Preparedness and Region 7 & 8 Full Scale Exercise

Value and Lessons Learned

Nancy Hall, Donald Simmons and Michael Wichman

State Hygienic Laboratory

• Iowa’s Environmental and Public Health Laboratory

• Established by Iowa Code 263.7 in 1903

• To protect the health of Iowans through – Laboratory and field based investigations of

microbiologic, chemical or other threats to human health;

– Recommending methods of overcoming and preventing disease; and

– Supporting state and local agencies in the ongoing evaluation of the state’s environmental quality and public health.

Iowa SHL Preparedness

1. CDC - Laboratory Response Network (LRN)

– Biological and Chemical Threats (Radiological)

2. FDA - Food Emergency Response Network (FERN)

– Biological, Chemical and Radiological Threats

3. EPA – Environmental Response Laboratory Response Network (ELRN)

– Biological, Chemical and Radiological Threats

4. EPA – Water Laboratory Alliance (WLA)

Why Participate?

• Test preparedness

• Participate in exercises – Test internal and external communication

– Test sample accessioning and chain-of-custody

– Test internal incident command structure

– Test methods

– Test reporting

• Full scale exercise – LRN-C, LRN-B, WLA and FERN

SHL Coordination

• Established command center

• Daily briefings

• Video conference with Ankeny

• Maintained log of emails and phone calls

• Participated in Missouri, EPA and FERN conference calls

• Reported results via EPA WebEDR, CDC Results Messenger and FDA eLEXNET

• Internal SHL evaluators

SHL Participation

• Chemical – Environmental and Clinical

– EPA

– CDC

– Ankeny Laboratory - Don Simmons led

• Biological – Environmental and Food

– EPA

– FERN

– Coralville Laboratory - Nancy Hall led

Assessing Exposure to Arsenic

• Environmental samples

–Arsenic in Water samples

• Human urine specimens

–Arsenic in urine specimens from potentially exposed people

Arsenic in Water Samples

• Water samples were received for analysis at the Laboratory

• Arsenic was one of the suspected agents of concern

Arsenic in Water Samples

• Chain of Custody extremely important in these situations

• The emergency nature of these samples require special attention

• Additional documentation required – internal chain-of-custody

• Sample storage – secure evidence area with limited access

Arsenic in Water Samples

• Samples were checked for proper preservative – pH < 2 – for metals determination

• Samples analyzed by ICP/MS for total arsenic

• SHL results were on target with known values provided at conclusion of exercise

Arsenic in Urine Specimens

• Received more than 100 Urine specimens for arsenic exposure

• Urine specimens analyzed by ICP-DRC-MS

• SHL CLIA Certified for determination of metals in blood and urine

Arsenic in Urine Specimens

• Evidence tape use necessary

• Secure storage and security

• Log-in process not routine

Arsenic in Urine Specimens

• All samples were double-bagged

• MORE evidence tape

• Inspected for tampering or

leakage

Arsenic in Urine Specimens

• Log-in process took about two hours – very time consuming

• Samples were frozen

• All labels checked against Chain-of-Custody forms

Results Reporting

• EPA – used WebEDR website and reporting system

• CDC – used Laboratory Results Messenger – Web-based reporting system

• Both systems worked but learning curve was steep for WebEDR system

• Required more time to report water sample results than it did to run them

What Went Well

• Good Communications - External and Internal – Daily meetings and teleconferences – Always felt in the loop – Phone numbers handy

• WebEDR Hotline – Someone available when you need to get

the data out

• Everyone was committed

Chemical Lessons Learned

• Chain-of-Custody forms for EPA water samples didn’t have enough signature lines

• WebEDR was not intuitive – in the future, we need to practice reporting data by any means so that time is not wasted in a real situation

• A way to report all results securely but quickly would be beneficial

• Overall: A very good exercise

Biological Samples

• Water Methodology

– EPA Non-Typhoidal Salmonella in Water Protocol

• Classical microbiology: plate and tube inoculation, following by Salmonella serologies for confirmation

• Results in 4 days

• In addition, SHL also performed BAX PCR; screening results in 2 days

• Food Methodology

– Not prescribed so used BAX PCR

– Screening results in 2 days

SHL Food Microbiology Lab

• FERN Micro CAP Lab

• Respond to food microbiology outbreaks – Salmonella in peanut

butter

– Salmonella in deli meat

• Participate in various FERN and FDA proficiency exercises

• Participate in FERN capacity exercises

SHL Environmental Molecular Lab

• Appropriate molecular workflow

• Separation from clinical and environ activities

• Validated new STEC and Shigella qPCR assays

• Participate in various MLV; Listeria

Biological Lessons Learned • Internal chain of custody versus sample

tracking discussions • Better communication from IC

– Emails to all participants with contact information and roles defined (e.g. esp POC)

• When reporting results, define “presumptive” and “confirmed” results

• Suggest incorporation of faster screening methods (e.g. molecular assays)

• Better understanding of multi-regional expanded incident command structure(see next slide)

Expanded Incident Command

Mutual Support Laboratory (MSL)

Analytical Services Requester (ASR)

Primary Response Laboratory (PRL)

Environmental Unit (EU)

Thank you!

Questions?