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**DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service**

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Centers for Disease Control

and Prevention (CDC)

Atlanta, GA 30341-3724

**Shipping Instructions for Specimens Collected from People**

**Potentially Exposed to Chemical Terrorism Agents**

**Collecting specimens**

***Required specimens***

Unless you are otherwise directed, collect the following specimens from
each person who may have been exposed:

-   **Urine---Collect at least 25 mL.** Use a screw-capped plastic
    container. Please do not overfill. **Freeze as soon as possible**
    (−70^○^ C or dry ice preferred). If possible, ship the specimen on
    dry ice. If dry ice is not available, you may ship frozen specimens
    with freezer packs. **For pediatric patients, collect urine only,
    unless otherwise directed by CDC.**

-   **Whole blood---**Use three 4-mL or larger purple-top (EDTA) tubes,
    vacuum-fill only **(unopened). If collecting in 3 mL purple top
    tubes, please collect a [fourth]{.underline} tube.**

-   **Whole blood---**Use one 3-mL or larger gray-top **or** one 3-mL or
    larger green-top tube, vacuum-fill only **(unopened).**

***Order of collection***

Please mark the first purple-top tube of whole blood collected with a
"1" using indelible ink. The first purple-top tube of whole blood
collected will be used to analyze for blood metals.

***Blanks***

For **each lot number** of tubes and urine cups used for collection,
please provide two empty unopened purple-top tubes, two empty unopened
green- or gray-top tubes, and two empty unopened urine cups to serve as
blanks for measuring background contamination. **Note: Although blanks
do not have to be labeled, please secure their container tops in the
same fashion described below for collected blood tubes and urine cups.**

**Labeling**

Label specimens with labels generated by your facility. These labels may
include the following information: medical records number, specimen
identification number, collector's initials, and date and time of
collection. **Follow your facility's procedures for proper specimen
labeling**. The collector's initials and date and time of collection
will allow law enforcement officials to trace the specimen back to the
collector should the case go to court and the collector is needed to
testify that they collected the specimen.

Information provided on labels may prove helpful in correlating the
results obtained from the Rapid Toxic Screen and subsequent analysis
with the people from whom the specimens were collected.

Place a single, unbroken strip of waterproof, tamper-evident forensic
evidence tape over each specimen top, being careful not to cover the
specimen ID labels. This tape must make contact with the specimen
container at two points. **The individual placing the evidence tape must
identify themselves by writing their initials ½ on the container and ½
on the evidence tape.**

Maintain a list of names with corresponding specimen identification
numbers at the collection site to enable results to be reported to the
patients.

**Packaging**

Packaging consists of three components: primary receptacle (blood tubes
or urine cups), secondary packaging (materials for protecting primary
receptacles, absorbent material, and waterproof, 95 kPa pressure
resistant packaging), and an outer packaging (Styrofoam-insulated
corrugated, fiberboard box).

Pack and ship these specimens as category B infectious substances.

***Secondary packaging***

**Blood Tubes---**

-   Separate each tube of blood collected from other tubes, or wrap
    tubes to prevent contact between tubes; this may be accomplished in
    a variety of ways such as a gridded box wrapped with absorbent
    material and sealed inside a plastic bag, sealable Styrofoam
    container, blood tube shipment sleeve and transport tube, and
    individually wrapped tubes sealed inside a plastic bag. **Secondary
    packaging must have its closure secured with a single strip of
    tamper-evident forensic evidence tape initialed ½ on the packaging
    and ½ on the evidence tape by the individual making the seal.**

-   Place absorbent material between the primary receptacle and the
    secondary packaging. Use enough absorbent material to absorb the
    entire contents of primary receptacles. **According to 49 CFR
    173.199(b), if specimens are to be transported by air, either the
    primary receptacle or the secondary packaging used must be capable
    of withstanding without leakage an internal pressure producing a
    pressure differential of not less than 95 kPa (0.95 bar, 14 psi).
    Verify in advance that the manufacturer of either the blood tube or
    secondary packaging used in your facility is in compliance with the
    pressure differential requirement.**

-   To facilitate processing, package blood tubes so that similar tubes
    are packaged together (e.g., all purple-tops together) and not mixed
    (i.e., purple-tops and green/gray-tops in the same package).

**Urine Cups---**

-   Separate each urine cup from other urine cups or wrap urine cups to
    prevent contact between urine cups.

-   Place urine cups in secondary packages. A variety of secondary
    packages may be used, for example, gridded box wrapped with
    absorbent material and sealed inside a plastic bag or individually
    wrapped urine cups sealed inside a plastic bag. In either case
    verify that the urine cup or secondary packaging complies with the
    requirements stated in 49 CFR173.199(b). **Secondary packaging must
    have its closure secured with a single strip of tamper-evident
    forensic evidence tape initialed ½ on the packaging and ½ on the
    evidence tape by the individual making the seal.**

***Outer packaging***

Use Styrofoam-insulated corrugated fiberboard boxes (may be available
from your transfusion service or send-outs department). **Do not ship
frozen urine cups and blood tubes in the same package.**

**Blood tubes--- Ship at 4°C**

-   For cushioning, place additional absorbent material in the bottom of
    the outer packaging.

-   Add a layer of frozen cold packs.

-   Place secondary packagings on top of the cold packs.

-   Place additional cold packs or absorbent material between the
    secondary packagings to reduce their movement within the outer
    packaging.

-   Place a layer of frozen cold packs on top of the secondary
    packagings.

**Urine cups--- Ship to ensure specimens remain frozen or freeze while
in transport**

-   For cushioning, place additional absorbent material in the bottom of
    the outer packaging.

-   **Add a layer of dry ice**. **Note:** Do not use large chunks of dry
    ice for shipment, because large chunks have the potential for
    shattering urine cups during transport.

-   Place additional absorbent material between wrapped urine cups to
    reduce their movement within the outer packaging.

-   **Add an additional layer of dry ice.**

**Preparing documentation**

**Since blood tubes and urine cups are shipped separately, prepare a
separate shipping manifest for each.** Place each shipping manifest
(with specimen identification numbers) in a plastic zippered bag on top
of the specimens before closing the Styrofoam lid of the corrugated
fiberboard box.

**Chain of custody forms [do not]{.underline} need to be transported
with specimens.** Each entity/organization handling the specimens is
responsible for the specimens only during the time that they have
control of the specimens. Each entity/organization receiving the
specimens must sign-off on the chain of custody form of the
entity/organization relinquishing the specimens to close that chain.
When receiving specimens, each new entity/organization must begin their
own chain of custody and have the entity/organization relinquishing the
specimens sign their chain of custody to start the chain and indicate
that they have transferred the specimens. **When specimens are
transferred between entities/organizations, each entity/organization
retains their chain of custody forms.**

**Note:** When the individual relinquishing the specimens (relinquisher)
and the individual receiving the specimens (receiver) are not together
at the time of specimen transfer, the relinquisher will document on
their chain of custody that the receiver is FedEx Tracking Number or
have the individual transporting the specimens sign the chain of custody
to indicate that they have taken control of the specimens. Likewise,
when the receiver receives the specimens, they will document on their
chain of custody that the relinquisher is FedEx Tracking Number or the
have the individual transporting the specimens sign the chain of
custody.

**Preparing packaged specimens for shipment**

-   Secure outer packaging tops and bottoms with filamentous
    shipping/strapping tape.

-   Affix labels and markings adjacent to the shipper's/consignee's
    address that appears on the package.

-   Place a UN 3373 diamond marking on the outer package.

-   Place the proper shipping name, "Biological substance category B" on
    the outer packaging adjacent to the UN3373 marking.

-   For packages containing dry ice, place a class 9 hazard label on the
    same side of the outer packaging as the UN3373 marking. If the
    proper shipping name, either dry ice or carbon dioxide solid, and
    UN1845 is not preprinted on the hazard label, add it adjacent to the
    label. Note the weight of dry ice in the packaging on the preprinted
    area of the hazard label or place that information adjacent to the
    class 9 hazard label and proper shipping name.

-   Orientation arrows are not required on an outer packaging containing
    category B infectious substances. If orientation arrows are present,
    be sure to orient the inner packagings with their closures in the
    proper orientation with the arrows.

-   If the package will be transported by a commercial air carrier,
    complete an airway bill. On the airway bill, note the proper
    shipping name and UN number for each hazardous material and identify
    a person responsible for the package per IATA packing instruction
    650.

**Shipping specimens**

-   Follow the guidance provided in your state's chemical terrorism
    comprehensive response plan.

-   If you are directed to ship the specimens to CDC, please ship the
    specimens to the following address:

> CDC
>
> Attn: Charles Dodson
>
> 4770 Buford Hwy,
>
> Building 110 Loading Dock
>
> Atlanta, GA 30341
>
> \(770\) 488-4305

**Questions**

If you have any questions or problems with specimen packaging or
shipment, please e-mail or call one of the following contacts at the
CDC's National Center for Environmental Health, Division of Laboratory
Sciences (DLS):

-   Jacob Wamsley, DLS Incident Response Laboratory Coordinator,
    <jwamsley@cdc.gov> , 770-294-2491 or Julia Ellenberg,
    <jellenberg@cdc.gov>, 770-488-4135.

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-   Dr. John Osterloh, DLS Chief Medical Officer, 770-488-7367

-   Dr. Jerry Thomas, ERAT Medical Officer, 770-488-7279

-   DLS administrative office, 770-488-7950