Oregon develops transport policy after drill shows gaps

Notify receiving facility, urge isolation precautions

In response to a drill that showed gaps in planning and communication regarding the transportation of potentially infectious agents, Oregon public health officials have adopted new policies, which were originally developed by public health officials in Lane County, OR. The policy is summarized as follows:

Purpose: To provide a transportation and communication procedure that will assure that lab specimens, collected by a health care provider or laboratory within Lane County, which have an urgent Public Health need for immediate transport to and processing at the Oregon State Public Health Laboratory (OSPHL), can be packaged and transported and the information communicated between the provider, sending lab, OSPHL, the Department of Human Services (DHS) Acute & Communicable Disease epidemiologist, and Lane County Public Health outside of normal working hours.

Situation: The Lane County Public Health on call supervisor receives a call stating that there is an immediate need to get a clinical lab specimen to the OSPHL for testing for a disease that has potential to trigger a public health emergency. An example of such a disease would be a specimen from a person who may have a virus capable of causing a highly pathogenic pandemic flu. The call may come in from the health care provider including hospital emergency rooms and clinics, a laboratory within Lane County, the DHS on call epidemiologist, or the OSPHL.

Assumptions:

  1. The need to collect, package, and transport a clinical specimen with potential to trigger a public health emergency and to accurately and efficiently communicate between the collecting provider and lab, the transporter, LCPH, the DHS epidemiologist, OSPHL necessitates joint planning with these agencies.
  2. OML has the capability to correctly collect and package such specimens and will use their own couriers to transport such specimens to OSPHL at all hours.
  3. Health care clinics without OML labs will have limited ability to correctly collect and package such specimens and may contact LCPH, the DHS epidemiologist, or local emergency room providers for information.
  4. Commercial couriers not provided by a laboratory or a public health agency are not certified by the Oregon Department of Transportation to transport hazardous material including lab specimens capable of causing serious illness.
  5. LCPH will not provide direct client testing either at the Health Annex or off site. If the notifying provider or lab is unable to collect and package the specimen to the standards of OSPHL, the client should be referred to an emergency room where the specimen can be collected. Before sending a client with a potentially highly pathogenic and highly communicable disease to an emergency room, the provider MUST notify the receiving facility and the transporting paramedics and request immediate isolation precautions for this client including a negative pressure room if the organism can be spread by droplet or airborne mechanism.

Procedure: When the LCPH on-call supervisor receives the call requesting OSPHL testing for a clinical specimen for a disease with potential to trigger a public health emergency the supervisor will:

  1. Gather the following information from the caller (assuming that the call is from a provider or lab):
    1. name and contact information for the provider or lab;
    2. name and contact information for the client from whom the specimen is to be obtained;
    3. the disease that is to be tested for;
    4. the type of testing requested;
    5. brief description of the clinical situation and reason the clinician is requesting the stat OSPHL testing (For example: Sacred Heart emergency room doctor calls and says they have just received a 20-year-old student in severe respiratory distress who gives a history of work/study travel one week ago in some-province-in-China that has a current outbreak of H5N1 influenza and is on the WHO recommended "Do Not Travel List");
    6. how the provider/lab will transport the specimen to OSPHL and request that they begin their process of setting up a transport;
    7. inform the caller that you will contact the state epidemiologist to request authorization for an after-hours transport to OSPHL for stat testing.
  1. LCPH supervisor then:
    1. contacts the DHS epidemiologist on-call by phone.
      1. provides information from lab/provider;
      2. requests approval for the transport;
      3. requests that:
        1. DHS epidemiologist contact OSPHL on-call person to receive specimen;
        2. DHS epidemiologist have OSPHL on-call person contact LCPH/lab/provider to provide instructions on collecting, packaging, and labeling specimen and determine when and exactly where the transport person will deliver the specimen to OSPHL;
        3. Requests that OSPHL and state epidemiologist notify LCPH immediately of test result (positive or negative).
    2. Calls the LCPH program manager and Public Health Officer to notify them of the situation and consider potential next steps. (In the absence of either of these two people, call the other LCPH supervisors and the H & HS director or designee)
    3. Calls the provider/lab and:
      1. provides information from DHS epidemiologist and OSPHL;
      2. confirms transportation arrangement;
      3. requests that the provider/lab notify LCPH of the test result — positive or negative;
    4. If lab/provider is unable to provide transport LCPH supervisor begins call-down process to locate a LCPH employee who will transport the specimen in a county vehicle.
    5. When the person transporting collects the specimen and leaves for Portland, the on-call supervisor notifies OSPHL of the estimated time of arrival.
  1. When LCPH on-call supervisor receives the test result, notify Public Health Officer and Program Manager (or backup management) and begin next steps as appropriate.