title: Enhancing crisis standards of care using innovative point-of-care testing.
abstract: OBJECTIVE
  To identify strategies with tactics that enable point-of-care (POC) testing (medical testing at or near the site of care) to effectively improve outcomes in emergencies, disasters, and public health crises, especially where community infrastructure is compromised.
  
  
  METHODS
  Logic model-critical path-feedback identified needs for improving practices. Reverse stress analysis showed POC should be integrated, responders should be properly trained, and devices should be staged in small-world networks (SWNs). First responder POC resources were summarized, test clusters were strategized, assay environmental vulnerabilities were assessed, and tactics useful for SWNs, alternate care facilities, shelters, point-of-distribution centers, and community hospitals were designed. PARTICIPANTS AND ENVIRONMENT: Emergency-disaster needs assessment survey respondents and Center experience.
  
  
  RESULTS
  Important tactics are as follows: a) develop training/education courses and '"just-in-time" on-line web resources to ensure the competency of POC coordinators and high-quality testing performance; b) protect equipment from environmental extremes by sealing reagents, by controlling temperature and humidity to which they are exposed, and by establishing near-patient testing in defined environments that operate within current Food and Drug Administration licensing claims (illustrated with human immunodeficiency virus-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.
authors.affiliation: University of California Davis Point-of-Care Technologies Center and the Point-of-Care Testing Center for Teaching and Research (POCT-CTR), Pathology and Laboratory Medicine, School of Medicine, University of California Davis, California, USA.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Kost
authors.forename: Ann
authors.initials: A
authors.lastname: Sakaguchi
authors.forename: Corbin
authors.initials: C
authors.lastname: Curtis
authors.forename: Nam K
authors.initials: NK
authors.lastname: Tran
authors.forename: Pratheep
authors.initials: P
authors.lastname: Katip
authors.forename: Richard F
authors.initials: RF
authors.lastname: Louie
mesh_terms: D019411:Clinical Laboratory Techniques / Q000295:instrumentation*; D003195:Computer Communication Networks; D019091:Critical Pathways; D054597:Disaster Medicine / Q000295:instrumentation*; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000592:standards*; D005246:Feedback; D006749:Hospital Design and Construction; D006801:Humans; D054527:Mass Casualty Incidents; D019095:Point-of-Care Systems / Q000592:standards*; D014218:Triage / Q000592:standards