This survey includes a series of questions about the nature, organization, and preparedness for emergencies, was created using Google forms, officially mailed to over 12,000 potential EFLM contacts with an official newsletter to collect responses between May 8 and June 8, 2023. Although obviously not representative of all European countries, the collected data provides an overview of the current situation with respect to laboratory readiness for emergencies

Cadamuro, Janne

Danese, Elisa

Favaloro, Emmanuel J.

Favresse, Julien

Henry, Brandon M.

Jovičić, Snežana

Lippi, Giuseppe

Ozben, Tomris

Plebani, Mario

Thachil, Jecko

Clinical Chemistry and Laboratory Medicine (CCLM)

English

Favaloro, Emmanuel J

Henry, Brandon M

Jovicic, Snezana

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Results of the first survey of the EFLM Task Force Preparation of Labs for Emergencies (TF-PLE)

Giuseppe Lippi

Janne Cadamuro

Elisa Danese

Emmanuel J. Favaloro

Julien Favresse

Brandon M. Henry

Snežana Jovičić

Tomris Ozben

Mario Plebani

Jecko Thachil

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FarFar - Repository of the Faculty of Pharmacy, University of Belgrade

Letter to the EditorGiuseppe Lippi*, Janne Cadamuro, Elisa Danese, Emmanuel J. Favaloro, Julien Favresse,Brandon M. Henry, Snežana Jovičić, Tomris Ozben, Mario Plebani and Jecko ThachilResults of the first survey of the EFLM Task ForcePreparation of Labs for Emergencies (TF-PLE)https://doi.org/10.1515/cclm-2023-0622Received June 14, 2023; accepted June 18, 2023;published online June 29, 2023Keywords: COVID-19; laboratory medicine; pandemic;SARS-CoV-2To the Editor,According to the World Health Organization (WHO), theEuropean region is in a “polycrisis” and “permacrisis” thatgoes far beyond pandemic, climate change, and war [1]. Theongoing coronavirus disease 2019 (COVID-19) pandemic,with hundreds of millions of confirmed cases and over 3million recorded deaths in Europe so far, is another crisisthat has put health at the top of the scientific agenda [2].Then, there is the current monkeypox emergency that iscausing additional international concern [3]. And, finally,there is the devastating war in Ukraine, which unfortu-nately shows no signs of de-escalation and is exacerbatedby horrific attacks on healthcare facilities and providers[4]. Other potentially devastating scenarios include climaticemergencies (tornadoes, thunderstorms, hail), earthquakesand tsunamis, fires, floods, chemical/biological/radiologicalemergencies, plane crashes, terrorism and bioterrorism,civil unrest, and so on. Specifically, with respect to infec-tious diseases, the response capabilities of clinical labora-tories are necessary to ensure the timeliness, completeness,and accuracy of case reporting during outbreaks andenhance feedback and transparency.The past has taught us that laboratory medicine is largelyunprepared formost of these challenges [5–7]. For this reason,the European Federation of Clinical Chemistry andLaboratoryMedicine (EFLM) has decided to establish a Task Force called“Preparation of Labs for Emergencies”, specifically designedto improve preparedness and put into practice appropriatesolutions for laboratory diagnostics in areas impacted byvarious anthropogenic and non-anthropogenic emergencies.Specifically, the terms of reference encompass actions suchas (i) surveying the state of the art in EFLM countries tounderstand the state of laboratory preparedness for emer-gencies across Europe and potentially identify (or establish) abenchmark, (ii) identifying priority areas (i.e., types of emer-gencies) to become specific targets for laboratory medicine inemergencies, and (iii) providing guidance on appropriatestrategies to prepare laboratory medicine facilities for emer-gencies. As a very first step, therefore, the Task Force designeda special survey to gather a wide range of information on thepreparedness of European laboratories for emergencies, theresults of which are reported and discussed here.Giuseppe Lippi, Janne Cadamuro, Elisa Danese, Emmanuel J. Favaloro, JulienFavresse, Brandon M. Henry, Snežana Jovičić, Tomris Ozben, Mario Plebani,and Jecko Thachil contributed equally to this work.*Corresponding author: Prof. Giuseppe Lippi, MD, Section of ClinicalBiochemistry and School of Medicine, University Hospital of Verona,Piazzale LA Scuro, 37134 Verona, Italy, Phone: +39 045 8124308,Fax: +39 045 8122970, E-mail: giuseppe.lippi@univr.it. https://orcid.org/0000-0001-9523-9054Janne Cadamuro, Department of Laboratory Medicine, University HospitalSalzburg, Paracelsus Medical University, Salzburg, Austria.https://orcid.org/0000-0002-6200-9831Elisa Danese, Section of Clinical Biochemistry and School of Medicine,University of Verona, Verona, ItalyEmmanuel J. Favaloro, Haematology, NSW Health Pathology,Sydney Centres for Thrombosis and Haemostasis, ICPMR,Westmead Hospital, Sydney, Australia. https://orcid.org/0000-0002-2103-1661Julien Favresse, Services of Clinical Biology, Clinic Saint-Luc, Bouge,BelgiumBrandon M. Henry, Cardiac Intensive Care Unit, The Heart Institute,Cincinnati Children’s Hospital Medical Center, Cincinnati, USASnežana Jovičić, Department for Medical Biochemistry, Faculty ofPharmacy, University of Belgrade, Belgrade, Serbia. https://orcid.org/0000-0002-6878-8645Tomris Ozben, Department of Medical Biochemistry, Faculty of Medicine,Akdeniz University, Antalya, TürkiyeMario Plebani, University of Padova, Padova, Italy. https://orcid.org/0000-0002-0270-1711Jecko Thachil, Immune Thrombocytopenic Purpura (ITP) Clinic,Haematology Department, Manchester University NHS Foundation Trust –Manchester Royal Infirmary, Manchester, UKClin Chem Lab Med 2023; aopThe survey, which includes a series of questionsabout the nature, organization, and preparedness foremergencies, was created using Google forms (the layoutis still available here: https://docs.google.com/forms/d/e/1FAIpQLScqjqn0w13MrbuXMMg3D66RcdRdwx9hxy3GxoPNEoN2opGMlA/viewform). The survey was officially mailedto over 12,000 potential EFLM contacts with an officialnewsletter to collect responses between May 8 and June 8,Figure 1: Responses to the first survey of the EFLM Task Force Preparation of Labs for Emergencies (TF-PLE).2 Lippi et al.: EFLM survey2023. Responses were downloaded into an Excel spreadsheetand analyzed graphically.During the one-month period, 235 responses werecollected, 200 of which were from European countries andrepresented the basis for the following analyses. Mostresponses came from Italy (20.0 %), followed by Serbia(9.0 %), Turkey (6.5 %), Spain (5 %), Croatia, Romania,Lithuania (all 4.0 %), while each other single countrycontributed <3 %. Most respondents were from publiclaboratories (78 %) and worked in general laboratories(74.5 %) that also perform urgent/stat tests (88.5 %). Most ofthese laboratories performed <1 million tests per year(42.0 %), followed by laboratories performing between 1and 4 million tests per year (32.0 %), while 15.5 % of allrespondents worked in large laboratories performingmore than 8 million tests per year.Responses regarding the availability of a recovery planat the national, hospital, or laboratory level are shown inFigure 1A. After subtracting “I don’t know” responses, themajority of respondents indicated that a recovery plan existsfor selected emergencies across all the three healthcaresettings (47–49 %), while approximately 20 % of respondentsindicated that no recovery plan exists.We then ranked the responses to the question “Rankthe threats that aremore likely to disrupt the function of yourlocal laboratory based on organization and geographicallocation” adding the “moderately likely” and “likely” options.It was found that epidemics/pandemics and heat waves top-ped the list with over 50% “likely” responses, followed by“transportation and other incidents,” “drought,” “floods,”“earthquakes,” and “heavy snow/ice storms” (between 40 and50% of “likely” responses). Terrorism/bioterrorism, fire-storms/wildfires, explosions, radiation/chemical/biologicalpoisoning, war/civil disorders and thunderstorms/hurricaneswere cited as less likely causes of disruption to laboratoryoperations in Europe (20–30% of likely responses), whilevolcanic eruptions were rated as only about 5 % likely todisrupt laboratory operations (Figure 1B).For the question “Rank the system failures that scareyou more for the functioning of your lab”, we also groupedthose who responded “Medium concern” and “Highconcern”. This showed that the most worrisome problemswere “Laboratory Information System (LIS) failure”,“Shortage of test reagents/supplies” and “Blackout and/orlocal interruption of energy supply” (≥80 % of worrisomeresponses), followed by “Hospital Information System (HIS)failure”, “Personnel shortage (due to lab inaccessibility,isolation, etc.)” and “Interruption of water supply” (between70 and 80 % of worrisome responses), whist “Interruptionof air conditioning system” was a concern for 65 % of allrespondents (Figure 1C).Responses to the question “What would you do duringprolonged (i.e., >3–6 h) LIS/HIS failure” are summarized inFigure 1D. Most laboratories (over 60 %) responded that theywould only test “stat” or “emergency” samples, while a sig-nificant number of respondents (i.e., about 40 %) also indi-cated that they would continue to perform all tests on allsamples manually. The percentage of respondents whowould “Stop receiving routine samples”, who would “Stopreceiving all samples” and who would “Not process anysample” were 20, 2 and 5 %, respectively.In response to the question “Do you have backupenergy power supply in your laboratory/hospital (morethan one can be selected)?” only 5 % of respondents indi-cated that they do not have any form of emergency powersupply, the majority answered that they have a dedicatedUPS (uninterrupted power supply) for some equipment(80 %), but almost half of respondents indicated thatthey have a generator for the entire laboratory (48 %)(Figure 1E).Finally, only 6.4 % of respondents indicated that theywere not interested in receiving advice from the EFLM onthis topic. Of thosewhowere interested instead, themajoritymade no distinction as to the form of guidance, while themajority of those who indicated a preference mentionedrecommendations most frequently (49 %), followed by offi-cial guidelines (35 %) and general indications (16 %).Although obviously not representative of all Europeancountries, the collected data provides an overview of thecurrent situation with respect to laboratory readiness foremergencies. Thus, the results of this first survey of theEFLM Task Force-Preparation of Labs for Emergencies willprovide an essential foundation for the development ofofficial recommendations for managing disruptive emer-gencies in European medical laboratories.Research ethics: Not applicable.Informed consent: Not applicable.Author contributions: The authors have accepted respon-sibility for the entire content of this manuscript andapproved its submission.Competing interests:The authors state no conflict of interest.Research funding: None declared.Data availability: The data can be obtained on reasonablerequest from the corresponding author.References1. Bendell J. Replacing sustainable development: potential frameworks forinternational cooperation in an era of increasing crises and disasters.Sustainability 2022;14:8185.Lippi et al.: EFLM survey 32. Busse R, Muscat NA, de la Mata I, Figueras J. Lessons learned from theCOVID-19 pandemic. Health Pol 2022;126:347.3. Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and treatmentof monkeypox. Drugs 2022;82:957–63.4. Almoshantaf MB, Swed S, Sakkour R, Shoib S. War and health crisis:humanitarian catastrophe in Ukraine. Int J Surg 2023. https://doi.org/10.1097/JS9.0000000000000051 [Epub ahead of print].5. Lippi G, Favaloro EJ, Plebani M. Laboratorymedicine and natural disasters:are we ready for the challenge? Clin Chem Lab Med 2010;48:573–5.6. Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novelcoronavirus outbreak? Ann Transl Med 2020;8:48.7. Lippi G, PlebaniM. COVID-19: the global health emergency is over for theWHO, but not yet for laboratory medicine. J Lab Precis Med 2023.https://doi.org/10.21037/jlpm-23-25.4 Lippi et al.: EFLM survey

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Results of the first survey of the EFLM Task Force Preparation of Labs for Emergencies (TF-PLE)

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