Objectives To study health resources and point-of-care (POC) testing requirements for urgent, emergency, and disaster care in Phang Nga Province, Thailand; to determine instrument design specifications through a direct needs assessment survey; to describe POC test menus useful in the small-world network; and to assess strategies for preparedness following the 2004 Tsunami. Methods We surveyed medical professionals in community hospitals, a regional hospital, and the Naval Base Hospital; and officials at the offices of Provincial Public Health and Disaster Prevention and Mitigation. Questions covered: a) demographics and test requirements, b) POC needs, c) device design specifications, and d) pathogen detection options. Respondents scored choices. Scores determined priorities. Results Respondents selected complete blood count, electrolytes/chemistry, blood type, oxygen saturation (by pulse oximeter), hematocrit, and microbiology as top priorities, and preferred direct blood sampling with cassettes. Cardiac biomarkers were important in alternate care facilities. Staphylococcus aureus, SARS, Streptococcus pneumoniae, and hepatitis B were top infectious disease problems. Temperature, vibration, humidity, and impact shock were four important environmental conditions during extreme conditions. Conclusions Point-of-care testing can be used on a daily basis for competency and efficiency. Familiarity improves preparedness. Instrument designs must anticipate user preferences and environment stresses. The results show how a region at risk can adapt its small-world network. Point-of-care testing has become an important risk-reducing modality for crises and works equally well in low-resource settings to speed the delivery of routine and urgent care.

Objective To identify strategies with tactics that enable point-of-care (POC) testing (medical testing at or near the site of care) to improve outcomes effectively in emergencies, disasters, and public health crises, especially where community infrastructure is compromised. Design Logic model-critical path-feedback identified needs for improving practices. Reverse stress analysis showed POC should be integrated, responders properly trained, and devices staged in small-world networks (SWNs). We summarize first responder POC resources, strategize test clusters, address assay environmental vulnerabilities, and design tactics useful for SWNs, alternate care facilities, shelters, point-of-distribution centers, and community hospitals. Participants and Environment Emergency-disaster needs assessment survey respondents and Center experience. Outcomes Important tactics are: a) develop training/education courses and “just-in-time” on-line web resources to assure the competency of POC coordinators and high quality testing performance; b) protect equipment from environmental extremes by sealing reagents, controlling temperature and humidity to which they are exposed, and establishing near-patient testing in defined environments that operate within current FDA licensing claims (illustrated with HIV-1/2 tests); c) position testing in defined sites within SWNs and other environments; d) harden POC devices and reagents to withstand wider ranges of environmental extremes in field applications; e) promote new POC technologies for pathogen detection and other assays, per needs assessment results; and f) select tests according to mission objectives and value propositions. Conclusions Careful implementation of POC testing will facilitate evidence-based triage, diagnosis, treatment, and monitoring of victims and patients, while advancing standards of care in emergencies and disasters, as well as public health crises.

Objective: The 2004 earthquake/tsunami devastated Southeast Asia.We studied point-of-care testing (POCT) and O 2 saturation monitoring in Phang Nga, hardest hit southern coastal province, to develop preparedness strategies for low-resource small-world networks (SWNs).Design, Setting, and Participants: Early 2005, we surveyed 4 provinces then, in 2007Y2011, focused on Phang Nga with new field/ phone/mail/e-mail/fax surveys of 7 primary care units, all 7 community hospitals, and both regional hospitals. We used short-and long-form Thai surveys, photodocumented instruments, and assessed resources. Chiang Rai, unaffected by the tsunami in the north, served as control for pulse oximeter utilization.

Objectives: Our objectives were (a) to define resiliency strategies for catastrophic floods; (b) to report how these strategies that evolved during the Great Bangkok Flood; (c) to anticipate crisis care during weather disasters and mitigate risk for victims, patients, residents, and professionals; (d) to offer leadership approaches for disaster laboratory medicine, modeled after the Bangkok Medical Center and National Health System Laboratory response to Thai government requests for help; and (e) to identify point-of-care (POC) and laboratory diagnostic requirements during weather disasters, including infectious disease outbreaks summarized historically.Methods: Great Bangkok Flood data were gathered by 2 members (G.J.K., C.V.) of the response Working Group established at the request of the Division of Medical Sciences, Ministry of Public Health. We also conducted follow-up interviews of medical professionals and surveyed the National Health System, which provided emergency diagnostic services.Results: The historical record proves the impact of infectious diseases in weather disasters. Problems encountered during the Bangkok Flood included leptospirosis, presumed cholera at very low penetration, and fungal infections. Widespread prolonged inundation interrupted supply chains motivating future preparedness.Conclusions: Feasibility of POC testing was demonstrated in previous flood episodes (eg, Hurricane Katrina) and again during the Great Bangkok Flood, although on a limited basis. Preparation, training, mobility, and deployment were challenges. In addition, some medical problems require sophisticated analytical methods not yet amenable to testing directly at the site of need. Unmet needs ensure a bright future for innovators who develop new POC solutions and increase the mobility of diagnostic services for weather disasters.

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