Clinical Laboratory
A key component to the success of the deployed health system mission and defense against potential biothreat exposure is robust, in theater, clinical laboratory support. Clinical laboratory assets are crucial in determining the cause of disease and dictating all follow-on actions including IPC, FHP measures, and definitive MCM use (see below and Appendix B for discussion on this topic). Although agent specific clinical assays are crucial to definitive diagnosis, basic clinical lab values (complete blood count (CBC), chemistries, coagulation, etc.) can help narrow the differential diagnosis as well. Providers should understand what clinical laboratory assets are available in their area of operations, what is the test menu, who are the laboratory points of contact (POCs) and predetermine if it is practical and safe to collect clinical specimens (including potential BSAT specimens) at their level depending on the threats of concern. Different clinical laboratory capabilities by role of care and service are summarized in Table 13. For example, the Army Role 3 (32-bed field hospital (FH) + Augmentation Assets) could render a presumptive diagnostic answer to many different biothreats including a number of BSAT agents.
Clinical personnel should also understand the difference between DoD clinical and environmental laboratories as there are sometimes misconceptions about their functions. The key difference is that clinical laboratories are regulated by the Clinical Laboratory Improvement Program (CLIP) per DODI 6440.02, and as such, clinical results can be utilized directly for patient care and be included in the medical record (see table below). However, that does not mean that information reported from environmental labs are not useful for the clinician to be aware of as part of the common clinical operating picture.