Combat & Casualty Care

Q1 2016

Military Magazines in the United States and Canada, Covering Combat and Casualty Care, first responders, rescue and medical products programs and news\Tactical Defense Media

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tacticaldefensemedia.com 6 | Combat & Casualty Care | Spring 2016 Epidemic Management and Prevention USAMRIID EBOLA VIRUS DIAGNOSTIC RESPONSE TIMELINE 20 April 2014: USAMRIID establishes laboratory capability, in collaboration with NIH National Institute of Allergy and Infectious Diseases-Integrated Research Facility (NIAID-IRF) at the Liberian Institute for Biomedical Research (LIBR) a. USAMRIID trains local staff at the National Reference Laboratory (NRL) on how to safely and accurately test clinical samples for Ebola virus b. April - August 2014: LIBR is the only Ebola testing facility in the country of Liberia c. August 2014 – present: USAMRIID and NIAID-IRF continue to provide constant "on the ground" support for Ebola diagnostics at LIBR. To date, over 17,000 samples have been processed. 19 June 2014: CDC suspends routine operations and LRN support (safety stand-down) a. 28 July 2014: CDC Emergency Operations Center asks for USAMRIID support for domestic Ebola diagnostics during CDC shutdown b. 29 July 2014: Hospital in Houston, Texas sends patient samples to USAMRIID for testing (negative) c. 1 August 2014: Hospital in Mississippi sends patient samples to USAMRIID for testing (negative) 29 September 2014: USAMRIID begins supporting the National Institutes of Health (NIH) Special Clinical Studies Unit in Bethesda, Md., with diagnostic testing in support of patient care at the facility 21 October 2014: Texas Animal Health Commission requests testing support for domestic canine of Houston nurse who was exposed to Ebola virus a. USAMRIID had validated EZ1 assay for canine blood for use in military working dogs b. Assay is used on dog of Dallas nurse; she is eventually reunited with her pet Sample extraction laboratory at the Liberia National Public Health Reference Laboratory. (Photo by Dr. Randal Schoepp, USAMRIID) FDA had granted the DoD's request for an EUA of the USAMRIID assay, dubbed EZ1. That assay was deployed to 16 DoD diagnostic laboratories (10 CONUS, 6 OCONUS) and 56 state public health laboratories within the United States. USAMRIID's status as a CDC National Laboratory within the LRN provided a critical interface to the CDC, and that partnership led to the rapid deployment of diagnostic capability throughout the United States. Training and Education USAMRIID also plays a critical role in training personnel who perform diagnostic assays in field laboratory settings. It all began prior to the Persian Gulf War in 1991, when military planners realized there was a significant need for battlefield detection of biological warfare agents. As environmental detectors were developed and deployed, the ability to confirm what the detectors were "seeing" was crucial to add confidence for battlefield, medical, and National Command Authority decisions. The requirement for a deployable biological agent laboratory was born. With development and deployment of biological agent detection assays, the need for transition to field deployment and subsequent training of personnel was necessary. USAMRIID's Diagnostic Systems Division developed a course to train individuals in both molecular and immunological assays. Currently, the Field Identification of Biological Warfare Agents (FIBWA) course offers the most advanced fieldable technologies for confirming biological agents. Students are trained to set up, maintain, and operate a deployable laboratory under field conditions. The deployed laboratory capability supports combatant commanders and theater surgeons as a resource for biological agent testing. Since the FIBWA course was first offered in 1999, nearly 1,000 students, including members of three services, DoD civilians, and foreign national scientists have attended. In 2005, the National Guard Bureau began using the FIBWA training program as the foundation for the advanced biological component of their Civil Support Teams (CST). These teams, assigned to each state and territory, form the basis of a highly specialized weapons of mass destruction (WMD) response element. The training capability that supports FIBWA also has been utilized and adapted for special training needs when required. For example, when USAMRIID and the NIAID- IRF helped the Liberian government to establish a diagnostic laboratory during the Ebola virus disease outbreak in 2014, the FIBWA program developed a three-day training program for all personnel traveling to Liberia to support the laboratory testing effort. This specialized support is still ongoing. Looking Ahead The Ebola virus diagnostic response within the U.S. was a good example of how interagency cooperation and collaboration can work. While the magnitude of the Ebola outbreak cannot be overstated, the fact that DoD and USAMRIID were prepared for such an event and responded quickly and effectively with a regulatory-compliant diagnostic capability must not be forgotten. USAMRIID's science and technology base serves not only to address current threats to our armed forces, but is an essential element in preparing for any future biological threats that may confront our nation.

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