ASSOCIATION OF PUBLIC HEALTH LABORATORIES MODEL PRACTICE: Algorithm and Guidelines for Responding to an Incident Involving a Suspicious ...

 
ASSOCIATION OF PUBLIC HEALTH LABORATORIES MODEL PRACTICE: Algorithm and Guidelines for Responding to an Incident Involving a Suspicious ...
ASSOCIATION OF   Algorithm and Guidelines for
                  Responding to an Incident
  PUBLIC HEALTH   Involving a Suspicious
  LABORATORIES    Non-Clinical Sample
MODEL PRACTICE:   VERSION 3.0, MARCH 2018
ASSOCIATION OF PUBLIC HEALTH LABORATORIES MODEL PRACTICE: Algorithm and Guidelines for Responding to an Incident Involving a Suspicious ...
THE ASSOCIATION OF PUBLIC HEALTH LABORATORIES (APHL) IS A NATIONAL NON-
PROFIT ORGANIZATION DEDICATED TO WORKING WITH MEMBERS TO STRENGTHEN
GOVERNMENTAL LABORATORIES THAT PERFORM TESTING OF PUBLIC HEALTH
SIGNIFICANCE. BY PROMOTING EFFECTIVE PROGRAMS AND PUBLIC POLICY,
APHL STRIVES TO PROVIDE MEMBER LABORATORIES WITH THE RESOURCES AND
INFRASTRUCTURE NEEDED TO PROTECT THE HEALTH OF US RESIDENTS AND TO
PREVENT AND CONTROL DISEASE GLOBALLY.

This APHL Report was 100% supported by Cooperative Agreement #NU060OE00103 funded
by the US Centers for Disease Control and Prevention. Its contents are solely the responsi-
bility of the authors and do not necessarily represent the official views of CDC.
Copyright © 2018, Association of Public Health Laboratories. All Rights Reserved.
TABLE OF CONTENTS
USING THE APHL MODEL PRACTICE .....................................................................................................................1
  First Responder Algorithm................................................................................................................................................. 2
  LRN-B Reference and LRN-C Laboratory Testing Algorithm............................................................................................. 3

GUIDELINES ON HOW TO USE THE ALGORITHMS...................................................................................................6
        1.0 Incident involving a Suspicious Non-Clinical Sample Occurs............................................................................ 7
        2.0 First Responders Perform a Risk Assessment................................................................................................... 7
        3.0 No Apparent Risk (continue to box 4.0)............................................................................................................. 7
              3.1 Risk Low or High (continue to box 4.1)......................................................................................................... 7
        4.0 No Testing Necessary ......................................................................................................................................... 7
              4.1 Threat Assessment........................................................................................................................................ 8
        5.0-5.2 No Apparent Threat, Potential or Credible Threat........................................................................................ 8
        6.0 No Testing............................................................................................................................................................ 9
              6.1 Field Screening (Explosives and Radiation at a minimum).......................................................................... 9
        7.0 Field Screening is Negative................................................................................................................................. 9
        8.0 Sample Arrives at the State or Local Public Health LRN Member Laboratory................................................ 10
        9.0 Perform Recommended Preliminary Screening and Split Sample for Biological,
              Radiological and Chemical Testing Groups for Future Testing ........................................................................ 11
        10.0 Sample is sent to the LRN-B Reference Laboratory and tested for Biological Threat Agents......................13
        11.0 Preliminary Positive Laboratory Result...........................................................................................................13
        11.1 Preliminary Negative Laboratory Result.........................................................................................................13
        12.0 Agent Specific Confirmatory Testing...............................................................................................................13
        13.0 Report Confirmatory Testing Results..............................................................................................................13
        14.0 Sample sent for Chemistry Analysis...............................................................................................................13
        15.0 General Chemical Compound Classification.................................................................................................. 14
        16.0 Determine if further classification of the material is needed. ...................................................................... 15
        17.0 Perform chemical class or agent specific confirmatory testing using SAM or other methods. ................... 15

APPENDIX A: CHAIN-OF-CUSTODY GUIDANCE.....................................................................................................18
APPENDIX B: DESCRIPTION OF THE LABORATORY RESPONSE NETWORK (LRN).................................................21
APPENDIX C: HIGH PRIORITY CHEMICALS FOR CHEMICAL THREAT ASSESSMENT..............................................23
REFERENCES......................................................................................................................................................24
1   Association of Public Health Laboratories Model Practice

                                                               ALGORITHM AND GUIDELINES FOR RESPONDING TO AN
                                                               INCIDENT INVOLVING A SUSPICIOUS NON-CLINICAL SAMPLE
                                                               The purpose of the response and testing algorithms is to provide guidance
                                                               to state and local public health Laboratory Response Network (LRN) member
                                                               laboratories working with multiple organizations and agencies to respond to an

                   USING
                                                               incident involving a suspicious non-clinical sample. This guidance should be a
                                                               starting point for communication between the laboratory and response com-

                THE APHL
                                                               munities and should supplement other guidance documents currently available
                                                               in the field. It is critically important for laboratories to understand the roles of all

                  MODEL
                                                               partners involved in a suspicious incident event to ensure a timely and effective
                                                               response. The algorithms should be followed step by step until a resolution point
                                                               has been reached. The accompanying guidelines in this document should be

               PRACTICE:                                       used for further clarification on how to follow the algorithm. These are minimal
                                                               guidelines, and APHL anticipates that state and local public health LRN member
                                                               laboratories will adapt these algorithms to best fit their needs and protocols.
                                                               These practices are not meant as a standalone protocol, and it is strongly rec-
                                                               ommended that laboratorians work closely with their first responder communi-
                                                               ties to provide additional guidance.

                                                               This document is available online at http://www.aphl.org/
                                                               AboutAPHL/publications/Documents/PHPR_2015June_
                                                               AlgorithmandGuidelinesWhitepaper.pdf.
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                                             Version 3.0 • March 2018   2

                      FIRST RESPONDER ALGORITHM
                                                       [1.0] Incident with a Non-clinical Sample
                                                         (See FBI/DHS/HHS-CDC Guidance on Initial Responses to a
                                                          Suspicious Letter/Container with a Biological Threat for
                                                          more information on response scenarios, if a biothreat.)

                                                 [2.0] 1st Responders Perform Risk Assessment
                                                        (See ASTM 2770-17 and NFPA 1600 for more information on
                                                                     performing a risk assessment.)

       [3.0] No Apparent Risk                                                                                                     [3.1] Risk

                                                                                               [4.1] Threat Assessment is performed in
                     [4.0] No Testing                                                           consultation with FBI Weapons of Mass
                                                                                               Destruction Coordinator and /or local law
                                                                                               enforcement: notify appropriate state or
                                                                                                  local public health LRN laboratory.

                                                                              [5.1] Potential Threat                         [5.2] Credible Threat
       [5.0] No Apparent Threat

                                                                                  [6.1] Field Screening for Explosives, Radiation,
                                                                                        and Specific Chemical Compounds.
                                                                                 NO FIELD SCREENING FOR BIOLOGICAL THREAT
                        [6.0] No Testing                                                      AGENTS SHOULD OCCUR.
                                                                                   (See ASTM 2458-17 for more information on sample collection for field
                                                                                               screening and transfer to LRN laboratories)

                                                                                          Samples not screened are accepted at the lab
                                                                                           director’s discretion and may be rejected for
                                                                                           submission to the LRN reference laboratory.
    [7.0] Negative: follow proper decontamina-
      tion and appropriate packaging require-
     ments. Consult with appropriate state or
       local public health LRN staff and send
      sample immediately to appropriate LRN                                                [7.1] Positive: follow first responder guidelines.
       laboratory, following Chain of Custody                                               Consult with appropriate state or local public
                     procedures.                                                          health LRN laboratory in order to send sample to
                                                                                         appropriate testing agency. Follow Chain of Custo-
                                                                                                      dy procedures at all times.
3   Association of Public Health Laboratories Model Practice

                 LRN-B REFERENCE AND LRN-C
               LABORATORY TESTING ALGORITHM
                                                        [8.0] Non-clinical Sample arrives at the
                                                      state or local public health LRN laboratory.
                                                      Perform gamma radiation screening on the
                                                                 exterior of packaging.

                         [9.0] Perform recommended preliminary screening and Split Sample for Bio, Chem or other testing
                      - For credible threat samples submitted by the FBI, they request that no chemical threat testing should be
                         conducted. Be sure to consult with your FBI WMD Coordinator regarding the testing being requested.
                                        - Perform alpha and beta radiation screening before the sample is split.

             Follow the LRN-B Refer-
             ence Level Protocol for
             Processing an Unknown                        [10.0] Test for Biological Threat Agents
             Non-Clinical Sample for
               Bioterrorism Agents

                                                                                        [11.1] Negative: Report preliminary
                                                                                     results using LRN Notification and Data
                                                                                    Messaging Policies and consult with the
                 [11.0] Positive: Report preliminary                                LRN-C laboratory to determine capability
               results using LRN Notification and Data                                 for Chemical Threat Agent Analysis.
                         Messaging Policies.

                    [12.0] Perform agent specific
                   confirmatory testing using LRN
                     Reference Level Protocols.

                              [13.0] Report confirmatory
                               testing results using LRN
                             Notification and Data Messag-
                                       ing Policies.

                                                                                          [14.0] Sample sent for Analysis
                                                                                            for Chemical Threat Agents
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                        Version 3.0 • March 2018   4

                    LRN-B REFERENCE AND LRN-C
                  LABORATORY TESTING ALGORITHM
                             (CONT'D)

                                                                                                          [15.1]
                                                                                                        Microscope/
                                                                                                         IR/ Raman

                                                                                                         [15.2]
                                                                                                      Solubility Tests

                                              [15.0]
                                         General Chemical                               -                [15.3]
                                            Compound                                                   Colorimetric
                                           Classification                                                 Tests

                                                                                                         [15.4]
                                                                                                            XRF
                                                                                                       (Solids Only)

                                                                                                         [15.5]
                                                                                                     Other Techniques
                                                                                                    (NMR, GC/MS, etc.)
5   Association of Public Health Laboratories Model Practice

                 LRN-B REFERENCE AND LRN-C
               LABORATORY TESTING ALGORITHM
                          (CONT'D)

                                                                            [17.1] Explosives        FTIR, IMS,
                                                                               (Explosives)          Calorimetry

                                                                           [17.2] Non-Volatile,      LC/MS/MS,
                                                                             Organic, Com-             UV/VIS,
                                                                             pounds (Gases)         Fluorescence

                                                      [16.1] No: Report    [17.3] VOCs/SVOCs
                                                                                                      GC/MS,
                       [16.0] Further                using LRN Notifica-    (Flammable, Com-
                                                                                                    SPME-GC/MS
                        Classifcation                   tion and Data        bustable Liquids)
                          Needed?                    Messaging Policies

                                                                              [17.4] Metals
                                                                              and Elemental           ICP/MS,
                                                                               Compounds             LC-ICP/MS
                                                                           (Flammable Solids)

                [16.2] Yes: Identify                   [17.0] Perform        [17.5] Inorganic
                  likely analytical                  chemical class or         compounds            IC-FTIR, Other
                 targets based on                      agent specific           (Oxidizers)       (NMR, XRF, Raman)
                  preliminary and                       confirmatory
                   first responder                      testing using
                        results                      available methods
                                                                              [17.6] Toxic
                                                                                                   GC/MS, GC-FID,
                                                                              Gases (Toxic
                                                                                                      GC-NPD
                                                                              Substances)

                                                                              [17.7] Radio-        Gammas Spec.,
                                                                                chemicals         Alpha Spec., LSC
                                                                              (Radioactive)

                                                    [18.0] Positive or
                                                    Negative results:            [17.8]
                                                    Report using LRN          Acids/Bases         Titration indicators,
                                                     Notification and         (Corrosives)              pH, FTIR
                                                     Data Messaging
                                                         Policies

                                                                            [17.9] Pesticides      GC/MS, GC-FID,
                                                                                 (Misc.)          GC-ECD, GC-NPD

                                                                            [17.10] Chemical
                                                                                                      Variable
                                                                            Warfare Agents
GUIDELINES   THESE ARE MINIMAL GUIDELINES,
              AND APHL ANTICIPATES THAT STATE
 ON HOW TO    AND LOCAL PUBLIC HEALTH LRN
    USE THE   MEMBER LABORATORIES WILL
              ADAPT THESE ALGORITHMS TO
ALGORITHMS    BEST FIT THEIR NEEDS.
7                               Association of Public Health Laboratories Model Practice

                                                                                            Business Continuity Programs, available
                                 FIRST RESPONDERS ALGORITHM                                 at: https://www.nfpa.org/assets/files/
                                 FOR RESPONDING TO AN INCIDENT                              AboutTheCodes/1600/1600-13-PDF.pdf.ii
                                 INVOLVING A SUSPICIOUS NON-
                                                                                           3.0
                                 CLINICAL SAMPLE
    HOW TO USE THE ALGORITHMS
    GUIDELINES ON
                                                                                           NO APPARENT RISK (CONTINUE
                                 1.0                                                       TO BOX 4.0)
                                 INCIDENT INVOLVING A SUSPICIOUS NON-                       3.0.1 If the sample/situation is deemed to
                                 CLINICAL SAMPLE OCCURS                                     have no apparent risk, no testing is neces-
                                    1.0.1 An incident here is defined as an                 sary and the algorithm ends. An example
                                    event that initiates a call to public safety            of a sample/situation with no apparent risk
                                    (e.g., 911) and activates first responders,             is an unknown powder found next to a box
                                    such as hazardous materials (HAZMAT)                    of powdered donuts in a kitchen area or a
                                    personnel, local law enforcement and fire               mailing from a company with a free sample
                                    department personnel. Such incidents                    of their new and improved detergent.
                                    involve environmental samples, defined                  Essentially, the potential sample (liquid, par-
                                    here as non-clinical samples (e.g., powders,            ticulate matter, solid) is expected to be there
                                    liquids, mixtures, pastes and solids).                  and there is no articulated threat.

                                 2.0                                                       3.1
                                 FIRST RESPONDERS PERFORM A RISK                           RISK LOW OR HIGH (CONTINUE TO BOX 4.1)
                                 ASSESSMENT                                                 3.1.1 First responders determine there
                                    2.0.1 Risk is defined as the probability of             is a risk which may require the assistance
                                    suffering a harm, trauma or peril. The risk             of public health agencies. A sample/situa-
                                    assessment is defined here as an assess-                tion that has risk may be the presence of
                                    ment that indicates the potential for suf-              powder, particulate matter, or liquid with

                                    fering harm or peril. Factors that influence            no obvious explanation, with or without an
                                                                                            explicit threat or prior intelligence. Examples
                                    the level of risk include the nature of the
                                                                                            of risk may include a suspicious liquid
                                    hazardous material, amount of material,
                                                                                            found in a hallway of an office building or a
                                    type of containment device and the level
                                                                                            powder found with a threat letter. Risk can
                                    of available resources. The risk assess-
                                                                                            be broken down into categories such as low
                                    ment is a fluid process that should be
                                                                                            or high, but for the purposes of this model
                                    performed in coordination with local or
                                                                                            and to simplify the equation, any risk (low
                                    federal law enforcement. More detailed
                                                                                            or high) proceeds through the algorithm. An
                                    explanations are outlined in the American
                                                                                            example of a risk assessment plan can be
                                    Society for Testing and Materials
                                                                                            found in the ASTM Standard E2770-17.
                                    (ASTM) E2770-17, Standard Guide for
                                    Operational Guidelines for Initial Response            4.0
                                    to a Suspected Biological Agents and                   NO TESTING NECESSARY
                                    Toxins, available at: https://www.astm.                 4.0.1 If a sample/situation is deemed
                                    org/Standards/E2770.htm.i Information                   to have no apparent risk, no laboratory
                                    for performing a risk assessment can                    testing is needed, the state or local public
                                    be found in the National Fire Protection                health LRN member laboratory is not
                                    Agency (NFPA) Guidance 1600, Standard                   involved and the appropriate first responder
                                    on Disaster/Emergency Management and                    agency protocols should be followed to
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                            Version 3.0 • March 2018   8

     resolve the incident.                                              for first responders to restrict access to
                                                                        the area for public safety pending confirma-
  4.1                                                                   tion from the state or local public health
  THREAT ASSESSMENT
                                                                        LRN member laboratory.i
     4.1.1 A critical aspect of characterizing

                                                                                                                          HOW TO USE THE ALGORITHMS
                                                                                                                          GUIDELINES ON
     the unknown non-clinical sample includes                        5.0-5.2
     an evaluation of the threat, which provides                     NO APPARENT THREAT, POTENTIAL OR
                                                                     CREDIBLE THREAT
     an indication of potential violence, harm
     or danger, and may include an indication                        After performing the threat assessment,
     of intent and capability. The credibility of a                  the incident is categorized as follows:
     threat is determined by evaluating all avail-
                                                                        5.0
     able information, including that derived from
                                                                        No Apparent Threat
     law enforcement interviews, intelligence
                                                                        The assessment determines that no threat
     information, hazard assessment results and
                                                                        exists and as such no testing is required.
     communication with public health, including
                                                                        Note: In some situations, further analysis
     the state and local public health LRN
                                                                        may be requested due to ongoing public
     member laboratory.
                                                                        safety concerns and samples could
     At the incident scene, the threat assess-                          continue through the algorithm. First
     ment is coordinated by the local FBI Field                         responders on scene will proceed as
     Office WMD Coordinator and on-scene                                directed by supervising officials.
     personnel. The state and local public health
     LRN member laboratory may be asked to
                                                                        5.1
                                                                        Potential Threat (low risk)
     participate by phone during the FBI-led
                                                                        The assessment determines that a threat
     threat assessment so they are aware that
                                                                        exists and there is no readily available
     public health testing and referral support
                                                                        information that explains the presence of
     may be needed. On-scene responders,
                                                                        the unidentified substance. In these situ-
     public health representatives, local law
                                                                        ations, communication between the first
     enforcement and FBI representatives
                                                                        responders on scene and the jurisdictional
     should work together to determine
                                                                        state or local public health LRN member
     the threat level.
                                                                        laboratory determines if the sample should
     Following the initial threat assessment, fac-                      be sent to the laboratory.
     tors such as technical feasibility, operational
     practicability and behavioral resolve com-                         5.2
                                                                        Credible Threat (high risk)
     bined with examination of pertinent intelli-
                                                                        The assessment determines that a threat
     gence will inform the credibility level
                                                                        exists and that it is credible. On-scene infor-
     of the threat.
                                                                        mation leads law enforcement officials to
     If the initial threat assessment determines                        have a reasonable belief that an event has
     that there is a potential threat, the FBI will                     occurred. All credible threats should imme-
     perform their credibility threat procedure,                        diately be sent to the jurisdictional state or
     which is conducted by the local FBI WMD                            local public health LRN member laboratory
     Coordinator with guidance from the FBI                             for confirmatory testing.
     Headquarters. Based on the risk and
     threat assessments, it may be necessary
9                               Association of Public Health Laboratories Model Practice

                                 6.0                                                              The purpose of the field screen is to rule
                                 NO TESTING                                                       out explosive materials and devices, limited
                                 Since there is no apparent threat, no                            chemical agents, radiological substances
                                 further testing is necessary. First responders                   and materials that may pose significant
                                 on scene will proceed as directed                                risks to transport personnel, state and local
    HOW TO USE THE ALGORITHMS
    GUIDELINES ON
                                 by supervising officials.                                        public health LRN member laboratories and
                                                                                                  laboratorians.
                                 6.1
                                 FIELD SCREENING (EXPLOSIVES AND                                  In some instances and at the Governor’s
                                 RADIATION AT A MINIMUM)                                          discretion, the National Guard Bureau
                                                                                                  Weapons of Mass Destruction (WMD) Civil
                                    6.1.1 Field screening is defined as testing
                                                                                                  Support Teams (CSTs) will be deployed to
                                    performed by first responders prior to the
                                                                                                  an incident. During these events, the CSTs
                                    sample being taken to the appropriate state
                                    or local public health LRN member labora-                     may be called upon to provide onsite safety

                                    tory. Such testing should include, at a min-                  screening characterization of potentially

                                    imum, radiation and explosives screening                      hazardous environmental samples. The
                                    and other basic analyses that do not                          CSTs are equipped with mobile laborato-
                                    consume the sample. To perform the field                      ries, referred to as an Analytical Laboratory
                                    screen, the sample should be collected as                     System (ALS), which is a standardized
                                    stated in the ASTM Standard, ASTM E2458-                      mobile laboratory system accessible in every
                                    17, Standard Practices for Bulk Sample                        state and territory of the United States. The
                                    Collection and Swab Collection of Visible                     ALS is designed to apply standardized anal-
                                    Powders Suspected of Being Biological                         ysis to screen potentially hazardous samples
                                    Agents from Nonporous Surfaces, see:                          and prepare them for safe transport, by the
                                    http://www.astm.org/Standards/E2458.htm.               iii    appropriate law enforcement entity, to the
                                                                                                  appropriate LRN reference laboratory for
                                    Guidance on performing field screening
                                                                                                  confirmatory testing and definitive analysis.
                                    can be found in the FBI, Department of
                                                                                                  State and local public health laboratories
                                    Homeland Security (DHS), Health and
                                                                                                  are encouraged to develop relationships
                                    Human Services (HHS)/CDC Coordinated
                                                                                                  with their CSTs prior to an incident. More
                                    Document, Guidance on Initial Response
                                                                                                  information on the capabilities of the CSTs
                                    to a Suspicious Letter/Container with a
                                                                                                  is available in the document, The Role
                                    Potential Biological Threat, available at:
                                                                                                  of Civil Support Teams in Support of the
                                    https://emergency.cdc.gov/planning/pdf/
                                                                                                  Laboratory Response Network.vi
                                    suspicious-package-biothreat.pdf.iv
                                                                                                  6.1.2 Samples not properly screened are
                                    The field screen should be performed by
                                                                                                  accepted at the lab director’s discretion and
                                    trained HAZMAT personnel and other trained
                                    first responder teams. Responder training                     may be rejected for submission to the LRN

                                    guidance can be found in National Fire                        reference laboratory. It is up to the indi-
                                    Protection Agency (NFPA) Guidance 472:                        vidual state lab director to determine if
                                    Standard for Competence of Responders                         they will accept incomplete screens.
                                    to Hazardous Materials/Weapons of Mass
                                                                                                 7.0
                                    Destruction Incidents, available at: https://
                                                                                                 FIELD SCREENING IS NEGATIVE
                                    www.nfpa.org/codes-and-standards/all-codes-
                                    and-standards/list-of-codes-and-standards/                    7.0.1 If the field screen is negative, com-
                                    detail?code=472.v                                             plete proper decontamination, appropriately
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                          Version 3.0 • March 2018   10

     package and transport sample along with
     the proper Sample Submission and Chain-
     of-Custody Form to the appropriate state or                     STATE AND LOCAL PUBLIC HEALTH
     local public health LRN member laboratory.                      LRN MEMBER LABORATORY
     See Appendix A for Chain-of-Custody Form                        TESTING ALGORITHM FOR

                                                                                                                        HOW TO USE THE ALGORITHMS
                                                                                                                        GUIDELINES ON
     or use forms which are consistent with law                      PROCESSING A SUSPICIOUS
     enforcement requirements. All samples                           UNKNOWN NON-CLINICAL SAMPLE
     transported to the laboratory should be                         8.0
     triple sealed in leak-proof containers. Each                    SAMPLE ARRIVES AT THE STATE OR LOCAL
     container should be sprayed with 10%                            PUBLIC HEALTH LRN MEMBER LABORATORY
     bleach solution to decontaminate it with a                        8.0.1 Prior to accepting the sample,
     minimum of 20 minutes contact time for the                        the receiving laboratory must check the
     outermost container. Further sample trans-                        incoming sample to ensure that proper
     port requirements and instructions can be                         packaging occurred, that all accompanying
     found in ASTM 2770. Note: Ensure you con-                         documentation is included and correct,
     sult with your state or local public health                       and that it comprises any field screening
     LRN member laboratory. See Appendix B                             results to ensure that explosive, radiological
     for acceptable sample requirements. It                            and volatile organic compound (VOC) field
     is at the state or local public health LRN                        screening was performed, at minimum.
     member laboratory director’s discretion
     to accept a sample that arrives without                           8.0.2 Sample Preservation
     proper documentation or packaging                                 Photos of the materials should be taken;
     according to national sampling standards                          minimize handling of evidence (e.g. enve-
     such as ASTM 2458 Method A.                                       lopes), and store some of the original
                                                                       sample. The recommendation is to remove
     7.1
                                                                       materials from the outside packaging, such
     FIELD SCREENING IS POSITIVE
                                                                       as an envelope, and store the contents in
     7.1.1 If the field screening is positive for                      the appropriate conditions according to your
     radiation or explosives, immediately consult                      laboratory protocol. The outside packaging
     with the state or local emergency response                        should be minimally handled and stored
     or public health LRN member laboratory to                         in the best possible conditions to preserve
     send the sample without delay to an appro-                        traditional forensic evidence. Secondary
     priate testing agency capable of handling                         evidence such as growth plates can be
     such a sample. It is expected that both                           destroyed after final testing conclusions
     laboratory and first responders be familiar                       have been made and adhering to the LRN-B
     with US Department of Transportation                              Reference level protocols. The important
     Hazardous Materials Transportation Act                            material to save is the primary evidence,
     and Hazardous Materials Safety Act as                             which is the original sample, so that further
     mentioned in the All Hazards Receipt                              testing can occur if requested. The general
     Facility (AHRF) Screening Protocol,                               rule of thumb is to preserve the original
     available at: https://www.aphlweb.org/cmt/                        sample until all legal matters have been
     phprcmt/First%20Responder%20Outreach/                             resolved.
     All%20Hazards%20Receipt%20Facility%20
     Screening%20Protocol.pdf.
11                               Association of Public Health Laboratories Model Practice

                                 9.0                                                        screening process. If the laboratory has an
                                 PERFORM RECOMMENDED PRELIMINARY                            AHRF, then the AHRF and AHRF Screening
                                 SCREENING AND SPLIT SAMPLE FOR                             Protocolviii should be used for this prelimi-
                                 BIOLOGICAL, RADIOLOGICAL AND CHEMICAL                      nary screen.
                                 TESTING GROUPS FOR FUTURE TESTING
     HOW TO USE THE ALGORITHMS
     GUIDELINES ON
                                                                                            The following is the minimal recommended
                                   9.0.1 Preliminary Laboratory Screening: If
                                                                                            testing that should be performed if appro-
                                   sufficient sample is available, it is highly rec-
                                                                                            priate instrumentation and supplies are
                                   ommended, for the safety of the laborato-
                                                                                            available. Note: Before preliminary testing
                                   rians, that state and local public health LRN
                                                                                            is performed, laboratories must have pro-
                                   member laboratories perform a preliminary
                                                                                            tocols in place to triage potential positive
                                   laboratory screen to confirm field tests prior
                                                                                            samples.
                                   to further manipulation of the sample. Two
                                   trained laboratorians should perform a joint               The following list is not comprehensive
                                   initial assessment of the sample in at least             and any appropriate instrumentation should
                                   a Biosafety Level 3 (BSL-3) suite in a Class             be used to test the sample.
                                   II biological safety cabinet or a BSL-2 suite
                                   with a Class III Biological Safety Cabinet
                                   (glove box) in a facility capable of filtering
                                   and protecting against chemical, radiolog-
                                   ical and biological agents. If LRN Biological
                                   and Chemical member laboratories are
                                   co-located and staff are cross-trained in
                                   basic practices, both a biologist and a
                                   chemist should work together to perform
                                   this screening process. If the laboratory has
                                   radiological capability, then a radiochemist
                                   should also be engaged in this preliminary

                                                      EQUIPMENT/TEST                               HAZARD CLASS/COMPOUNDS
                                    Geiger Counter with a Geiger Mueller Probe
                                    (β/γ) and Pancake Probe (α)
                                    -Gamma radiation screening should be con-
                                                                                              Radiation
                                    ducted on the exterior of the package.
                                    -Alpha/beta radiation screening should be con-
                                    ducted on the sample before it is split.
                                    Explosives Kit                                            Explosives and Oxidizers
                                       E.L.I.T.E Tickets                                      Explosives
                                       DropEx Plus Explosive Detection System                 Explosives
                                    M8, M9 Paper                                              Chemical Warfare Agents
                                                                                              Volatile Organic Compounds/
                                    Gas Meter
                                                                                              Lower Explosive Limit
                                    Oxidizer Test Kit/Strip                                   Oxidizers
                                    Litmus Paper                                              pH, Corrosives, Water Reactivity
                                                                                              Additional Chemical Classifications via
                                    FTIR/Raman
                                                                                              Spectroscopy
                                    Water Reactivity Test                                     Water reactive chemicals
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                        Version 3.0 • March 2018   12

  If preliminary positive results are obtained                         that a separate chain-of-custody form
  from these screening assays, the state or                            should be started for derivative samples.
  local public health LRN member laboratory                            An example of documentation is to note
  should follow existing protocols for subsequent                      that 10 plates, such as 5 chocolate agar
  testing or referral. If all screening assays                         and 5 sheep blood agar, were created

                                                                                                                      HOW TO USE THE ALGORITHMS
                                                                                                                      GUIDELINES ON
  performed are negative for both radiation and                        from sample 1 and were delivered by
  explosives, accession the sample into the                            Person A and received by Person B at X
  LRN-B Reference laboratory for further testing.                      time. Derivative or secondary evidence
  Take into consideration results for all tests to                     can often be properly decontaminated and
  ensure proper PPE, air filters, fume hoods or                        destroyed after testing is complete (see
  other protection equipment is used.                                  Sample Preservation 8.0.2).

     9.1.1 Prior to performing any labora-                             It is critical to maintain chain-of-custody
     tory analyses, the sample may be split to                         on each sample. If chain-of-custody is not
     allow for biological, chemical and other                          maintained, this may severely jeopardize
     testing. To maintain chain-of-custody for a                       law enforcement prosecution of suspected
     split sample, a laboratory should create a                        perpetrators. Note: If chemical, biological,
     new chain-of-custody form and document on                         and radiological laboratory facilities are
     the new form the creation of an additional                        not co-located and biological testing is
     sample identification number on the original                      negative and the need exists for chemical
     form. For example, if a powder comes into                         testing or it is requested, the sample
     the laboratory (sample 1) and is immedi-                          should be appropriately packaged and
     ately split for biological and chemical testing                   transported to a laboratory capable of
     then the new samples would be 1.0 and 1.1.                        such testing.
     Each additional split must also be noted and
                                                                       Note: For credible threat samples sub-
     given a unique identification. If the sample
                                                                       mitted by the FBI, be sure to consult
     1.1 is split again, the resulting samples
                                                                       with the WMD Coordinator regarding the
     would be identified as 1.1 and 1.2. This type
                                                                       testing being requested. Per FBI policy, no
     of splitting identifies each sample individu-
                                                                       chemical testing should be performed on
     ally and avoids the issue of disappearing
                                                                       credible threats by LRN laboratories.
     identifiers such as splitting 1 into 1.1 and
     1.2, where item 1 seems to disappear. As                           • Minimum Sample Size Requirements
     long as records are kept and a logical iden-                         for Biological Analysis:

     tification is used, chain-of-custody is main-                         If there is bulk liquid or solid, save 1

     tained. Each time any portion of the sample                           milliliter of liquid or a swab of solid

     changes hands or is transferred chain-of-                             material. Acceptable sample types for

     custody must be completed and maintained.                             biological testing include swab, wipe,
                                                                           liquid, powder, HEPA sock and filters.
     For derivative or secondary evidence such                             First responders should consult with
     as plates, slants and cultures, a similar                             their LRN-B Reference level laboratory
     system can be employed. The general rule of                           to determine additional acceptable
     thumb still holds that as long as records are                         sample types.
     kept in a logical system and documented at
                                                                        • Minimum Sample Size Requirements
     each step, then chain-of-custody is main-                            for Chemical Analysis:
     tained. Guidance from the FBI (see Appendix                           Save 1-2 milliliters or 1-2 grams (pea-
     A for an example form) laboratory suggests
13                               Association of Public Health Laboratories Model Practice

                                        size) of remaining, unprocessed sample                policies. Consult with the LRN-C laboratory
                                        in a sealable glass container. First                  to determine capability for chemical threat
                                        responders and state or local public                  agent analysis.
                                        health LRN-B Reference level labora-
                                        tories should consult with the state or             12.0
                                                                                            AGENT SPECIFIC CONFIRMATORY TESTING
     HOW TO USE THE ALGORITHMS
     GUIDELINES ON
                                        local public health (LRN-C) or state radi-
                                        ological laboratory to verify testing capa-           12.0.1		 LRN-B Reference level laboratories
                                        bility and sample size requirements.                  will perform agent specific confirmatory
                                                                                              testing per existing protocols.
                                  10.0
                                  SAMPLE IS SENT TO THE LRN-B                               13.0
                                  REFERENCE LABORATORY AND TESTED FOR                       REPORT CONFIRMATORY TESTING RESULTS
                                  BIOLOGICAL THREAT AGENTS
                                                                                              13.0.1		 Report positive and negative
                                     10.0.1		 Perform the LRN-B Reference
                                                                                              results using LRN-B Reference level
                                     level protocol for Environmental Sample
                                                                                              notification and data messaging policies
                                     Processing for Bioterrorism Agents Panel,
                                                                                              as well as your laboratory specific communi-
                                     PCR Screening and Ricin Toxin TRF Testing
                                                                                              cation policies.
                                     and begin culturing for microorganisms.
                                                                                               • Sample Disposal
                                  11.0                                                           Biological: Upon completion of all
                                  PRELIMINARY POSITIVE LABORATORY                                tests and depending on the needs
                                  RESULT                                                         of the requestor, sample may be
                                     11.0.1		 Report preliminary positive                        returned to submitter, referred to
                                     results using LRN-B Reference level                         another laboratory or destroyed using
                                     notification and data messaging policies                    an autoclave. All sample disposal
                                     as well as your laboratory-specific                         procedures should comply with federal
                                     communication policies.                                     guidancex and the select agent regula-
                                                                                                 tion.xi Note: The original sample should
                                     11.0.2		 Consult with your laboratory
                                                                                                 be kept for evidence unless specified by
                                     director and biological, chemical and/or
                                                                                                 an appropriate source.
                                     radiological terrorism coordinators terrorism
                                     coordinators to determine if there is a need           14.0
                                     for chemical or radiological threat agent              SAMPLE SENT FOR CHEMISTRY ANALYSIS
                                     analysis. If testing is determined necessary,          Additional federal guidance is needed to deter-
                                     the sample should be prepared for chemical             mine what chemical analyses should
                                     testing using appropriate personal protec-             be performed. APHL developed this algorithm
                                     tive equipment (PPE) and biological safety             to assist laboratories with analyzing these
                                     hoods/rooms.                                           suspicious non-clinical samples for
                                                                                            chemical threat agents.
                                  11.1
                                  PRELIMINARY NEGATIVE                                      Sample submitters should consult with the
                                  LABORATORY RESULT                                         LRN-C laboratory to determine testing capa­
                                     11.1.1		 Report preliminary negative                   bilities. Upon receiving a request, the LRN-C
                                     results using LRN-B Reference level notifica-          laboratory should ensure the Laboratory
                                     tion and data messaging policies as well               Director, LRN-B Coordinator, and FBI WMD
                                     as your laboratory specific communication              Coordinator are contacted and consulted.
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                           Version 3.0 • March 2018   14

  LRN laboratories have different capabilities                          15.1
  for chemical testing and may not be able to                           Microscope / IR/ Raman.
  perform certain methods. Laboratories should                          Fourier-Transform Infrared (FTIR) techniques,
  not accept any sample that is beyond their                            either FTIR-Microscopy or FTIR coupled with
  analytical capability or ability to accept, store,                    Raman will allow library screening, which

                                                                                                                         HOW TO USE THE ALGORITHMS
                                                                                                                         GUIDELINES ON
  and analyze the sample safely. If this situation                      may provide compound specific or mixture
  occurs, they should contact another LRN lab                           specific classification. This technique is not
  that has the ability to perform the requested                         effective on most metal/metalloid com-
  testing method or the CDC LRN- C through                              pounds and dilute and/or complex mixtures.
  the LRN Help Desk or DEOC. The labora-                                Few LRN-C laboratories have this capability
  tory must have trained personnel available                            and instrumentation.
  to perform the requested testing and these
  laboratorians should have competency assess-                          15.2
                                                                        Solubility Tests. More traditional
  ments for the methods in place before any
                                                                        wet chemistry techniques will provide gen-
  samples are tested. If the LRN lab can per-
                                                                        eral classification of materials (liquid or
  form chemical testing, the sample is sent to
                                                                        solid). Coupled with FTIR results, potential
  the LRN-C labora­tory for analysis for chemical
                                                                        structure elucidation is possible. Most
  threat agents. The sample initially is classi-
                                                                        LRN-C laboratories have this capability, but
  fied according to general chemical class. If
                                                                        may not have a standard written protocol or
  additional analysis is needed to either confirm
                                                                        reagents available.
  the identity of the material or classification,
  it is completed after the initial classification.                     15.3
  All results are reported using the appropriate                        Colorimetric Tests.
  laboratory and network reporting mechanisms.                          Wet chemistry colorimetric techniques, such
  Note: EPA has a program with National                                 as a hazard classification test, can be used
  Homeland Security Research Center called                              to determine chemical class and/or provide
  Standardized Analytical Methods (SAM)                                 hazard recommendation. Most LRN-C labo-
  for Environmental Restoration Following                               ratories have this capability, but may not
  Homeland Security Events. These analytical
                                        xii
                                                                        have a standard written protocol or reagents
  methods may be used to determine the                                  available.
  chemical involved in the event or to confirm
  field screening results.                                              15.4
                                                                        XRF (solids only).
  15.0                                                                  X-ray fluorescence (XRF) is widely used
  GENERAL CHEMICAL COMPOUND                                             for elemental analysis, particularly in the
  CLASSIFICATION                                                        investigation of metals, glass, ceramics and
  This first level of testing provides a general                        building materials. Detector types vary, and
  chemical classification, such as acidic inor-                         can include gas flow proportional counters,
  ganic compound, volatile organic compound,                            sealed gas detectors, scintillation counters
  carbonate salt, cyanide or fluoride compound,                         and semi-conductor detectors. Most LRN-C
  etc. Depending on the instrumentation and                             laboratories do not have this capability or
  material in question, a specific chemical or                          instrumentation.
  class may be identified. If the capability exists,
  chemical identification should be performed.
15                               Association of Public Health Laboratories Model Practice

                                    15.5                                                    17.0
                                    Other Techniques (NMR, GC/MS, etc.) –                   PERFORM CHEMICAL CLASS
                                    dependent on availability.                              OR AGENT SPECIFIC CONFIRMATORY
                                    These techniques will be dependent on the               TESTING USING SAM OR OTHER METHODS.
                                    availability of instrumentation, expertise and          This is broken down into 10 general high
     HOW TO USE THE ALGORITHMS
     GUIDELINES ON
                                    material available for testing. Many LRN-C              priority categories of materials. See also
                                    laboratories do not have this capability                Appendix C.
                                    or may not have a written protocol
                                    or reagents available.                                    17.1
                                                                                              Explosives – (corresponds to US DOT
                                  16.0                                                        Class 1 – Explosives).
                                  DETERMINE IF FURTHER CLASSIFICATION                         This includes materials, such as Diazonium
                                  OF THE MATERIAL IS NEEDED.                                  salts, Nitro compounds, Perchlorates,

                                    16.1                                                      Peroxides, RDX, etc. Recommended
                                    No further classification is needed                       instrumentation for this category is FTIR
                                    Consult with your laboratory director and FBI             Spectroscopy, Ion Mobility Spectroscopy
                                    WMD Coordinator (if applicable) to deter-                 (IMS) and calorimetry. At present,
                                    mine how to report results. Note: A central-              most LRN-C laboratories do not have
                                    ized mechanism, LIMS or other electronic                  instrumentation.
                                    data reporting capability, is still needed to
                                    report non-clinical chemical test results.
                                    Report results using LRN Notification and                 17.2
                                                                                              Non-Volatile Organic Compounds – (this does
                                    Data Messaging Policies if clinical speci-
                                                                                              NOT correspond to US DOT Class 2 – Gases)
                                    mens are tested.
                                                                                              This category includes materials such
                                    16.2                                                      as pharmaceutical and environmental
                                    Additional Classification is needed                       contaminates or toxins. Recommended
                                    Identify likely analytical targets based upon             instrumentation for this category includes
                                    preliminary and first responder results.                  Liquid Chromatography Tandem Mass
                                    Select the appropriate methods available to               Spectrometry (LC/MS/MS), Ultraviolet-
                                    the laboratory. Consult with your laboratory              Visible Spectroscopy (UV/Vis) or
                                    director and FBI WMD Coordinator (if appli-               Fluorescence spectroscopy. At present,
                                    cable) to determine how to report results.                some LRN-C laboratories have LC/MS/MS;
                                    Note: A centralized mechanism, LIMS or                    most laboratories do not have Fluorescence
                                    other electronic data reporting capability,               or UV/VIS spectroscopy.
                                    is still needed to report non-clinical chem-
                                                                                              17.3
                                    ical test results. Report results using LRN
                                                                                              VOCs/SVOCs – (corresponds to US
                                    Notification and Data Messaging Policies                  DOT Class 3 – Flammable Liquids and
                                    if clinical specimens are tested. Determine               Combustible Liquids).
                                    if analysis can be completed within the                   This category includes volatile and semi-
                                    selected laboratory or requires referral to               volatile materials. Recommended instru-
                                    another laboratory.                                       mentation for this category includes
                                                                                              Gas Chromatograph-Mass Spectrometry
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                           Version 3.0 • March 2018   16

     (GC/MS), Solid Phase Micro Extraction                              Fluorine, Hydrogen cyanide, Hydrogen
     (SPME)-GC/MS, and purge and trap GC/MS.                            sulfide, Methane, Ozone, Phosphine,
     At present, LRN-C laboratories have GC/MS                          Phosgene, Radon, etc. Recommended
     instrumentation; however, not all laborato-                        instrumentation varies for this category, but
     ries have purge and trap GC/MS capability.                         in general is calorimetric, GC/MS, GC-FID

                                                                                                                         HOW TO USE THE ALGORITHMS
                                                                                                                         GUIDELINES ON
                                                                        or GC-NPD. LRN-C laboratories have GC/MS
     17.4
                                                                        capabilities; however, most do not have the
     Metals and Element Compounds –
                                                                        appropriate autosampler, such as a SUMA
     (corresponds to US DOT Class 4 –
     Flammable Solids).                                                 canister or Tedlar bag introduction system.
     This category includes metals (Arsenic,
                                                                        17.7
     lead, cadmium, mercury, chromium, other
                                                                        Radiochemicals – (corresponds to US DOT
     heavy metals, etc.) and elemental com-
                                                                        Class 7 – Radioactive Materials).
     pounds (non-metals, transition elements,
                                                                        This category includes a variety of radio-
     etc.). Recommended instrumentation for
                                                                        chemicals, such as Polonium-210, Radon,
     this category includes Inductively Coupled
                                                                        Uranium, etc. Recommended instrumenta-
     Plasma Mass Spectrometry (ICP/MS), Liquid
                                                                        tion includes Gamma Spectroscopy, Alpha
     Chromatography Inductively Coupled Plasma
                                                                        Spectroscopy and Liquid Scintillation
     Mass Spectrometry (LC-ICP/MS), as well as
                                                                        Counting techniques. At present, few LRN-C
     older techniques such as graphite furnace
                                                                        laboratories have basic capabilities and
     atomic absorption (GFAA) spectroscopy. At
                                                                        limited capacity. The state Conference
     present, LRN-C laboratories have ICP/MS
                                                                        for Radiation Control Program Directors
     instrumentation, but not all laboratories
                                                                        (CRCPD) group may have the capability or
     have LC-ICP/MS or GFAA capability.
                                                                        instrumentation necessary for this testing.

     17.5                                                               17.8
     Inorganic Compounds – (generally corre-                            Acid/Bases – (corresponds
     sponds to US DOT Class 5 – Oxidizers and                           to US DOT Class 8 – Corrosives).
     US DOT Class 9 – Miscellaneous).
                                                                        This category includes corrosive materials,
     This category includes ionic compounds
                                                                        such as acids (either single or mixed) and
     (such as cyanides, sulfides, phosphates,
                                                                        bases (either single or mixed) and can
     etc.). The recommended instrumentation for
                                                                        be either organic or inorganic corrosive
     this category includes Ion Chromatography
                                                                        materials. Recommended instrumentation
     (IC), Ion Chromatography Mass Spectrometry
                                                                        includes FTIR and wet chemical techniques
     (IC-MS), FTIR and other techniques, such
                                                                        (such as pH, indicators, titrations, etc.). At
     as XRF, Raman or MP. At present, most
                                                                        present, most LRN-C laboratories do not
     LRN-C laboratories do not have this
                                                                        have FTIR capabilities or instrumentation.
     instrumentation.
                                                                        17.9
     17.6                                                               Pesticides – (does not correspond to US
     Toxic Gases – (corresponds to US DOT                               DOT Class 9 – Miscellaneous).
     Class 6 – Toxic Substances, specifically
                                                                        This category includes pesticides, herbi-
     Division 6.1 Toxic or Poisons).
                                                                        cides, fungicides, insecticides, etc., such as
     This category includes toxic asphyxiant,
                                                                        Carbamates, Organo-phosphates, haloacetic
     explosive, acute or chronic effects, or gases,
                                                                        acids, etc. Recommended instrumentation
     such as Ammonia, Chlorine, Carbon mon-
                                                                        varies, but primarily includes GC, GC/MS
     oxide, Cyanogen chloride, Diazomethane,
17                               Association of Public Health Laboratories Model Practice

                                     and LC/MS/MS. At present, LRN-C labo-                  Radiological: Consult the Integrated
                                     ratories have GC/MS capabilities, but not              Consortium of Laboratory Networks (ICLN)
                                     all laboratories have GC and LC/MS/MS                  Laboratory Logistics Limiting Issues Report
                                     capabilities.                                          for potential solutions to waste disposition.

                                                                                            Training Requirements
     HOW TO USE THE ALGORITHMS
     GUIDELINES ON
                                     17.10
                                     Chemical Warfare Agents – (this is a sepa-             To ensure consistent implementation of this
                                     rate category and does not directly corre-             guidance, it is strongly recommended that
                                     spond to any US DOT Hazard Class).                     the following training courses be conducted
                                     This category is broad and includes known              on an annual basis or more frequently as
                                     and suspected Chemical Warfare Agents,                 needed by the local jurisdiction:
                                     such as Vesicants, Mustards, Blister Agents,
                                                                                            1. First Responder Outreach and
                                     Organophosphate Nerve Agents, cho-
                                                                                               Cross-Training in Laboratory and
                                     linesterase inhibitors, choking agents, etc.              Field Environments. It is important
                                     Recommended instrumentation includes                      to develop and implement national
                                     GC/MS and LC/MS/MS. At present, LRN-C                     training and competency assessment
                                     laboratories have GC/MS capabilities, but                 programs (e.g., proficiency testing,
                                     not all laboratories have GC and LC/MS/MS                 certification) for first responders
                                                                                               involved in responding to all-hazard
                                     capabilities.
                                                                                               threats. Cross-training should
                                     18.0                                                      include ASTM Standards E2770-17
                                     REPORT RESULTS.                                           and ASTM E2458-17.

                                  All results (positive or negative) should be              2. Preliminary Laboratory Screening –
                                  reported to the appropriate network and/or                   chemists and other laboratorians may
                                                                                               not be familiar with the stringent
                                  organizations utilizing your laboratory specific
                                                                                               requirements for working in a BSL-3
                                  communication policies. At present, LRN-C
                                                                                               or Class III BSC. As such, joint training
                                  does not have a reporting mechanism for                      for biologists and chemists is essential
                                  non-clinical samples. All results should be                  to ensure employee safety and adher-
                                  reported up the proper chain of command                      ence to laboratory protocols. Laboratories
                                  and to the local WMD Coordinator and local                   are encouraged to cross-train on the
                                  law enforcement as deemed necessary. The                     All-Hazards Receipt Facility Protocol.
                                                                                               Currently, training is offered through the
                                  Environmental Response Laboratory Network
                                                                                               Wadsworth Center in Albany, New York,
                                  (ERLN) is still expanding laboratory partici-
                                                                                               http://www.wadsworth.org/programs/
                                  pation and developing the Electronic Data                    ed/biodefense/training.html.
                                  Deliverable (EDD) for reporting. ERLN requires
                                                                                            3. Class III Biological Safety Cabinet Training
                                  a Basic Ordering Agreement (BOA) to be in
                                                                                               – many laboratorians do not work in a
                                  place prior to utilization of the laboratory and/
                                                                                               Class III BSC on a routine basis. Annual
                                  or method.                                                   training on the Class III BSC is vital to
                                                                                               ensure proper use of this equipment.
                                     Sample Disposal
                                     Chemical: Upon completion of tests, follow             4. Radiation detection equipment training
                                     Material Safety Data Sheet (MSDS) guide-                  – many laboratories may not be trained
                                                                                               on the proper equipment and procedures
                                     lines and consult safety officer for guidance
                                                                                               for testing samples for radiation. Annual
                                     to dispose of remaining sample.
                                                                                               training and refresher courses should be
                                                                                               conducted for this function.
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                        Version 3.0 • March 2018   18

   I. GENERAL: GUIDANCE FOR PROPER USE                               II. RECEIPT OF PROPERTY FORM:
   OF CHAIN-OF-CUSTODY FORM                                          A. This form must be completed, signed,
   A. The custodian is responsible to maintain                          providing date and time, upon the receipt
      and collect additional chain-of-custody                           of evidence. Both the laboratory and the
      documentation generated at the                                    law enforcement official will retain a copy

                                                                                                                       CHAIN-OF-CUSTODY GUIDANCE
                                                                                                                       APPENDIX A
      laboratory.                                                       of the completed form.

   B. The laboratory will maintain originals                         B. This form must be completed, signed and
      (copies if necessary) of all chain-of-                            dated upon the release of evidence to a
      custody documentation and provide                                 law enforcement official. Both the labo
      originals to law enforcement officials upon                       ratory and the law enforcement official will
      transfer of evidence. Copies should be                            retain a copy of the completed form.
      maintained by the laboratory for its
                                                                     C. Description information should include
      records.
                                                                        the following information for each
   C. In the event that custodianship of the                            and every item:
      evidence is split, due to sampling of a                            1. Unique identifier for each item
      specimen or the transfer of one or more                            2. Number/quantity
      items, the chain-of-custody forms must                             3. Type/description
      be initiated, maintained and transferred
      with that portion of evidence; the                             D. If multiple items are received, all items
      custodians receiving and releasing                                must be listed on the form or attached.
      the sample or item will keep a copy of the                        Each item should be assigned a unique
      Receipt of Property form.                                         identifier (e.g., number). The original
                                                                        identifier should be maintained on the
   D. The chain-of-custody documentation                                chain-of-custody records for any sample/
      should be considered confidential/classi-                         portion of that item.
      fied information; it should be maintained
      in a secure location.                                          E. The name of the carrier/courier and
                                                                        the shipping/reference number should be
                                                                        recorded if item(s) are delivered by a
                                                                        carrier/courier.

                                                                     F. Additional information may be attached
                                                                        as appropriate (e.g., original source/
                                                                        submitter, collected by, emergency
                                                                        contacts, situational information).
19                               Association of Public Health Laboratories Model Practice

                                  III. CHAIN-OF-CUSTODY FORM:
                                  This form must be signed and dated when transferring custody within the laboratory, from the
                                  initial receipt of the evidence, through the processing, storage, and release of the evidence to
                                  a law enforcement official.
     CHAIN-OF-CUSTODY GUIDANCE
     APPENDIX A
                                  RECEIPT FOR PROPERTY RECEIVED/RETURNED
                                  Case ID:________________________________________________________________________

                                  Collection/Sampling Date:_____________________________ Time:______________________

                                  Collected/Sample Taken By: ______________________________________________________

                                  Organization: ___________________________________________________________________

                                  Address: _______________________________________________________________________

                                  ______________________________________________________________________________

                                  City, State:______________________________________________________________________

                                  Phone:_________________________________________________________________________

                                  Description of Sample/Evidence:___________________________________________________

                                  ______________________________________________________________________________

                                  ______________________________________________________________________________

                                  ______________________________________________________________________________

                                  This Chain-of-Custody form remains with the sample/evidence at all times. By signing this form,
                                  all parties verify the sample/evidence is attended at all times.

                                  Received from: _________________________________________________________________

                                   (sign/date/time)

                                  Received by: __________________________________________________________________ _

                                   (sign/date/time)
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample    Version 3.0 • March 2018   20

  CHAIN-OF-CUSTODY FORM
  Case ID #:_________________________

  Date:_______________________________________________ Time:______________________

                                                                                                    CHAIN-OF-CUSTODY GUIDANCE
                                                                                                    APPENDIX A
  Transfer From (print/sign):________________________________________________________

  Transferred To (print/sign):________________________________________________________

  Security Method while held:_______________________________________________________

  Date:_______________________________________________ Time:______________________

  Transfer From (print/sign):________________________________________________________

  Transferred To (print/sign):________________________________________________________

  Security Method while held:_______________________________________________________

  Date:_______________________________________________ Time:______________________

  Transfer From (print/sign):________________________________________________________

  Transferred To (print/sign):________________________________________________________

  Security Method while held:_______________________________________________________

  Date:_______________________________________________ Time:______________________

  Transfer From (print/sign):________________________________________________________

  Transferred To (print/sign):________________________________________________________

  Security Method while held:_______________________________________________________

  Date:_______________________________________________ Time:______________________

  Transfer From (print/sign):________________________________________________________

  Transferred To (print/sign):________________________________________________________

  Security Method while held:_______________________________________________________

  Additional Comments or Instructions:_______________________________________________
21                                   Association of Public Health Laboratories Model Practice

                                       (LRN) FOR BIOLOGICAL (LRN-B) AND                         pathogens. When sentinel clinical laboratories
                                       CHEMICAL (LRN-C) TERRORISM                               cannot rule out the presence of a biological
                                       PREPAREDNESS                                             terrorism agent, they refer specimens and
                                       The Laboratory Response Network (LRN),                   isolates to an LRN-B Reference laboratory.
                                       the nation’s premier laboratory system                   The Reference laboratories, made up of over
     RESPONSE NETWORK (LRN)
     DESCRIPTION OF THE LABORATORY
     APPENDIX B
                                       for identifying, testing and characterizing              170 state and local public health, military,
                                       potential agents of biological and chemical              international, veterinary, agriculture, food and
                                       terrorism, was founded in 1999 by the                    water testing laboratories, are responsible for
                                       Centers for Disease Control and Prevention               performing complex analyses and providing
                                       (CDC), the Association of Public Health                  support to law enforcement for threat inves-
                                       Laboratories (APHL) and the Federal Bureau               tigations. In the years since its inception,
                                       of Investigation (FBI). This integrated network          the LRN-B has played an instrumental role in
                                       of laboratories is a unique asset in responding          improving public health infrastructure (e.g.,
                                       to all-hazard threats, providing immediate and           staffing, laboratory equipment) by helping to
                                       sustained laboratory testing and communica-              boost laboratory capability and capacity, and
                                       tion to respond quickly to acts of chemical              by responding to real threats in a timely and
                                       or biological terrorism, emerging infectious             efficient manner. At the apex of the pyramid
                                       diseases and other public health threats and             are national laboratories, such as those at the
                                       emergencies.                                             CDC and the Department of Defense. These
                                                                                                laboratories test and characterize samples
                                       LRN FOR BIOLOGICAL TERRORISM                             that pose challenges beyond the capabilities
                                       PREPAREDNESS (LRN-B)                                     of Reference laboratories, and provide support
                                       The LRN-B is comprised of National, Reference            for other LRN members during a serious out-
                                       and Sentinel laboratories forming a tiered               break or terrorist event.
                                       network (see Fig. 1). At the foundation are
                                       thousands of sentinel clinical laboratories,
                                       which perform initial screening for potential

                                         Figure 1: LRN Structure
                                         for Biological Threats
                                         Preparedness
Algorithm and Guidelines for Responding to an Incident Involving a Suspicious Non-Clinical Sample                             Version 3.0 • March 2018   22

   THE LABORATORY RESPONSE                                            LEVEL 3 LABORATORIES
   NETWORK FOR CHEMICAL TERRORISM
                                                                      Although every network member participates
   PREPAREDNESS (LRN-C)
                                                                      in Level 3 activities, only nine laboratories
   The LRN-C was established in 1999, and                             are designated as Level 3 laboratories. These
   comprised CDC and four public health labora-                       seven laboratories work with hospitals and

                                                                                                                         RESPONSE NETWORK (LRN)
                                                                                                                         DESCRIPTION OF THE LABORATORY
                                                                                                                         APPENDIX B
   tories (New York State Department of Health,                       other first responders within their jurisdiction
   Wadsworth Center; CA State Public Health                           to maintain competency in clinical specimen
   Laboratory; VA Division of Consolidated                            collection, storage and shipment.
   Laboratory Services and Michigan Public
   Health Laboratory). In 2000, New Mexico                            LEVEL 2 LABORATORIES
   Department of Health, Scientific Laboratory                        Thirty-five laboratories are designated as Level
   Division joined the network. These labora-                         2 laboratories within the LRN. These laborato-
   tories use methods that are based on mass                          ries can detect exposure to a limited number
   spectrometry and are quantitative, detecting                       of toxic chemicals—such as cyanide or toxic
   the actual chemical agent, or more common, a                       metals—in human specimens, such as blood
   metabolite of the agent, in urine or blood.                        or urine.

   Today there are 55 LRN-C members (CDC and
                                                                      LEVEL 1 LABORATORIES
   54 public health laboratories). All labs are
   qualified to package and ship clinical samples.                    Ten laboratories in the nation are Level 1

   Thirty-five laboratories have the capability                       laboratories. These laboratories can detect

   to test for exposure to nine different threat                      an expanded number of chemical agents

   agents. Ten laboratories have expanded capa-                       in human specimens, including all Level 2

   bility to test for exposure to an additional four                  laboratory analyses plus analysis for mustard

   threat agents, and have expanded capacity to                       agents, nerve agents and other toxicants that

   provide 24/7 analytical analyses in the case of                    could be used in chemical warfare. These

   a large scale event. (See Fig. 2).                                 laboratories are intended to provide the CDC
                                                                      with much needed surge capacity during a
                                                                      large scale event.

                                                                    9

                                                                                  9
                                                                        5

    Figure 2: LRN Structure for
    Chemical Terrorism Preparedness
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