1 st aml – first team out
DESCRIPTION
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 PresentationTRANSCRIPT
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
11stst AML – First Team Out AML – First Team Out
Area Medical Laboratory (AML)
Capabilitiesand
Applications
LTC Ken Pell, Jr., XO 1st AMLOffice: 410-436-4156
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AgendaAgenda
• 1st/9th Area Medical Laboratory History Mission Operation Personnel Equipment/Capability
• Alternate configurations• Planning considerations
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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.
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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.
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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
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AML OrganizationAML Organization
Total: 19 Officers + 24 Enlisted = 43Full Time: 6 Officers + 24 Enlisted = 30
COMMANDCOMMAND
Analytical Chemistry Analytical Chemistry
Analytical MicrobiologyAnalytical MicrobiologyEnvironmental SurveillanceEnvironmental Surveillance
HQ StaffHQ Staff
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AML ProcessAML Process
Definitive Analysis
OEH Surveillance Oversight Screening Tests
Portable assays
Presumptive or “Field Confirmatory “ Analysis
Identification; some quantification
Routine
Sample In
put
PM DET
Sample ProcessingAir, Soil, Water, Food, Waste, Vectors
Other
Sam
ple In
put:
20th S
UPCOM*;
cust
omer
com
plain
ts
Field Drinking Water Testing
Chemical Warfare Agents; Toxic Industrial Compounds;Toxic Industrial Materials
Radiologic Materials
Bio-Warfare Agents;Endemic/Epidemic Disease
USACHPPM
USAMRICDECBC
USACHPPM
USAMRIID
* 20th SUPCOM: 22d Chem BN & 110th Chem BN manage Technical Escort Unit (TEC Escort) for WMD agents/munitions
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Tailored TeamsTailored Teams
• AML – PAX 4325,000 ft3 / 9 vehicles / 380,000 lbs
• Expeditionary AML – PAX 1513,500 ft3 / 4 vehicles / 178,000 lbs
After PREPO vehicles, power, ECUs: 4,500 ft3 / 67,000 lbs
• Section (heavy either C,B,R/N) – PAX 5-86,500 ft3 / 3 vehicles / 65,000 lbs
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
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• 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
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• 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
iliti
es
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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
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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
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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
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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
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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
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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
• Bacterial culture Bacterial identification Antibiotic susceptibility (Microscan platform) Gamma-phage (Bacillus anthracis)
Microbiology SectionMicrobiology Section
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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
)
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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)
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• 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
)
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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)
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Microbiology SectionMicrobiology Section
• Bacterial Identification and antibiotic susceptibilities
– most Gram (-)– most Gram (+)
• Analysis total time ~24hrs from sample receipt, depending on isolate
Microscan Analyzer
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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
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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
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Environmental Surveillance Section
Am
bie
nt
Air
Particulate Sampling• Deployable Particulate Sampler (DPS) System
PM10 & PM 2.5
Volatile Sampling• SKC pumps
ppm ug/m3
Particulate (PM10) Annual Avg. ----- 50< 10 micrometers 24-hour ----- 150Particulate (PM2.5) Annual Avg. ----- 15< 2.5 micrometers 24-hour ----- 65
Pollutant
40 ug/m3
AveragingTime
70 ug/m3
NAAQS TG 230 1- YearMEG
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Dri
nki
ng
Wat
er
Bacteriological Testing• Bact-T (CFU)• Collilert (Presence / Absence)
Requirements• Incubator needs AC Power• Replacement Media
Environmental Surveillance Section
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Dri
nki
ng
Wat
er
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
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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
TIC
s an
d T
IMs
Limitations• Sample must have a covalent chemical bond• Target must comprise > 10% of sample• Can not definitively identify biological agents
Environmental Surveillance Section
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En
tom
olo
gy
Ser
vice
s • Arthropod Surveillance and ID Mosquitoes, ticks, filth flies, biting flies,
fleas etc.
• Rodent and small animal trapping• Handheld vector testing assays
Environmental Surveillance Section
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Ind
ust
rial
Hyg
ien
e
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
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Ep
idem
iolo
gy
DNBI Monitoring/Outbreak Investigation• MC4 system• Epidemiological Computing
CDC Statistical Surveillance Software Epi Info 2000
Microsoft package
Environmental Surveillance Section
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Rad
iolo
gic
al S
urv
eilla
nce • 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
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Command/StaffCommand/Staff
* PROFIS
Per
son
nel
Commander O6 67B
Chief Medical Laboratory NCO E9 68K
Executive Officer O5 71E
Biomed Information Mgmt Officer * O3 70D
Medical Operations Officer O3 70H
Medical Laboratory NCO E6 68K
Medical Logistics SGT E5 68J
Wheeled Vehicle Mechanic E4 63B
Personnel Admin Specialist E4 42A
Cook E3 92G
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Expeditionary Laboratory Expeditionary Laboratory OrganizationOrganization
Lab Officer 71E O-5Lab Officer 71E O-5Biomed Info Mgmt 70D O-3Biomed Info Mgmt 70D O-3
Med Log SGT 68JMed Log SGT 68J
ESO 72D O-4ESO 72D O-4Prev Med NCO 68S20Prev Med NCO 68S20Prev Med NCO 68S20Prev Med NCO 68S20
Hlth Phys NCO 68S20N4Hlth Phys NCO 68S20N4
Biochemist 71B O-4Biochemist 71B O-4Med Lab NCO 68K30Med Lab NCO 68K30Med Lab NCO 68K20Med Lab NCO 68K20Med Lab SPC 68K10Med Lab SPC 68K10Med Lab SPC 68K10Med Lab SPC 68K10
Microbiologist 71A O-4Microbiologist 71A O-4Med Lab NCO 68K30Med Lab NCO 68K30Med Lab NCO 68K20Med Lab NCO 68K20Med Lab SPC 68K10Med Lab SPC 68K10Med Lab SPC 68K10Med Lab SPC 68K10
Headquarters
MicrobiologyChemistryEnvironmental Surveillance
17 Personnel (5 Officers, 12 Enlisted)
4444thth Medical Command A Team of Teams Ready, Relevant, Reliable Medical Command A Team of Teams Ready, Relevant, Reliable
Tailored TeamsTailored Teams
• AML – PAX 4325,000 ft3 / 9 vehicles / 380,000 lbs
• Expeditionary AML – PAX 1713,500 ft3 / 4 vehicles / 178,000 lbs
After PREPO vehicles, power, ECUs: 4,500 ft3 / 67,000 lbs
• Section (heavy either C,B,R/N) – PAX 5-86,500 ft3 / 3 vehicles / 65,000 lbs
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
1st AML CommanderCOL Peggy Carter, CDR 1st AML
Office: 410-436-4857DSN 584-4857
9th AML CommanderCOL Terrell Blanchard, CDR 9th AML
Office: 410-436-7143DSN 584-7143
QuestionsQuestions