SubscribeThis article introduces a new era for Environmental and Medical Testing.
The threat of biological warfare coupled with naturally occurring diseases like avian influenza, severe acute respiratory syndrome (SARS), and leishmaniasis are causing governments to rethink their approach to biological defense. Traditionally, militaries around the world have separated biological defense from medical readiness. However, pandemic threats are capable of producing as much, if not more, devastation than a direct bio-attack. Consequently, military environmental and medical missions need more unity while maintaining their distinct technological and operational needs.
Environmental soldier commands, which predominantly include environmental engineers, are responsible for biodefense. These commands handle point detection, remote sensing systems, collective protection, and contamination avoidance. The goal is to detect the threat early and to accurately posture troops and avoid casualties while maintaining high mission readiness. It is no secret that troops in gas masks and full personal protective gear are severely hampered and cannot keep that posture for long durations. Therefore, specific detection and sampling technologies need to have high mean time before operational failure (MTBOF) due to the nature and environment of the deployment. Commanders must also place the technology using mission and technology understanding. 
Environmental sampling uses either routine testing or post-detection sampling to take samples from relatively clean sources (air, water, or swab samples). These types of samples are fairly clean and require less sample preparation than blood or tissue samples, or samples that have large amounts of solids associated with them. Antibody test strips and other immuno-based methodologies are often used as the primary screen. The main technological advantage to this method is speed and ease of use, though it is at the expense of sensitivity and specificity. To confirm initial testing, technicians use polymerase chain reaction (PCR) followed by culture. This follow-on PCR can be performed in minutes (a critical requirement when force protection is the primary goal)providing additional strategic information for commanders. Current real-time PCR systems are engineered to be rugged, stand-alone, and low maintenance.
In contrast to environmental missions, physicians and other medical professionals handle medical missions. Medical detection or diagnosis uses more sophisticated technologies that have a high level of sensitivity and specificity but require longer time to results and more complex sample handling. The primary mission of this area is treatment after infection or perceived infection. Antibody tests such as enzyme-linked immunosorbent assay (ELISA) and antibody test strips are still used for medical testing; however, there is a move to more advanced molecular-based technologies like PCR or microarrays. Genetic-based tests offer higher quality information about the pathogen or even the immune response of the host. This information coupled with the clinical manifestation of the disease increases the possibility of saving lives.
There are limitations to genetic-based tests, including a perceived high initial capital cost and higher technical training of the user. With recent advances in sample preparation techniques and automation, the time-to-result gap between environmental and medical tests is narrowing, as well as the need for complex sample manipulation. Some PCR results, including sample prep, can be accomplished in less than 30 minutes. Along with diagnosis and treatment, these technologies can be used for forensics. Generating much more specific data, technicians can identify data such as pathogen subspeciation and pathogen antibiotic resistance patterns. However, only with culture can you determine if the pathogen is alive or dead. Because medially based tests are performed in relatively stable environments, the MTBOF is not as critical. Technicians have access to the technology and can do maintenance and services not available to the stand-off technologies discussed earlier.
Environmental and medical technologies have very distinct advantages and disadvantages for each particular mission. The growing trend is to develop technology that can be used across the entire spectrum of need, technology for both environmental and medical testing. For example, the Joint Program Executive Office for Chemical and Biological Defense of the United States Department of Defense developed and is fielding the Joint Biological Agent Identification and Diagnostics System (JBAIDS) around the world. JBAIDS tests both environmental and medical samples ranging from whole blood to air samples including food testing like tuna salad and lettuce - 16 different types of samples in all.
The goal of the program is to offer as much flexibility as possible to commanders and to cast a wide net over biological threats. To achieve this goal, capabilities are added as they become available, with a strong emphasis on getting solutions to the field quickly and then improving on them when applicable. In addition to its assay capabilities, this innovative program offers limits of sensitivity and specificity related to medical use but has engineering and design requirements associated with field testing. Thus, this new system may be used for testing environmentally sampled pathogens in the morning and diagnosing blood samples later in the day, a revolutionary concept that keeps the technology consistent and gives commanders a tremendous amount of flexibility and confidence. Although the same technology is used for medical and environmental tests, the results are handled much differently. There is a defined environmental reporting process that is different from medical tests, which are governed by the U.S. Food and Drug Administration (FDA).
Currently, scientists are developing SARS and avian influenza tests for the JBAIDS system: tests for both environmental and clinical samples. As the system grows, so do the types of the missions it will be used for. Natural disasters like Hurricane Katrina and the tsunamis of the Pacific Rim are excellent examples of naturally occurring tragedies that need both medical and environmental support. There are distinct advantages of being able to test water to make sure it is safe to drink and to test wounds of injured people to identify possible infection.
It is critical to get technology out in use as early as possible. When leadership has that vision, inevitably the users and populace benefit. It allows the system to fully mature in an operational environment and gives users more of a stake in success. As far as technology, there is nothing more important than operational performance and the ability to offer users flexibility and value.
