5-9. General
Laboratory services must continue their support role even under
NBC conditions. For the provision of clinical and diagnostic
support, the facility must be located in a contamination-free
area or be inside collective protection. Designated laboratories
within the theater will analyze NBC samples/specimens (including
in theater field confirmation identification of biological agents
by evaluating specimens from symptomatic patients and animals
and environmental samples collected from the AO). See Appendix
B for procedures in collecting biological samples/specimens,
handling/packaging, maintaining chain of custody, transporting
samples/specimens, and analysis.
5-10. Level II
Laboratory support at this level is extremely limited; it consists
of laboratory procedures in direct support of MTF and FST
activities. Laboratory personnel prepare collected suspect NBC
specimens for submission to the supporting laboratory for analysis;
the specimens are forwarded to supporting medical laboratories
(Appendix B).
5-11. Level III
Laboratory support in a CSH is intended for providing clinical
laboratory support and is primarily in support of acute surgical
cases, blood services, and statim (STAT) services required for
intensive care operations. Only extremely limited microbiology
services (parasitological exams and gram stains) are provided. In
a mature theater, the microbiology services may be augmented to
include limited cultures and sensitivity testing. Patients with
documented or suspected exposure to NBC weapons/agents will be
medically evaluated, specimens will be collected, packaged, and
have chain of custody established. The specimens will be forwarded
through technical channels to the supporting medical laboratory
(such as the theater Army medical laboratory [TAML]) for analysis.
See Appendix B for specimen collection, packaging, chain of
custody, and processing requirements.
5-12. Level IV
_a._ _Clinical Laboratories._ The clinical laboratories in the
combat support, field, and general hospitals have the ability to
perform a general, but limited, array of analytical procedures in
hematology, urinalysis, chemistry, microbiology, serology, and
blood bank. Patient specimens of suspected biological or chemical
agent exposures are forwarded through technical channels to the
supporting medical laboratory. See Appendix B for sample/specimen
collection, packaging, chain of custody, processing, and
transporting requirements.
_b._ _Field Laboratories._
(1) _Theater Army Medical Laboratory._ The TAML is the specialized
echelons above corps (EAC) laboratory that provides clinical and
nonclinical medical laboratory support. When equipped and staffed,
the TAML provides in-theater field confirmation identification
of NBC samples or specimens. Using sophisticated equipment and
methods, the TAML has the capability to detect and identify NBC
agents in a variety of specimens/samples (such as human, air,
soil, water, animals, vegetation, and food). Direct support from
continental United States (CONUS)-based laboratories aids the TAML
with identification of NBC agents. Command decision on use of
protective/preventive measures and patient care may be based on the
TAML findings. Proper collection, packaging, and rapid shipment
of specimens by MTFs and samples from other sources will ensure
effective, timely, and accurate laboratory analyses.
(2) _Area Medical Laboratory._ The Area Medical Laboratory (AML)
is the specialized laboratory within the theater that provides
nonclinical medical laboratory support. The AML can be deployed in
the corps or to EAC for support missions. When fielded, the AML
will replace the TAML in the force structure. The AML provides
in-theater field confirmation identification of NBC samples or
specimens. Using sophisticated equipment and methods, the AML has
the capability to detect and identify NBC agents in a variety
of specimens/samples (such as human, air, soil, water, animals,
vegetation, and food). Direct support from CONUS-based laboratories
aids the AML with identification of NBC agents. Command decision
on use of protective/preventive measures and patient care may be
based on the AML findings. Proper collection, packaging, and rapid
shipment of specimens by MTFs and samples from other sources will
ensure effective, timely, and accurate laboratory analyses.
5-13. Level V (Continental United States)
Designated Level V medical laboratories perform analyses to
provide definitive identification of suspect biological agents for
the President and Secretary of Defense purposes. The definitive
identification of suspect biological agents also aids commanders in
the AO in maintaining the health of their command.
5-14. Field Samples
Chemical corps personnel collect environmental, air, soil, and
vegetation samples. Preventive medicine personnel collect samples
from drinking water sources and supplies. Veterinary personnel
collect samples from food supplies and medical specimens from
animals. All other units collect soil, vegetation, and small
animal samples for laboratory analysis. Samples are subjected to
initial screening with rapid test kits and in-theater confirmatory
identification at the supporting medical laboratory. The President-
and Secretary of Defense-required definitive identification
is performed at the designated Level V medical laboratory.
Comprehensive databases will be maintained to provide historical
testing results and will aid in the AO commander's decisions to
conduct operations in an NBC environment. See Appendix B for
specific procedures for sample collection, packaging, transporting,
maintaining chain of custody, and analysis.