team of Teams Ready, Relevant, Reliable Tailored Teams AML – PAX 43 25,000 ft 3 / 9 vehicles / 380,000 lbs Expeditionary AML – PAX 17 13,500 ft 3 / 4 vehicles / 178,000 lbs After PREPO vehicles, power, ECUs: 4,500 ft 3 / 67,000 lbs Section (heavy either C,B,R/N) – PAX 5-8 6,500 ft 3 / 3 vehicles / 65,000 lbs After PREPO vehicles, power, ECUs: 1,800 ft 3 / 20,000 lbs

37 44 th Medical Command A Team of Teams Ready, Relevant, Reliable 1 st AML Commander COL Peggy Carter, CDR 1 st AML Office: 410-436-4857 DSN 584-4857 peggy.carter@us.army.mil 9 th AML Commander COL Terrell Blanchard, CDR 9 th AML Office: 410-436-7143 DSN 584-7143 terrell.blanchard@us.army.milQuestions


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