44 th medical command a team of teams ready, relevant, reliable 1 st aml – first team out area...

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

[email protected]


AgendaAgenda

• 1st/9th Area Medical Laboratory History Mission Operation Personnel Equipment/Capability

• Alternate configurations• Planning considerations


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.


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.


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


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


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


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



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




• 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


• 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


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



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



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



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.



Microbiology SectionMicrobiology Section

Infectious Disease Officer* O4 61G

Veterinary Pathologist* O4 64D

Veterinary Microbiologist* O4 64E

Microbiologist* O4 71A

Microbiologist O4 71A


Medical Lab Sergeant E5 68K

Medical Lab Sergeant E5 68K

Medical Laboratory Sp E4 68K



* PROFIS

Per

son

nel


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)



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

)



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)


• 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

)



• 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)



• Bacterial Identification and antibiotic susceptibilities

– most Gram (-)– most Gram (+)

• Analysis total time ~24hrs from sample receipt, depending on isolate

Microscan Analyzer


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



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


• 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



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


Dri

nki

ng

Wat

er

Bacteriological Testing• Bact-T (CFU)• Collilert (Presence / Absence)

Requirements• Incubator needs AC Power• Replacement Media



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



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



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



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



Ep

idem

iolo

gy

DNBI Monitoring/Outbreak Investigation• MC4 system• Epidemiological Computing

CDC Statistical Surveillance Software Epi Info 2000

Microsoft package



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



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 Logistics SGT E5 68J

Wheeled Vehicle Mechanic E4 63B

Personnel Admin Specialist E4 42A

Cook E3 92G


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)


Tailored TeamsTailored Teams

• AML – PAX 4325,000 ft3 / 9 vehicles / 380,000 lbs

• Expeditionary AML – PAX 1713,500 ft3 / 4 vehicles / 178,000 lbs


• Section (heavy either C,B,R/N) – PAX 5-86,500 ft3 / 3 vehicles / 65,000 lbs



1st AML CommanderCOL Peggy Carter, CDR 1st AML

Office: 410-436-4857DSN 584-4857

[email protected]

9th AML CommanderCOL Terrell Blanchard, CDR 9th AML

Office: 410-436-7143DSN 584-7143

[email protected]

QuestionsQuestions

44 th medical command a team of teams ready, relevant, reliable 1 st aml – first team out area...

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