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1 st AML – First Team Out

1 st AML – First Team Out. Area Medical Laboratory (AML) Capabilities and Applications LTC Ken Pell, Jr., XO 1 st AML Office: 410-436-4156 robert.pell@us.army.mil. Agenda. 1st/9th Area Medical Laboratory History Mission Operation Personnel Equipment/Capability

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1 st AML – First Team Out

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  1. 1st AML – First Team Out Area Medical Laboratory (AML) Capabilities and Applications LTC Ken Pell, Jr., XO 1st AML Office: 410-436-4156 robert.pell@us.army.mil

  2. Agenda • 1st/9th Area Medical Laboratory • History • Mission • Operation • Personnel • Equipment/Capability • Alternate configurations • Planning considerations

  3. History 520th Theater Army Medical Laboratory (TAML) Deactivates in 2004 under Medical Re-engineering initiative (MRI) and is replaced by: 1st Area Medical Laboratory (AML) 9th Area Medical Laboratory (AML) 520th TAML had a clinical mission. 1st and 9th AMLs do not.

  4. Area Medical Laboratory(AML) Mission Deploy world-wide as a unit or by task-organized teams to perform surveillance, confirmatory analytical laboratory testing and health hazard assessments of environmental, occupational, endemic and CBRNE threats in support of force protection and WMD missions.

  5. Application AMLs test air, water, soil, food, waste and vectors (insect, animal, blood) for a broad range of microbiological, radiological, chemical contaminants under two basic scenarios: 1) As a level 4 field laboratory in support of theater operations • When samples cannot be transported to a fixed facility in less than 24 hours or results are needed in less than 20 days. • Able to support multiple PM Detachments with surveillance oversight, sample management, and rapid laboratory analysis. 2) In contingency operations, for example after WMD use • Immediate hazard identification (presumptive or ‘field confirmatory’ laboratory analysis) in high risk environments with chemical or biological agent contamination, epidemic disease or industrial contamination. • In the initial stages of supporting energetics analysis

  6. COMMAND HQ Staff Analytical Chemistry Environmental Surveillance Analytical Microbiology AML Organization Total: 19 Officers + 24 Enlisted = 43 Full Time: 6 Officers + 24 Enlisted = 30

  7. Presumptive or “Field Confirmatory “ Analysis Identification; some quantification OEH Surveillance Oversight Screening Tests Portable assays Routine Sample Input PM DET USACHPPM Field Drinking Water Testing Chemical Warfare Agents; Toxic Industrial Compounds; Toxic Industrial Materials USAMRICD ECBC Air, Soil, Water, Food, Waste, Vectors Sample Processing Radiologic Materials USACHPPM • Other Sample Input: • 20th SUPCOM*; customer complaints Bio-Warfare Agents; Endemic/Epidemic Disease USAMRIID * 20th SUPCOM: 22d Chem BN & 110th Chem BN manage Technical Escort Unit (TEC Escort) for WMD agents/munitions AML Process Definitive Analysis

  8. Tailored Teams • AML – PAX 43 25,000 ft3 / 9 vehicles / 380,000 lbs • Expeditionary AML – PAX 15 13,500 ft3 / 4 vehicles / 178,000 lbs After PREPO vehicles, power, ECUs: 4,500 ft3 / 67,000 lbs • Section (heavy either C,B,R/N) – PAX 5-8 6,500 ft3 / 3 vehicles / 65,000 lbs After PREPO vehicles, power, ECUs: 1,800 ft3 / 20,000 lbs

  9. Chemistry Section Personnel * PROFIS

  10. Chemistry Section • Sample extraction to provide accurate screening and presumptive identification of unknown chemical contaminants (TICS/TIMS) using GC-MS, GC-ECD and GC-FPD. • Thermal desorption of solid sorbent tubes (tenax or DAAMS) for the purpose of monitoring air with a Dynatherm ACEM 900 in combo with GC-MS. • Focus on extremely low level (ppm-ppb) presence of chemical warfare agents G agents (nerve), V agents (nerve) and HD (blister). Capabilities

  11. Chemistry Section • Determination of unknown bacteria utilizing gas chromatographic analysis (GC-FID) of cell membrane fatty acids following culture of the bacteria on blood/agar (MIDI). • Evaluation of soldier exposure to nerve agent by analyzing for plasma cholinesterase inhibition using the Test-mate Kit from EQM Research. Capabilities

  12. Chemistry Section Gas Chromatograph with Mass Selective Detector • Selective and Sensitive Detection and Identification of Chemical contaminants in samples prepared using multiple extraction techniques. Presumptive level analysis based on matching derived spectra to those in spectral libraries.

  13. Chemistry Section Gas Chromatograph with Flame Photometric Detector • Extremely Sensitive Detection of chemical contaminants containing phosphorus or sulfur (ie. Nerve and/or blister agent) in samples prepared using multiple extraction techniques. Utilized as a screening technique; sample management tool.

  14. Chemistry Section MIDI System • Identification of unknown bacteria by analysis of cell membrane fatty acids. Complementary to techniques utilized by Endemic Disease Section (ie. PCR, ECL). • Particularly helpful in identification of background bacterial flora. Can be used as a parallel system for identification of endemic disease agents.

  15. Chemistry Section Test-mate Kit from EQM Research, Inc. Determination of Soldier exposure to Nerve agent by measuring whether acetylcholinesterase levels are suppressed. Determined from finger stick. 5 min test. CAUTION. Nonspecific (exposure to organophosphate pesticides can lead to AChE inhibition). Only capable of screening small groups of soldiers.

  16. Microbiology Section Personnel * PROFIS

  17. Microbiology Section Analytical Methods Nucleic Acid based assays RAPIDS (Real-time PCR) JBAIDS (Real-time PCR) Gel based PCR Antibody based assays Electrochemiluminescence (ECL) Immunohistochemistry (IHC) ELISA Bacterial culture Bacterial identification Antibiotic susceptibility (Microscan platform) Gamma-phage (Bacillus anthracis)

  18. Microbiology Section • Provides real-time PCR analysis • 32 test capacity • Screening analysis completed in 4-5 hours (includes specimen preparation and testing) • Reagents come from USAMRIID and JPEO-CBD Critical Reagents Program RAPID Analyzer BW ANALYSIS (PCR)

  19. Microbiology Section Joint Biological Agent Identification and Diagnosis System (JBAIDS) • Real-Time PCR analysis • Machine pre-programmed with standard protocols for all analytical assays • 32 test capacity • Sample extraction kits provided for: blood, stool, soil, liquid, swipe, culture, tissue, vegetative matter, food • Reagents come from Idaho Technology, Inc. BW ANALYSIS (PCR)

  20. Microbiology Section BioVeris M1M Analyzer • Electrochemiluminescence (ECL) antigen detection • 96 test capacity • Run completed in about 1 hr • Reagents come from USAMRIID and JPEO-CBD (Critical Reagents Program) BW ANALYSIS (ECL)

  21. Microbiology Section • Immunohistochemistry (IHC) Cryostat (Leica CM1100) • Frozen tissue sections for IHC • Identification of BW agents • Identification of endemic disease agents • Supports • Vet Pathology (animal pathology) • Occ/Env Health (endemic disease surveillance)

  22. Microbiology Section Microscan Analyzer • Bacterial Identification and antibiotic susceptibilities • most Gram (-) • most Gram (+) • Analysis total time ~24hrs from sample receipt, depending on isolate

  23. Environmental Surveillance Section PROFIS Officers * PROFIS

  24. Environmental Surveillance Section Assigned Personnel

  25. Environmental Surveillance Section • Ambient Air Monitoring • Drinking Water Surveillance • Toxic Industrial Compounds/Materials • Entomological Services • Occupational \ Industrial Hygiene Services • Radiological Surveillance • Food service inspection Core Capabilities

  26. Environmental Surveillance Section Particulate Sampling • Deployable Particulate Sampler (DPS) System • PM10 & PM 2.5 Volatile Sampling • SKC pumps Ambient Air

  27. Environmental Surveillance Section Bacteriological Testing • Bact-T (CFU) • Collilert (Presence / Absence) Drinking Water • Requirements • Incubator needs AC Power • Replacement Media

  28. Environmental Surveillance Section Chemical Testing • HACH DR4000 • Portable spectrophotometer for analysis of metals and inorganics • Chemetrics Colormetric Test Kits • Cyanide 0-1.0 ppm • Arsenic 0-10 ppb • Hach Arsenic Test Kit • 10 ppb or greater Drinking Water

  29. Environmental Surveillance Section Hazmat ID System • Can be operated in a dirty environment • Utilizes IR technology • Capable of presumptively identifying • WMD - nerve and blister agents • WMD precursors • Toxic industrial chemicals • Forensic drugs • White powders • Explosives • Common chemicals • Pesticides TICs and TIMs • Limitations • Sample must have a covalent chemical bond • Target must comprise > 10% of sample • Can not definitively identify biological agents

  30. Environmental Surveillance Section • Arthropod Surveillance and ID • Mosquitoes, ticks, filth flies, biting flies, fleas etc. • Rodent and small animal trapping • Handheld vector testing assays Entomology Services

  31. Environmental Surveillance Section • Air Analysis Tools • Agilent GC-MS • HAPSITE Portable GC/MS • TMX 412 multi-gas monitor • Miran SaphIRe • Occupational Health • Air Data Multimeter • Quest Sound Level Meter • WBGT Heat Stress Monitor • Carbon monoxide monitor Industrial Hygiene

  32. Environmental Surveillance Section • DNBI Monitoring/Outbreak Investigation • MC4 system • Epidemiological Computing • CDC Statistical Surveillance Software Epi Info 2000 • Microsoft package Epidemiology

  33. Environmental Surveillance Section • AN PDR 77 Radiac Set • Alpha, X-ray, beta and gamma radiation • DART Multi channel analyzer • portable gamma-spectroscopy • Identifinder • Portable handheld gamma spectrometer • Liquid Scintillation Counter (wipe tests) • TFIA Series High Volume Air Sampler • Radio-particulate characterization Radiological Surveillance

  34. Command/Staff * PROFIS Personnel

  35. 17 Personnel (5 Officers, 12 Enlisted) Lab Officer 71E O-5 Biomed Info Mgmt 70D O-3 Med Log SGT 68J Headquarters Microbiologist 71A O-4 Med Lab NCO 68K30 Med Lab NCO 68K20 Med Lab SPC 68K10 Med Lab SPC 68K10 ESO 72D O-4 Prev Med NCO 68S20 Prev Med NCO 68S20 Hlth Phys NCO 68S20N4 Biochemist 71B O-4 Med Lab NCO 68K30 Med Lab NCO 68K20 Med Lab SPC 68K10 Med Lab SPC 68K10 Environmental Surveillance Chemistry Microbiology Expeditionary Laboratory Organization

  36. Tailored Teams • AML – PAX 43 25,000 ft3 / 9 vehicles / 380,000 lbs • Expeditionary AML – PAX 17 13,500 ft3 / 4 vehicles / 178,000 lbs After PREPO vehicles, power, ECUs: 4,500 ft3 / 67,000 lbs • Section (heavy either C,B,R/N) – PAX 5-8 6,500 ft3 / 3 vehicles / 65,000 lbs After PREPO vehicles, power, ECUs: 1,800 ft3 / 20,000 lbs

  37. Questions 1st AML Commander COL Peggy Carter, CDR 1st AML Office: 410-436-4857 DSN 584-4857 peggy.carter@us.army.mil 9th AML Commander COL Terrell Blanchard, CDR 9th AML Office: 410-436-7143 DSN 584-7143 terrell.blanchard@us.army.mil

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