Building Connecticut's clinical biodosimetry laboratory surge capacity to mitigate the health consequences of radiological and nuclear disasters: A collaborative approach between the state biodosimetry laboratory and Connecticut's medical infrastructure

Abstract

Biodosimetry, based on the analysis of dicentric chromosomes in circulating mononuclear cells, is considered the “gold standard” for estimating radiation dose and is used to make informed decisions regarding the medical management of irradiated persons. This paper describes the development of biodosimetry laboratory surge capacity for the health consequences of radiological and nuclear disasters in Connecticut, including: (1) establishment of the Biodosimetry Laboratory for the timely assessment of radiation dosage in biodosimetry specimens; (2) identification of clinical laboratories qualified and willing to process biodosimetry specimens from a large number of victims; (3) training of clinical laboratorians in initial biodosimetry specimen processing; and (4) conducting a functional drill that evaluated the effectiveness of these elements. Descriptive information was obtained from: (1) personal observations; (2) a needs assessment of clinical laboratories in Connecticut; (3) records from a training program of clinical laboratorians in biodosimetry specimen processing that was developed and provided by the Yale New Haven Center for Emergency Preparedness and Disaster Response; and (4) records from a statewide functional drill in biodosimetry specimen processing that was developed and conducted by the State of Connecticut Biodosimetry Laboratory. A needs assessment of clinical laboratories in Connecticut identified 30 of 32 clinical laboratories qualified and willing to perform initial biodosimetry specimen processing. Currently, 79 clinical laboratorians in 19 of these qualified clinical laboratories have been trained in biodosimetry specimen processing. A functional exercise was conducted involving 37 of these trained clinical laboratorians in 18 qualified laboratories as well as the Biodosimetry Laboratory. The average turnaround time for biodosimetry specimen processing in this drill was 199 min. Exercise participants provided feedback which will be used to further optimize biodosimetry specimen processing protocols in Connecticut. Based on our findings, we conclude that clinical laboratory professionals are an important resource for assisting with the processing biodosimetry specimens that are used for triage of patients from accidental or terrorist-related mass-casualty radiological or nuclear catastrophies. The approach described in this paper to enroll and train clinical laboratorians in sample preparation for dicentric analysis forms the basis for the next step (namely, further training on harvesting cultured cells and preparing cytogenetic slides) in collaborative efforts between the State of Connecticut's Biodosimetry Laboratory and the state's medical infrastructure towards building laboratory surge capacity to estimate radiation dose in victims of a mass casualty event.