ASSOCIATION OF PUBLIC HEALTH LABORATORIES MODEL PRACTICE: Algorithm and Guidelines for Responding to an Incident Involving a Suspicious ...
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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
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......................................................................................................................................................241 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 AgentsAlgorithm 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 AgentsGUIDELINES 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 toAlgorithm 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 necessary9 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, appropriatelyAlgorithm 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 chemicalsAlgorithm 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 suggests13 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 SpectrometryAlgorithm 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
PreparednessAlgorithm 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
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