Point-of-Care Testing Value Proposition for Disaster Preparedness in Small-World Networks

Objective The 2004 earthquake/tsunami devastated Southeast Asia. We studied point-of-care testing (POCT) and O2 saturation monitoring in Phang Nga, hardest hit southern coastal province, to develop preparedness strategies for low-resource small-world networks (SWNs). Design, Setting, and Participants Early 2005, we surveyed 4 provinces then, in 2007–2011, focused on Phang Nga with new field/phone/mail/e-mail/fax surveys of 7 primary care units, all 7 community hospitals, and both regional hospitals. We used short- and long-form Thai surveys, photodocumented instruments, and assessed resources. Chiang Rai, unaffected by the tsunami in the north, served as control for pulse oximeter utilization. Results Community hospital laboratories installed electrolyte analyzers. Pulse oximeters increased in Phang Nga, but fell short of the number used in the control province (P < 0.05). Nurses reported uncertainty with calibration. Glucose meters remained common. Community hospital microbiology was deficient. Dengue hemorrhagic fever outbreaks required hourly bedside spun hematocrits for transfusion decisions. Prolonged SWN travel times and ambulance shortages still render transport vulnerable. Helicopters are unavailable. Conclusions Overall, preparedness for medical testing improved significantly. Pulse oximeters to monitor oxygenation status during ambulance transfer, emergency department evaluation, and ventilation became available more widely and, in the future, should be matched by adequate blood gas analyzers for timely O2 saturation validations, plus critical arterial PO2, PCO2, and pH measurements. Quality control education in POCT must parallel increasing use. Continuous noninvasive hemoglobin monitoring of dengue patients could save time when transfusing blood frequently. Value proposition strategies built on post-tsunami advances enhance SWN POCT preparedness, as well as daily emergency care.