SPECIAL SECTION: THE LABORATORY RESPONSE NETWORK
Ready or Not: 20 Years of Chemical Threat Preparedness
by Amy D. Watson, PhD, Emergency Response Branch, National Center for Environmental Health, Department of Laboratory Services, US Centers for
Disease Control and Prevention and Jennifer N. Liebreich, MPH, manager, Environmental Health
In 1999, the US Centers for Disease
Control and Prevention (CDC) funded
four state public health laboratories to
expand laboratory capacity to prepare
for a potential national terrorism event
involving chemical agents such as sarin
gas and sulfur mustards. In the years
that followed, other local and state public
health departments identified the need
for similar response capabilities in their
own jurisdictions. In 2002, APHL convened
a 50-state meeting—now called the “Ready
or Not” meeting—to assess the nation’s
readiness for chemical threats. APHL
brought together key stakeholders from
state and local public health laboratories,
CDC, DoD, the US Environmental
Protection Agency (EPA) and FBI to identify
target areas for improving national
chemical threat preparedness:
• Create a national laboratory network
• Expand national analytical laboratory
testing capabilities and capacity
• Develop standardized protocols for
emergency response
• Strengthen partnerships.
During the meeting, state and local
laboratories volunteered to become a part
of what is now known as the Laboratory
Response Network for Chemical Threat
Preparedness (LRN-C). Today, LRN-C
laboratories are in all 50 states, three
major US cities and Puerto Rico. Currently,
84% of Americans live within 100 miles of
an LRN-C laboratory, increasing national
preparedness for high-threat chemical
agents.
Originally designed for CDC surge capacity
during large-scale chemical terrorism
events, today’s LRN-C serves a crucial
role in local chemical responses across
the country. Over the last 20 years, LRN-C
labs have responded to public health
situations related to arsenic in private
wells in Alaska, toxic metals in local
rivers in Colorado, per-and polyfluoroalkyl
substances in drinking water in upstate
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LAB MATTERS Fall 2019
The LRN-C in-person meetings
allow CDC to provide critical
communications regarding new
technical approaches for addressing
emerging chemical threats such as
those observed in the current U.S.
opioids crisis.”
Dr. Rudolph C. Johnson, CDC/Emergency
Response Branch
New York, and the ongoing lead crisis
in Flint, Michigan. These agile testing
capabilities can all be attributed to the
strong partnership between CDC and
APHL.
An Agile Network, A Sharing
Network
The APHL and CDC cooperative agreement
partnership has been integral to the
growth and support of the LRN-C.
Retaining a competent, well-trained
workforce has always been a challenge
because of high employee turnover rates
in the local public health sector. This is
especially true for LRN-C laboratories,
which employ highly specialized,
sophisticated methodology for identifying
chemical threat exposures in human
samples.
When LRN-C mass spectrometers were
approaching the end of their service life
in 2018, APHL worked with equipment
vendors to ensure comparable equipment
configurations and pricing were made
available to member laboratories. LRN-C
laboratories also receive support for
research, vendor traineeships, equipment
maintenance contracts and travel to
LRN-C meetings through the cooperative
agreement.
APHL facilitates the LRN-C Biannual
Technical Meetings held in the fall and
spring of each year to provide LRN-C
laboratories with programmatic updates
Chemical Threat Agents
Found in Synthetic
Marijuana (2018)
Following six suspected cases of synthetic
marijuana poisonings, the Wisconsin LRN-C
Level 1 laboratory began developing a method
to detect the anticoagulant brodifacoum.
Brodifacoum is described as a “super-
warfarin” and was originally designed to
be used as a rodent poison. As new cases
emerged daily, CDC’s Emergency Response
Branch, Division of Laboratory Sciences
provided the state lab with internal standard
to assist with the method development. Within
a couple of weeks, the Wisconsin lab was
able to develop and validate a quantitative
brodifacoum method in blood specimens. At
the close of the Spring 2018 outbreak, more
than 200 hospital cases in over 10 states
were reported.
from CDC, technical training and guidance
on laboratory response planning. The
meetings enable LRN-C laboratories to
network and build relationships and share
best practices for partnership engagement
with local preparedness and response
stakeholders such as Weapons of Mass
Destruction (WMD) coordinators, senior
health officials and civil support teams.
Thanks to APHL’s continued support
for these meetings, the LRN-C Biannual
Technical Meetings have observed
increasing record attendance each year. n
Through our LRN-C relationship
with CDC, we were able to rapidly
obtain the materials needed for this
important national response.”
Noel Stanton, Wisconsin State
Laboratory of Hygiene
PublicHealthLabs
@APHL
APHL.org