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The EMF-K Laboratory Experience

The EMF-K Laboratory Experience. By LCDR L. N. Griffin With contributions from LT C. Baker, LCDR D. Baker & LT E. Angelo 22 Mar 2010. EMF. Welcome to EMF-Kuwait. A US Army facility run by the US Navy-GO NAVY.

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The EMF-K Laboratory Experience

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  1. The EMF-K Laboratory Experience By LCDR L. N. Griffin With contributions from LT C. Baker, LCDR D. Baker & LT E. Angelo 22 Mar 2010

  2. EMF • Welcome to EMF-Kuwait. • A US Army facility run by the US Navy-GO NAVY. • Lots of sand and heaven forbid, do not get caught anywhere without your “glow” belt. The ultimate joke: the military spends millions to make you camouflaged; only to wear a glow belt so everyone can see you! Hmmm..go figure!

  3. Training • Training Consisted of: • Weapons (9mm) qualification • IED detection • TCCC-again for most HMs! • Land Navigation • First Aid • Survival Skills • ISO Container Construction • LOTS of downtime!!

  4. EMF-K DET ECHO ECHO ECHO • LT Charles Baker volunteered after tour in Japan • Summer 2007-Winter 2008 • 32nd St • Camp Pendleton • March, AFB; WA, Maine, Germany-30 hrs • 2 days of thorough L seat/R seat

  5. EMF-K DET ECHO ECHO ECHO

  6. EMF-K DET ECHO ECHO ECHO • SWOT: Personnel, BB, TMC merger (N/A) Supply chain, heat & dust • MWR: Qatar-1st beer in 4.5 months! Simultaneous USA-USN football game. Who won? Gooooo Navy!

  7. DCSS The One of One All Star Team! • Laboratory • Optometry • Pharmacy • Physical Therapy • Radiology From left to right: LT Boyd, PT; LCDR Griffin, Lab; LCDR Kras, Pharmacy; CDR Bergren, Radiology; LCDR Hicks, Optometry; HMC Gamboa, DCSS SEL.

  8. OUTLINE • Taking care of yourself: Mind, Body & Spirit • Structured five day turnover • Your mailing address • How do I call home? • When do I eat at the DFAC? • Admin notes: Working hrs, meetings, evals, awards, BPAs, OPMs, Cmd website, etc. • Most commonly called numbers • Chain of Command • S-Shops/MTF (“Behind the wire”) • Supply lessons learned • Important forms and procedures • History • Talking points for DV tours • Daily routine • Personnel • Supply & equipment • Reference labs • IT • Excel tracking database • Medically related tours • Reports and frequencies • Daily blood inventory report • Oh by the way…! • New blood bank, WBDP and MASCAL procedures • SWOT • Accomplishments • Resources • Questions?

  9. Taking Care of Yourself • Keep in constant touch with family members and friends. • http://www.aafes.com/ems/euro/arifjan.htm • Mind: Library, Woodshop, MWR, Mental Health COPE classes, Qnet wireless internet (I-Bldg, Starbucks) and free video chats. • Body: 24/7 Gym, no excuses! Pool, free bicycle rental & MWR. • Spirit: Z1 Church services of all types at 0830, 1000, 1200, 1400… • Plan for and take your R&R midway! You’ll need it!

  10. Pool and Woodshop

  11. R&R to QATAR • Finally all the change of command protocol was done and over with and the last group to Qatar was on the way! Four whole days of NOTHING!! • Of course a sandstorm as we left…how fitting!

  12. Qatar

  13. Qatar

  14. Structured MT 5 day Turnover • Day 1: Lab, hospital and base tour • Day 2: Outlying TMC Tour • Days 3 & 4: Reference Lab Tours (Hadi, ICL, United, KCBB, Embassy-optional-PA source of medical intel) • Day 5: Verbal exchange with power point of pending challenges, opportunities for improvement, lessons learned, oh by the ways, electronic and paper files • Upon completion, Incoming and Outgoing MT sign PQS/Turnover Checklist & Equipment list • Turn over MT duty cell, bldg key & office keys • Provide recommended LOTTD to get off to a good start

  15. Temporary Housing

  16. Open Bay

  17. EMFK/TMC

  18. Your POC Info • Mailing Address: RANK LAST NAME, FIRST NAME EMF-K NAVY APO AE 09366 • TEL: DSN: 318-430-1942Office/1975Lab, CELL: 964-9745, COMM: 011 (965) 389-1942 • E-mail: NIPR (Public E-mail): firstname.middleinitial.lastname@kuwait.swa.army.mil SIPR (Secure or High Side E-mail): firstname.middleinitial.lastname@swa.army.smil.mil • DSN area codes: CONUS 312, Europe 314, Pacific 315 Central Cmd (SW Asia, incl Iraq) 318 • Keep in mind time differences: We are about 7 hrs ahead of East Coast 10 hrs ahead of West Coast, one hour ahead of Europe

  19. How do I call home? • 1. Call your parent Cmd and ask them to transfer, if it’s a local call • 2. Use DSN phone list to obtain local # or call Global DSN 312-560-1110 • 3. Morale call numbers: • 312-639-8909, 98-area code & #, enter code 360971# • Norfolk DSN 312-564-0111 Press 2 • MCRD DSN 312-524-1011 • 312-678-5056, 1, 2, 2, 991-area code, tel# • NHCP Morale DSN 312-365-0026, 3 • 4. Skype.com/MSN.com/Yahoo.com at the I-Bldg, Starbucks, etc. • 5. 800 Calling cards: 312-835-9870, 7, 1-800… • AT&T: 9480-9463-3376, 800#, Code, Tel#

  20.  When do I eat? DFAC Hrs • Breakfast 0500-0800 (except Sundays Z2) • Lunch 1130-1330 • Dinner 1700-2000 (except Z1 = 1930) • Midrats 2330-0100 (only Z 2 & 6)

  21. DFAC • The Dining Facilities became our “family time”. Each day had a special menu at a different zone AND we would all be there to share our day. • Monday, burrito night at Zone 1 • Wed, surf and turf: Zone 2 was the best and closest. • Friday, Mongolian BBQ Zone 6 • Sat, pizza and a movie • Sun brunch-Zone 1 of course, that’s were all the generals ate! That’s how engrained it was, I still remember it!!!

  22. Not so fresh

  23. AJ • Fast Food if you had a hankering….but why when you could eat at the DFAC free and have your choice of 3-4 different meals, 4 times a day PLUS dessert!

  24. Admin Notes • Colors: Salute in the AM with first song and in the evening start salute with second song. • Working Hrs: Mon-Sat 0700-1600. • Phlebotomy no earlier than 0700-0730 no later than 1630-1700. • Meetings: As needed depending on collaterals, DCSS, Lab PI, Wardroom, EOC, space utilization, EPRC, watchbill, etc. • Evals & awards: Process starts 3 months into deployment. Navy awards only. • Renew BPAmemo and draft thank you ltrs. • Command website/POW/tel dir: http://emfk/default.aspx • http://emfk/EMFK%20PHONE%20BOOK/Forms/AllItems.aspx • Weekly OPM renewal. • Transportation currently meets ICL courier at gate.

  25. Most Commonly Called • Lab MT Office: 318-430-1942 • MT Cell: (99 first from DSN line)-964-9745 • LCPO/SEL: 430-2809/99-722-5156 • Lab: 430 (389 from your cell) -1975 • AJ TMC Lab: 430-1801 • NMCSD 312-522-6400 • NHCP 312-365 1288 • LRMC Cyto 314-486-8909/6261 • Hadi Lab 533-9799/RN Fatma 919-3950 • United Dr. Khadije 720-9645 • ICL Felipa’s Cell (Supervisor) 604-7432 • FDPMU 720-9214 (Microscan?) • USAF Lab in Balad, Iraq • CAPT Ciolorito (Larry.Ciolorito@AFIP.OSD.Mil) 202-782-2267, DSN: 662-2267, Fax: ext. 6022 • Central Receiving Shipping Point (CRSP) 649-8656 Dexter Harp, Supervisor • Rock Cargo (Ali) 442-2774

  26. Chain of Command Det G • CO: CAPT Elaine Wagner • XO: CAPT Robin Wilkening • DCSS (CPS): CDR Lorraine Nadkarni • DFA (Senior MSC): CDR Jeanmarie Jonston • SEL: HMC Samuel Henry • (Theater Medical Command) • 1st TSC • 311th

  27. S-Shops/MTF • S-1 Admin (Leave, TAD, etc.) • S-3 Transportation (TAVs, courier, etc.) • S-4 Supply • S-6 IT/Telcom/Radio (K:Hospital/Blood, J: Awards) • MRO is “behind the wire” bldgs 506-7 X6147

  28. Supply Lessons LearnedOrder early, order often! • Be proactive vs reactive. • Keep accurate and all documentation, at all times for all items. • Conduct inventory at least bi-weekly. • Order small quantities daily. • Follow up on every single order after 24-48 hrs of submission. • If DCAM is down, use paper process and ALWAYS follow up. • Always be prepared w/NIR, 3 Quotes, LOJ.

  29. Important Forms & Procedures • POC: S-6/IT for U.S. Member Network Account Processing Form (Check NIPR AND SIPR) • POC Hayko.Worl@AMEDD.ARMY.MIL at DSN 314 486 8828 for LRMC CHCS Access • Know how to change your tel # in Outlook • Know how to create a PST file • Know how to scan a document • Know how to encrypt an e-mail • Direct cultural inquiries to Tom@malki.com • Save all of your e-mails (Sent box and prior to departure)

  30. History • The tent hospital was in use for 4-5 years. There was no space, supplies or any phlebotomy functions performed in the tent hospital Lab. • Billeted for 4 Techs only, in addition to 1 LCPO & 1 Lab Officer. Lab Officer on call 24/7 via command cell phone. Radio on board for MASCAL use. • Lab Officer Det E was the Command Urinalysis Coordinator. • Lab Officer Det F was the DCSS and at least one other Lab Officer was as well (Det D) • DCSS for Det E was the Radiologist. For Det G is a Provider due to the junior ranks of the Lab & Pharmacy Officers. Physical Therapist, Optometrist and Radiologist too busy with patient care for additional responsibility. • LCPO Det F was the Assistant Command Urinalysis Coordinator and SEL. • LCPO Det G is the Command Urinalysis Coordinator and DCSS SEL. • The new hospital was open for business on Easter Sunday, 20 Apr 2008.

  31. Lab Facts or Talking Points for VIP/DV Tours • The most distinguishing feature of our Laboratory department is the fact that we provide 100% of the Blood Bank and Microbiology testing for the USA, USAF & USN in the Kuwait theater. • We recently improved the quality of reference laboratory testing by visiting Kuwaiti Labs and choosing to send our general mailouts to the only College of American Pathologist accredited laboratory in Kuwait, which also provides free daily courier services. • We send histology to the Hadi Clinic downtown, and virology and cytology (PAPs) to LRMC. • We currently average approximately 4200 tests in-house monthly. We are awaiting the arrival of new, floor model, high volume type of equipment with increased capabilities. • In addition to Micro and Blood Bank, which are considered specialized areas, we also provide basic Phlebotomy services, Chemistry, Hematology, Coagulation, Urinalysis and Serology testing. All testing services, whether in house or from a reference lab, are provided 24/7.

  32. Daily Routine • 0700 Morning report • 0715 Blood Inventory Report • 0730 QC Review EMF Lab/Equipment status • 0800-0830 Check outlook/answer COC taskers • 0830-1130 Rounds/Work on projects • Lunch 1130-1230 • 1230-1300 Rounds • 1300 QC Review AJ TMC Lab • 1400-1600 Work on projects

  33. Personnel • Det F survived with 5 Techs because one was reallocated from his duties at the 708th Ambulance Company. He came to us as a motivated HM2 and left as a motivated HM1 • Two Techs extended from Det E, so we had lots of corporate knowledge • One of these two Techs came as an HN, straight out of school, serving as an Admin person at the school house and left here as an HM3 Lab Tech • Lab Tech 1: LPO • Lab Tech 2: ALPO • Lab Tech 3: Supply PO • Lab Tech 4: PM Swing Shift/Trng PO • Lab Tech 5: Night Swing Shift/Safety • 12 hr shifts during R&R and turnover between waves I & II • Techs should not stand command watches! • Techs should cross train at AJ TMC to run Vitros and Advia when the TMC Tech is unavailable Justification for 6 Personnel Phlebotomy duties 0730-1630 Blood Banking requires two Techs at all times for verification procedures Safely multitask between 6 analyzers, the telephone, visitors, couriers

  34. All Equipment on ER Power

  35. Supply & Equipment Issues

  36. How To Choose a Reference Lab • Accreditation • In house test menu • TAT • Quality • Location/distance from core EMF/travel time • Specimen requirements • Test methodologies • Result retrieval mechanisms (fax, online, encryption) • Courier services • Provider satisfaction • All of the above for their reference lab • Cost

  37. Reference Laboratories

  38. IT SystemsDon’t Talk To Each Other!

  39. Excel Tracking Database It is the responsibility of all Techs to monitor mail outs TAT and document status during turnover every shift to prevent specimens pending for weeks at a time without follow up.

  40. Medically Related Tours • AJ TMC/Walk in Refer/Host Nation Office/OIC/XO/DH • AJ TMC Annex • Dental • Refrigerated Conex • Room Temp Conex • FDPMU • WRU / WTP • TMCs: Buehring, VA, Ali USN & USAF and KNB • KCBB • Hadi • ICL • United • Embassy

  41. Off Base Trips • We had a few trips off base at the beginning, then due to the tragedy with our fellow MSC officers, all off base trips were stopped. All trips required a chase vehicle and tight security checks.

  42. Reports & Frequencies

  43. DailyBlood Inventory Report • Lab Techs conduct inventory at midnight • Use actual paper inventory to update electronic blood report • Log on to SIPR using first name.middleinitial.last name (BloodReport08$$) • Click on my computer, access K: drive • Then Hospital folder, EMF Blood Report • Det “G” 2008 Month (Aug) folder • Access yesterday’s file, update and save as today’s date • When inserting lines in the inventory by type, right click on shaded bar so the formula will work • Add new unit numbers to the bottom of the list in accordance with exp date • Open Outlook’s latest sent file, reply all and insert today’s report • Change the message title to today’s date • Change the body of the message to reflect today’s date • Delete any extra info and insert any pertinent comments

  44. Oh BTW…! • Any Legal inquiries from Provost Marshall, attorneys and others must go through the front office & Legalman 1st. • Host Nations and Kuwait reference laboratories are closed on Fridays. • Hadi will not fax us results, but ICL will. However, we don’t have a working fax in EMF. • Supply has to rotate between FedEx and DHL. As of recently, we are now utilizing DHL to send specimens out. • Dry ice shipments arrive automatically every Tuesday. • BTC in Qatar automatically resupplies us and we send left overs to Balad for Bucca or where ever as needed. • Base transportation delivers our blood shipments to us, but we have to go to Ali to send to Balad. Can’t leave until the air craft leaves in case it doesn’t take off for some reason. • Get clues for I-Stat & simulators for triage. • The QC card for the Act T Diff 2 works for the Act 10. • Implement use of micro QC organisms. There’s a $250 Influenza Wizard box in the admin rm from FDPMU. • Need rotors for centrifuges, CO2 regulator, polarizing lens for microscope. • Good luck with ever getting the Vitros 250 on board! • A Joint Standardization team came in early Aug and recommended disapproval of Bactec and Vitek purchase. • Evals and awards are done 3 months into the deployment! If it has not happened, it will be removed! • Biowaste is taken to the TMC. ASG has the contract. • We do not do command urinalysis for the USA nor paternity testing. • HM2 Demegillo wants to host a Bone Marrow Drive and HM2 Owen will be at NAVLEAD on 01 Sep (x2wks). • Draw extra tubes when sending to France via ICL/United to prevent lost in transit issues. • Ensure containers are labeled vs lids per Hadi. • Can’t result tissues in CHCS because we need a Pathologist (options encrypted email, paper delivery, LRMC). • Avoid batch testing when possible because it delays the TAT. • All formulas may not be correct in the blood report if you don’t use the “shaded” line to insert rows. • Discourage the Fleet from dropping off their HIVs here due to shipping materials and result retrieval challenges. They should collect, spin, separate, freeze and deliver to a large MTF or TPC en route. • No PDHA blood draws at this time! • When Techs extend, they only get one eval. Important to follow up. • Attend defensive driving course after online and paper tests, cultural awareness class on Friday Ams and woodshop safety brief. • Remind Pharmacy to order glucometer controls for wards and TMCs.

  45. New BB & MASCALProceduresWBDP • All Techs must have a verifier for their blood banking procedures from beginning to end (not just ABO/Rh, Cx too!) • Preserve O type blood at all costs • Phlebotomy must be performed ASAP and Type specific blood issued as first choice • Units sent with patients are documented as a shipment (eliminates f/u on disposition) • No Cryo or FFP used to date • Avg of 0-2 Tx/month (Jul 08 was unsual)

  46. Laboratory DepartmentStrengths Outstanding staff! Corporate Knowledge: HM2 Owen. All Blood Banking & Microbiology for Kuwait (USA, USAF & USN). CAP & AABB accredited reference Labs, ICL/United/LRMC and KCBB respectively. 46

  47. Laboratory DepartmentWeaknesses Staffing, if billets (4) not increased (6) for future dets Small, low volume POCT equipment Limited space for expansion of provider desired capabilities and sustainment (vs. EMF) mission Reference Lab TAT and procedures outside of our control (QCRs) Appropriate mechanism to give providers pathology results Qatar TAT for re-supply during MASCAL Reliance on MRO & KCBB working together for prompt resupply during MASCAL WBDP not implemented x 3 Dets 47

  48. Laboratory DepartmentOpportunities for Improvement Provider satisfaction surveys Staffing quantities and quality (experience) SOPs ^SLG Intermecprinters TAR (Transfer Auto Result) ^ WRM Capturing additional workload in CHCS Ordering specimens in CHCS prior to delivery & transport specimens in biohazard bags Warm transfers of specimens for accountability & TAT Standardized Hematology instrumentation in Kuwait (share parts, reagents, back ups in AOR) Supply chain drop shipments/Ordering reference books Micro reporting (certifying no growth daily, adding drugs/MRSA) CHCS Test files (interpretation, ref ranges, cpt codes, units, ref labs, etc.) 48

  49. Laboratory DepartmentThreats & Vulnerabilities Constantly changing procedures based on fluctuating individual provider preferences (ping-pong effect/mission creep) Supply system TAT from Qatar, Germany, U.S. USA/USN relationships Relationship with local reference laboratories Lack of Embassy sponsored blood drives for KCBBx1yr Contacting Techs without cell phones after hrs for MASCAL 49

  50. AccomplishmentsServing the Fleet and the Forward Deployed • Improved quality of reference laboratory services by switching to CAP accredited laboratory • Established relationship with Kuwait Central Blood Bank for MASCAL and CENTCOM Joint Blood Program Officer • Successfully completed transition from Tent Hospital to New Facility and successfully absorbed AJ TMC’s workload • Improved mail-outs, supply tracking and QC review • Obtained additional permanent (1) and temporary (3) personnel for assistance • Improved PAP TAT • Technical Assist Visit to all 5 BMCs (TMCs) • Identified equipment for the Command’s wish list that will reduce mail-outs and eliminate manual procedures. • Camp Buehring analyzer repairs • I-STAT clue software & CHCS workload capture • USS Cleveland supply assistance & USS Tarawa technical assistance • Djibouti Lab consultation • Creation of Lab divisions for CHCS merger & dual visibility within both systems • Access to LRMC CHCS • Successfully completed multiple VIP Tours • GC/Chlamydia by DNA • Chicken pox evolution • Document scanner in Lab • Cross trained LPO in AJ TMC Lab

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