The world has changed. The Oklahoma City bombing, the World Trade Center attacks, and the proliferation of terrorist organizations intent upon inflicting massive innocent loss of life have heightened the level of emergency preparedness we must achieve. A practical perspective is that while terrorist threats have driven enhanced emergency planning worldwide, the payoffs of preparedness for most of us will more likely accrue for a natural, nonterroristic disaster caused by incidents of nature or accidents of man.

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If the worst happens, we must respond as a team to best preserve lives and livelihoods: first responders; local, county and state governmental agencies; public health and humanitarian entities; and healthcare facilities and laboratories. This article highlights generic relationships within this team and promotes preparedness for selected nonanalytic challenges a laboratory may experience during a major emergency.

The purpose of the Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS) Report X4-R, Planning for Challenges to Clinical Laboratory Operations During a Disaster, is to fill a perceived gap in readily available information geared specifically to logistical, nonanalytic challenges to laboratory operations during a major emergency. The focus of this article is the challenges faced by hospital-associated laboratories, and it draws upon X4-R to help laboratory leadership appraise the preparedness level in their community, facility, and laboratory. It should be noted that preparedness plans for hospital-associated and independent laboratories are different.