44 44 th th Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable 1 1 st st AML – First Team Out AML – First Team Out Area Medical Laboratory (AML) Capabilities and Applications LTC Ken Pell, Jr., XO 1 st AML Office: 410-436-4156 [email protected]
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 [email protected]. Agenda. 1st/9th Area Medical Laboratory History Mission Operation Personnel Equipment/Capability - PowerPoint PPT Presentation
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4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
HistoryHistory
520520thth Theater Army Medical Laboratory Theater Army Medical Laboratory (TAML)(TAML)
Deactivates in 2004 under Medical Re-Deactivates in 2004 under Medical Re-engineering initiative (MRI) and is replaced engineering initiative (MRI) and is replaced
by:by:
11stst Area Medical Area Medical Laboratory (AML)Laboratory (AML)
99thth Area Medical Area Medical Laboratory (AML)Laboratory (AML)
520th TAML had a clinical mission. 1st and 9th AMLs do not.
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Area Medical LaboratoryArea Medical Laboratory(AML)(AML)
MissionMissionDeploy 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.
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
ApplicationApplication
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
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
After PREPO vehicles, power, ECUs: 1,800 ft3 / 20,000 lbs
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Chemistry SectionChemistry Section
* PROFIS
Per
son
nel
Biochemist * O5 71B
Biochemist * O4 71B
Biochemist * O3 71B
Biochemist O4 71B
Medical Laboratory NCO E6 68K
Medical Laboratory Sergeant E5 68K
Medical Laboratory Specialist E4 68K
Medical Laboratory Specialist E3 68K
Medical Laboratory Specialist E3 68K
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionChemistry SectionC
apab
iliti
es
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionChemistry SectionC
apab
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es
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionChemistry Section
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionChemistry Section
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionChemistry Section
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionChemistry Section
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Microbiology SectionMicrobiology Section
Infectious Disease Officer* O4 61G
Veterinary Pathologist* O4 64D
Veterinary Microbiologist* O4 64E
Microbiologist* O4 71A
Microbiologist O4 71A
Medical Laboratory NCO E6 68K
Medical Lab Sergeant E5 68K
Medical Lab Sergeant E5 68K
Medical Laboratory Sp E4 68K
Medical Laboratory Sp E4 68K
Medical Laboratory Sp E3 68K
* PROFIS
Per
son
nel
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
An
alyt
ical
Met
ho
ds
• Nucleic Acid based assays RAPIDS (Real-time PCR) JBAIDS (Real-time PCR) Gel based PCR
• Antibody based assays Electrochemiluminescence (ECL) Immunohistochemistry (IHC) ELISA
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionMicrobiology SectionB
W A
NA
LY
SIS
(P
CR
)
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Microbiology SectionMicrobiology 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
AN
AL
YS
IS (
PC
R)
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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 SectionMicrobiology SectionB
W A
NA
LY
SIS
(E
CL
)
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Microbiology SectionMicrobiology 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)
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Microbiology SectionMicrobiology Section
• Bacterial Identification and antibiotic susceptibilities
– most Gram (-)– most Gram (+)
• Analysis total time ~24hrs from sample receipt, depending on isolate
Microscan Analyzer
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
PR
OF
IS O
ffic
ers
* PROFIS
Nuclear Medicine Science Officer* O5 72A
Preventive Medicine Officer* O5 60C
Entomologist* O4 72B
Sanitary Engineer* O4 72E
Nuclear Medicine Science Officer* O3 72A
Environmental Surveillance Section
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Environmental Surveillance Section
Environmental Science Officer O4 72D
Preventive Med NCO E5 68S
Preventive Med NCO E5 68S
Food Inspection SGT E5 68R
Health Physics NCO E5 68S N4
Health Physics NCO E5 68S N4
Preventive Med Sp E4 68S
Preventive Med Sp E4 68S
Ass
ign
ed P
erso
nn
el
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable 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
Co
re C
apab
iliti
esEnvironmental Surveillance
Section
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Environmental Surveillance Section
Am
bie
nt
Air
Particulate Sampling• Deployable Particulate Sampler (DPS) System