Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical WarfarePreparing, Shipping, and Storing SpecimensCare must be taken not only when gathering samplesfor testing but when preparing them for transport.What follows are the basic guidelines for readying,transporting, and storing samples.LabelingSpecimens should be labeled in accordance with thestanding operating procedures of the receiving laboratoryto ensure forensic integrity. The labels shouldbe as comprehensive as possible and double-checkedfor accuracy. Label samples with the facility of originand clear markings resistant to water and refrigerationor freezing conditions. Labels should also includepatient identification information (name or other specificidentifiers), date and time of collection, specimenidentity, and some identification of the collector. Alist of samples with the corresponding names of individualsshould be maintained at the facility of originand should also be included with the samples if theyare shipped. Wrap each sample top with waterproof,tamper-evident, forensic evidence tape, being carefulnot to cover the sample identification labels.PackagingFor blood, separate each tube from the others orwrap individually to prevent direct contact. Tubesshould be placed in secondary packages, such as adivided box wrapped with absorbent material andsealed inside a plastic bag, other sealable containers,or individually wrapped tubes sealed inside a plasticbag. Place absorbent material between the primaryreceptacle and the secondary packaging. Use enoughabsorbent material to absorb the entire contents ofprimary receptacles. To facilitate processing and identification,package blood tubes so that similar tubes arepackaged together (eg, all purple tops together). Forurine, wrap frozen cups with absorbent material andplace them into sealable secondary packaging, suchas those described for blood. Do not ship frozen urineand blood in the same package.Shipping ContainerThe shipping container should be a sealable, polystyrenefoam or other insulated container capable ofmaintaining the contents at the preferred temperaturefor the specimens. For cushioning, place additional absorbentmaterial in the bottom of the outer containers.For samples that require refrigeration conditions, suchas whole blood, add a layer of frozen cold packs andplace the secondary containers on top of the cold packs.Place additional cold packs or absorbent material betweenthe secondary containers to reduce movementwithin the container. Lastly, place a layer of frozencold packs on top of the secondary containers. Whenshipping frozen samples (plasma, serum, urine), adda layer of dry ice on top of the cushioning material inthe bottom of the shipping container. Do not use largechunks of dry ice for shipment because they could shatteritems during transport. Place additional absorbentmaterial between wrapped urine cups to reduce theirmovement within the outer container. Finally, add anadditional layer of dry ice.Documentation (Shipping Manifest, Incident Report,Chain-of-Custody)Prepare separate documentation for each containershipped. Prepare and place a shipping manifest designatingsample identification numbers, quantity, andtype in a zippered plastic bag on top of the specimensbefore closing and sealing the container. Maintain acopy of the manifest at the point of origin. Enclosean incident report form with as much information aspossible describing the incident, providing the dateand time of suspected exposure, detailing the onsetand description of symptoms, sample collectiontime, and suspected agent involved. Include patientinformation, such as name, social security number,age, and gender, as well as a point of contact. Theincident report form should be stored in a zipperedplastic bag on top of the specimens before closing andsealing the container. A chain-of-custody form mustalso be included. Prepare a separate chain-of-custodyform for samples in each container. Indicate sampleidentity, any pertinent descriptors, and the numberof samples. Place the completed chain-of-custodyforms in a plastic zippered bag on the outside of theshipping container.ShippingClose and secure the outer container with filamentousshipping or strapping tape. Affix labels and markings.Place a label on the outer container that indicatesthe proper name, “Diagnostic Specimens.” For thosecontainers with dry ice, place a Class 9 (dry ice) labelon the outer container. This label must indicate theamount of dry ice in the container, the address of theshipper, and the address of the recipient. This labelmust be placed on the same side of the container asthe “Diagnostic Specimens” label.740