Evidence-based point-of-care tests and device designs for disaster preparedness

Abstract

Objectives: To define pathogen tests and device specifications needed for emerging point-of-care (POC) technologies used in disasters.Design: Surveys included multiple-choice and ranking questions. Multiple-choice questions were analyzed with the _2 test for goodness-of-fit and the binomial distribution test. Rankings were scored and compared using analysis of variance and Tukey’s multiple comparison test.Participants: Disaster care experts on the editorial boards of the American Journal of Disaster Medicine and the Disaster Medicine and Public Health Preparedness, and the readers of the POC Journal.Results: Vibrio cholera and Staphylococcus aureus were top-ranked pathogens for testing in disaster settings. Respondents felt that disaster response teams should be equipped with pandemic infectious disease tests for novel 2009 H1N1 and avian H5N1 influenza (disaster care, p _ 0.05; POC, p _ 0.01). In disaster settings, respondents preferred self-contained test cassettes (disaster care, p _ 0.05; POC, p _ 0.001) for direct blood sampling (POC, p _ 0.01) and disposal of biological waste (disaster care, p _ 0.05; POC, p _ 0.001). Multiplex testing performed at the POC was preferred in urgent care and emergency room settings.Conclusions: Evidence-based needs assessment identifies pathogen detection priorities in disaster care scenarios, in which Vibrio cholera, methicillin-sensitive and methicillin-resistant Staphylococcus aureus, and Escherichia coli ranked the highest. POC testing should incorporate setting-specific design criteria such as safe disposable cassettes and direct blood sampling at the site of care.