Point-of-Care Testing Value Proposition for Disaster Preparedness in Small-World Networks

Abstract

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.

Geospatial Science and Point-of-Care Testing: Creating Solutions for Population Access, Emergencies, Outbreaks, and Disasters

“…While one account touted successful disaster response at the Takuapa District Hospital slightly north and inland in Phang Nga Province (98), several others more objectively documented broad failure and inadequate preparedness in community hospitals, especially coastal resorts and muubaans (villages) hit by the tsunami (67,68,99,100). For example, the care of critical patients was compromised by lack of blood gas instruments throughout all community hospitals, and at the time, an analyzer that performs blood gases (pO 2 , pCO 2 ), pH, and electrolyte (e.g., K + , Na + , and Ca +2 ) tests simultaneously on whole blood was inoperable in the Takuapa District Hospital, to which hundreds of critically injured tsunami victims were transferred (67,68).…”

“…During follow-up surveys several years after the tsunami, still no blood gas testing (pO 2 , pCO 2 , pH) was found in any community hospital in Phang Nga Province (68). Default use of fingertip pulse oximeters (small battery-powered O 2 saturation monitors, see https://www.youtube.com/watch?v= 9ELSR7z0U4w) increased after the tsunami, but was complicated by the presence of several different brands that had been donated.…”

Strategic Point-of-Care Requirements of Hospitals and Public Health for Preparedness in Regions at Risk

“…The distance [mean (SD), range, median, and maximum] from 53 Primary Care Units (PCUs) to 7 Community Hospitals was 19 (12), 3–60, 15, and 60 kms, and from 7 Community Hospitals to 2 Regional Hospitals, 39 (20), 7–65, 40, and 65 kms, respectively, while the time needed for ambulances to travel from PCUs to Community Hospitals was 25 (22), 4–120, 20, and 120 mins, and from Community to Regional Hospitals, 43 (21), 20–80, 30, and 80. 5–7 …”

“…A previous extensive field study 7 in Phang Nga Province with follow-up described the need for, and use of, oxygen saturation monitoring (pulse oximetry), which was found in the present survey among the top five POC tests [i.e., complete blood count, electrolytes/chemistry, blood bank (blood group), oxygen saturation (by pulse oximeter), and hematocrit]. Pulse oximeters to monitor oxygenation status during ambulance transfer, ED evaluation, and ventilation have become available widely, and in the future, should be matched by adequate blood gas analyzers for timely O 2 saturation validations, plus critical arterial pO 2 , pCO 2 , and pH measurements.…”

“…Pulse oximeters to monitor oxygenation status during ambulance transfer, ED evaluation, and ventilation have become available widely, and in the future, should be matched by adequate blood gas analyzers for timely O 2 saturation validations, plus critical arterial pO 2 , pCO 2 , and pH measurements. 7 …”