Page 121 - Journal of Special Operations Medicine - Winter 2015

An Ongoing Series

Real-World Experience With Three Point-of-Care
Blood Analyzers in Deployed Environments

John Peffer, MD; Nathan Ley, PA-C; John Wuellner, MD; Paolo D’Andrea, MD;
Carissa Rittberg, DO; John Losch, PA-C; James H. Lynch, MD, MS

ABSTRACT
Austere environments such as Africa pose clinical chal- in forward deployed locations. These are not unique to
lenges, which are multiplied for Special Operations Africa, but their simplicity, size, and cost make them
Forces (SOF) providers who must face these challenges ideal for the medic in an austere location. Two fre-
with limited resources against the tyranny of distance. quently used test kits in Special Operations Command
These limited resources apply not only to treatment tools Africa (SOCAFRICA) Area of Operations include kits
but to diagnostic tools as well. Laboratory diagnostics for malaria and human immunodeficiency virus (HIV)
may provide critical information in diagnosis, initial infection. Patients with suspected malaria should be
2
triage, and/or evacuation decisions, all of which may tested with a total of three blood smears or RDT, one
enhance a patient’s survival. However, unlike in climate- every 8 to 12 hours. The BinaxNOW RDT (Alere Inc.,
®
controlled, fixed-facility hospitals, the deployed SOF Waltham, MA, USA; www.alere.com) uses whole blood
provider must have access to a simple, reliable device for from a finger stick and is the diagnostic tool of choice
point-of-care testing (POCT) to obtain clinically mean- when a skilled microscopist is not available. This RDT
3
ingful data in a practical manner given the surroundings. is suitable for point-of-care field use and can be ordered
through standard medical supply channels (NSN 6550-
Keywords: Africa; medicine, tactical; testing, laboratory; 01-554-8536/box of 12 tests). For rapid diagnoses of
analyzers, blood, point­of­care; malaria; HIV; medicine, HIV, OraQuick is commonly used by our forces in Af-
wilderness rica. This point-of-care diagnostic kit, OraQuick Ad-
vanced Rapid HIV-½ Ab test (NSN 6550-01-526-7431,
is available through medical supply channels (OraSure
Technologies Inc., Bethlehem, PA, USA; www.orasure.
Introduction
com) and has an extremely high sensitivity. Results are
This is Africa—TIA. This edition in the Journal of Spe- available in about 30 minutes.
cial Operations Medicine “This is Africa” series will fo-
cus on what laboratory POCT resources exist for SOF Employment of POCT Devices
providers supporting operations in Africa. The conti-
nent of Africa poses daunting clinical challenges, which Simple RDTs are useful for a very discrete clinical scenario
are multiplied for the SOF provider who must face these and yield a binary positive or negative result. However,
challenges with limited resources and the tyranny of dis- the remainder of this report focuses on more sophisti-
tance. These limited resources apply not only to treat- cated laboratory diagnostic point-of-care tests. Before
1
ment tools but to diagnostic tools as well. The authors fielding any POCT device, an understanding of biochemi-
will provide a summary of several handheld POCT de- cal measurement interpretation and correctly using these
vices currently used by SOF providers in Africa. values in patient management are critical. Proper initial
instruction, hands-on training, and sustainment train-
ing will build the medic’s level of competence in deciding
Disposable Rapid Diagnostic Test Kits
which patients warrant POCT. This level of competence
There are several disposable, single-use rapid diagnos- can range from a basic understanding of POCT that will
tic test (RDT) kits commonly used by SOF providers only be used with telemedicine prompting to a substantial

109