Health Service Support in a Nuclear, Biological, and Chemical Environment / Tactics, Techniques, and Procedures

by United States. Department of the Army

Section III. LABORATORY SERVICES

5-9. General

Laboratory services must continue their support role even under NBC conditions. For the provision of clinical and diagnostic support, the facility must be located in a contamination-free area or be inside collective protection. Designated laboratories within the theater will analyze NBC samples/specimens (including in theater field confirmation identification of biological agents by evaluating specimens from symptomatic patients and animals and environmental samples collected from the AO). See [Appendix B] for procedures in collecting biological samples/specimens, handling/packaging, maintaining chain of custody, transporting samples/specimens, and analysis.

5-10. Level II

Laboratory support at this level is extremely limited; it consists of laboratory procedures in direct support of MTF and FST activities. Laboratory personnel prepare collected suspect NBC specimens for submission to the supporting laboratory for analysis; the specimens are forwarded to supporting medical laboratories ([Appendix B]).

5-11. Level III

Laboratory support in a CSH is intended for providing clinical laboratory support and is primarily in support of acute surgical cases, blood services, and statim (STAT) services required for intensive care operations. Only extremely limited microbiology services (parasitological exams and gram stains) are provided. In a mature theater, the microbiology services may be augmented to include limited cultures and sensitivity testing. Patients with documented or suspected exposure to NBC weapons/agents will be medically evaluated, specimens will be collected, packaged, and have chain of custody established. The specimens will be forwarded through technical channels to the supporting medical laboratory (such as the theater Army medical laboratory [TAML]) for analysis. See [Appendix B] for specimen collection, packaging, chain of custody, and processing requirements.

5-12. Level IV

a. Clinical Laboratories. The clinical laboratories in the combat support, field, and general hospitals have the ability to perform a general, but limited, array of analytical procedures in hematology, urinalysis, chemistry, microbiology, serology, and blood bank. Patient specimens of suspected biological or chemical agent exposures are forwarded through technical channels to the supporting medical laboratory. See [Appendix B] for sample/specimen collection, packaging, chain of custody, processing, and transporting requirements.

b. Field Laboratories.

(1) Theater Army Medical Laboratory. The TAML is the specialized echelons above corps (EAC) laboratory that provides clinical and nonclinical medical laboratory support. When equipped and staffed, the TAML provides in-theater field confirmation identification of NBC samples or specimens. Using sophisticated equipment and methods, the TAML has the capability to detect and identify NBC agents in a variety of specimens/samples (such as human, air, soil, water, animals, vegetation, and food). Direct support from continental United States (CONUS)-based laboratories aids the TAML with identification of NBC agents. Command decision on use of protective/preventive measures and patient care may be based on the TAML findings. Proper collection, packaging, and rapid shipment of specimens by MTFs and samples from other sources will ensure effective, timely, and accurate laboratory analyses.

(2) Area Medical Laboratory. The Area Medical Laboratory (AML) is the specialized laboratory within the theater that provides nonclinical medical laboratory support. The AML can be deployed in the corps or to EAC for support missions. When fielded, the AML will replace the TAML in the force structure. The AML provides in-theater field confirmation identification of NBC samples or specimens. Using sophisticated equipment and methods, the AML has the capability to detect and identify NBC agents in a variety of specimens/samples (such as human, air, soil, water, animals, vegetation, and food). Direct support from CONUS-based laboratories aids the AML with identification of NBC agents. Command decision on use of protective/preventive measures and patient care may be based on the AML findings. Proper collection, packaging, and rapid shipment of specimens by MTFs and samples from other sources will ensure effective, timely, and accurate laboratory analyses.

5-13. Level V (Continental United States)

Designated Level V medical laboratories perform analyses to provide definitive identification of suspect biological agents for the President and Secretary of Defense purposes. The definitive identification of suspect biological agents also aids commanders in the AO in maintaining the health of their command.

5-14. Field Samples

Chemical corps personnel collect environmental, air, soil, and vegetation samples. Preventive medicine personnel collect samples from drinking water sources and supplies. Veterinary personnel collect samples from food supplies and medical specimens from animals. All other units collect soil, vegetation, and small animal samples for laboratory analysis. Samples are subjected to initial screening with rapid test kits and in-theater confirmatory identification at the supporting medical laboratory. The President- and Secretary of Defense-required definitive identification is performed at the designated Level V medical laboratory. Comprehensive databases will be maintained to provide historical testing results and will aid in the AO commander's decisions to conduct operations in an NBC environment. See [Appendix B] for specific procedures for sample collection, packaging, transporting, maintaining chain of custody, and analysis.