1. APHL/LRN Operational Work Group March 22, 2010 CPT Trent J. Peacock, Ph.D.

2. Northern Regional Medical Command Health Service Areas Walter Reed AMC (DC) REF Womack AMC REF (Ft Bragg, NC) Ft Drum (NY) SEN West Point (NY)SEN Ft Monmouth (NJ)SEN Ft Knox (KY)SEN Ft Eustis (VA)SEN Ft Lee (VA)SEN Ft Meade (MD)SEN Ft Belvoir (VA)SEN

3. Southern Regional Medical Command Health Service Areas SAMMC (FSHTX) REF Eisenhower AMCREF (Ft Gordon, GA) CRDAMC (Fort Hood, TX) REF Redstone Arsenal (AL) SEN Ft Sill (OK)SEN Ft Campbell (KY)SEN Ft Jackson (SC)SEN Ft Benning (GA)SEN Ft Stewart (GA)SEN Ft Rucker (AL)SEN Ft Polk (LA)SEN

4. Western Regional Medical Command Health Services Areas Madigan AMC (Ft Lewis, WA) REF William Beaumont AMCREF (Ft Bliss, TX) Ft Wainwright (AK)SEN Ft Irwin (CA)SEN Ft Huachuca SEN Ft LeavenworthSEN Ft Polk SEN Ft Leonard WoodSEN Ft Riley SEN Ft Sill SEN Ft CarsonSEN

5. Pacific Regional Medical Command Health Service Area Tripler AMC REF Korea REF JapanSEN

6. Europe Regional Medical Command Health Service Areas Landstuhl RMC, GE REF** Heidelberg SEN SHAPE SEN Vicenza SEN

7. 121 GH-ROK- Europe- LRMC Sentinel Labs at MEDDACs Reference National - USAMRIID ARMY LRN SITES TAMC SAMMC WBAMC CRDAMC EAMC WAMC WRAMC MAMC AFIP

8. LRN laboratories located across the United States

9. APHL/LRN Operational Work Group The APHL/LRN Operational Work Group provides feedback and makes recommendations to the Laboratory Response Branch (LRB) that help to improve the quality of products and services provided by the LRN Program Office to network members. APHL / LRN SCOPE OF WORK

10. Protocol and algorithm revisions Assessment of reagent utility Proficiency testing implementation Enhancements to electronic data messaging Evaluation of customer satisfaction levels Operational Work Group Topics

11. For each quality improvement initiative or task assigned by the CDC, the Operational Work Group: 1.Collect any relevant documents from the designated CDC representative 2.Discuss with LRB and determine whether the entire network can be represented solely by workgroup members or if queries of the entire network are required. 3.Develop quality improvement recommendations and report results to the designated CDC representative* * Final authority to make changes recommended by the APHL/LRN Operational Work Group, resides with LRB. Operational Work Group Topic Assignment Responsibility

12. Operational Work Group (OWG) membership Members are selected based on regional distribution, laboratory function and size, and respective LRN gate 1.Members are rotated every 2 years OWG is comprised of representatives from 10 member labs, 2 APHL staff and 2 CDC staff. Participant criteria: 1.Extensive knowledge of LRN protocols and algorithms 2.Affiliated with a member lab that is approved to perform testing for all or most LRN agents 3.Have expertise with survey design and development

13. Member labs Public Health Lab Dept. of Defense FBI Veterinary Diagnostic Agri- cultural Environ- mental CDC Representative APHL Representative Operational Workgroup Members Department of the Army Participating Members U.S Army Medical Research Institute of Infectious Diseases (USAMRIID) U.S. Army Operational Work Group (OWG) membership

14. … … APHL/LRN Operational Workgroup Communication, Objective, Methods and Flow Communication objective 1.Solicit information from LRN members for quality improvement process and projects Communication methods 1.Quarterly conference calls 2.Help desk 3.LRN Program Office 4.OWG Communication flow 1.Bidirectional  LRN member labs OWG LRB

15. APHL/LRN Operational Workgroup receives feedback for protocol revisions Army LRN member feedback 1.Conventional methods training identified improved methodology for India ink assay on blood specimens; thin smear instead of a drop.

16. APHL/LRN Operational Workgroup Projects Army support and participation in the OWG projects

17. Acknowledgements Chaitram, Jasmine, LRN Special Projects Manager, Centers for Disease Control and Prevention Lee, Phil M.Sc. FIBS, Biological Defense Coordinator, Molecular Microbiology Florida Department of Health Bureau of Laboratories Nauschuetz, William Ph.D., Clinical Laboratory Coordinator for Biopreparedness, and U.S. Army Coordinator for the Laboratory Response Network for Bioterrorism