Several studies have reported laboratory experiences in dealing with natural and human-made disasters. Many hospitals and laboratories suffered heavy damage, so the first step taken was to restore and replenish the destroyed laboratory services.6 One of the problems faced is the unavailability of shelters for storing laboratory equipment in an uncontrolled work environment. Changes in temperature drastically reduce the efficiency of using tools that are sensitive to changes in temperature and electricity supply in areas that have been severely damaged. The availability of generators is very limited, and if there are power fluctuations making it difficult to control the quality of laboratory results.7 Pasokan Regular supply and storage of sensitive laboratory reagents and diagnostic equipment are major challenges and clean water crisis to avoid water contamination.7

Therefore a strong laboratory management method and mechanism that includes integrated medical leadership and administration across all laboratory service lines enable the provision of appropriate and fast responses in case of disaster.8

The history of the use of POCT, which began in 1960, is that clinical laboratory examinations are practical and automatic so that technological development is smaller, their use is easy, especially for laboratory examinations in emergency departments. This was answered by making portable blood sugar (portable blood glucose). In the mid-1980s, it was introduced the examination technology to ensure accuracy (POCT), which at that time was in the form of the dipstick (dipstick) for the examination of urine (urine) quickly.

Point of Care Testing (POCT) is defined as an examination of diagnostic tests and laboratory tests carried out by officers with an educational background, not clinical laboratories, or conducted or done by the sufferer himself.9 POCT can be in the form of side tests (ancillary testing), satellite testing (satellite testing), bedside testing (bedside testing), near-patient testing (near-patient testing), home testing (home testing), outside laboratory testing (out of laboratory testing).10

The advantage of using POCT is that the results of the rapid examination are beneficial for doctors who treat patients, so they can analyze the development of the patient's condition, can take further treatment steps, and can discuss it with the patient or his family. It does not require handling samples, such as centrifugation. The use of POCTs does not need to use special staff who are educated in laboratory science but can be done by other health workers.11

The disadvantage of using POCT is due to easy and fast checks can lead to checks that are more than necessary or incorrect. The use of a small blood sample is difficult to know the quality of the sample that can affect the accuracy of the results of examinations with POCT, such as hemolysis, lipemia, and drugs. The use of POCT conducted by non-laboratory officers, requires quality management so that the results of the inspection are guaranteed and the arrangements in using it, so it needs to be regulated and determined who meets the requirements as POCT users.12

Some tests that can be done with POCT are blood glucose examination, hemoglobin A1c (HbA1c), blood gas analysis (AGD), cholesterol, hematological examination, and others.13 The laboratory examiner uses the POCT conducted by nurses or other health workers who do not have a basic education in laboratory science and laboratory technology. Thus, the feasibility of a POCT tool, which also involves accuracy (accuracy) and accuracy (precision) of the examination results, is the responsibility of the central laboratory. POCT quality assurance is recommended to be formally implemented as a support for risk management and reduce medical errors. Thus, management of quality management should be carried out by the parent laboratory, and the parent laboratory needs to set a gold standard.9,14

Quality assurance activities include the process of improving quality and strengthening quality. Quality improvement activities include strengthening internal and external quality. Quality assurance activities more broadly include activities to improve performance which include: pre-analytic, analytic, and post-analytic (Table 1).9

In this case, by consulting with POCT users or other health professionals, conducting periodic audits, periodically assessing service patterns with POCT, and evaluating the implementation of the quality assurance program by the quality assurance team. Research shows the use of POCT as one of the laboratory testing tools in conditions of limited resources due to disaster, namely POCT being an invaluable clinical tool in critical situations.15 However, the use of POCT is quite constrained by humidity, temperature, salinity, altitude, earthquake shock, and battery life while working at the rescue site. Storage and supply of reagents, test strips must be considered before a disaster occurs. It is necessary to improve the durability and validation of POCT tools in disaster preparation.16

The use of innovative POCTs, along with specific tactics, will increase disaster preparedness. Quality control and educational programs using POCT are required. Officers who work on POCs must be given information about the use of monitoring in cases of poor peripheral circulation and other confounding factors that can affect calibration or interfere with measurement results. Providing education to the POC coordinator will facilitate periodic assessments and adjustments to tactics, instrument innovation, and cost-effectiveness. The main test priorities according to the sequential response are complete blood count, electrolyte chemistry, blood type, oxygen saturation (using pulse oximeter), hematocrit, and microbiology as top priorities, and choosing to draw blood directly using cassettes. Cardiac biomarkers are needed at alternative service facilities. The main infectious diseases are Staphylococcus aureus, SARS, Streptococcus pneumonia, and hepatitis B. Temperature, vibration, humidity and the influence of vibrations are four important things that should be a concern in extreme situations.