The Laboratory Response Network: What is it?
Laboratories would be on the front lines of countering any biological or chemical terrorist attack that should occur. If people began showing up at emergency rooms with a mysterious ailment, the first challenge would be to diagnose the problem so that appropriate treatment could begin. With several dozen agents on the Centers for Disease Control and Prevention (CDC)’s list of possible biological and chemical weapons [see Bioterrorism], sorting out the particular causative agent(s) would be a difficult task. And speed would be a critical factor, both to initiate treatment of those infected and to stop the spread of any infectious disease.

There are thousands of hospital laboratories around the country staffed with personnel qualified to perform high volumes of accurate tests. However, they are not set up to test for diseases they never encounter, such as anthrax or smallpox. There are more specialized laboratories with these capabilities, but without large volume capacities. The solution public health officials have devised is the Laboratory Response Network.
The Laboratory Response Network is not a formal organization but an interactive partnership, a framework for organizing and improving existing resources to cope with a terrorist attack. The network categorizes laboratories into four levels, with Level A laboratories at the base of the pyramid and level D at the top. Each type has unique capabilities, which complement each other to provide a complete system.

Level A laboratories are those that do routine clinical testing, such as independent clinical labs and those at universities and in community hospitals. Level B generally includes public health laboratories, run by a state or local government, that have more specialized capabilities. Level C includes more sophisticated public health labs and reference laboratories, such as the ones run by the CDC. At the top of the pyramid, Level D labs have the containment equipment and expertise to deal with the most dangerous, virulent pathogens and include only CDC and Department of Defense labs, the FBI, and the U.S. Army Medical Research Institute of Infectious Diseases.

CDC guidelines delineate a laboratory’s responsibilities according to the dangers and complexities of analyzing the particular pathogen involved. For example, anthrax and plague could be confirmed in a Level B laboratory. Tularemia, however, is considered more virulent because less than 50 cells can cause infection, so it would be confirmed at Level C. The release of smallpox virus would be especially disastrous because it is so contagious, can be lethal, and no treatment is available. It would be tested at only a Level D lab.

Anthrax illustrates the kind of threat with which such a network is designed to deal. Level A laboratories are generally not equipped to make a definitive anthrax diagnosis on a patient sample. They can run tests that rule out anthrax but cannot positively identify it. Thus, if their tests reveal that anthrax is a possibility in a particular case, they should send the sample to a Level B laboratory. These upper level laboratories would also be the ones to conduct any environmental sampling for anthrax, since such testing involves a high level of expertise and requires containment procedures to avoid contaminating the lab.