In recent years, disasters worldwide seem to be occurring not only more frequently but also in densely populated areas. The United States' experiences with the man-made "911" disaster in 2001 and with Hurricane Katrina in 2005 tested our disaster systems and responses. The identified deficits gave rise to significant increases in federal funding targeted toward enhancement of disaster planning, training, and increases in equipment and supply caches. As a result, many health care professionals have received disaster training in recent years.

The catastrophic earthquake in Haiti on January 12 left more than a million homeless and countless injured or dead. More recently, the Chile earthquake in February prompted large numbers of nurses, physicians, and other health care workers to seek volunteer opportunities to help. Some with no disaster experience and/or a sponsoring agency have taken great risks by traveling alone to ravaged areas without structured plans or resources. Some were able to link with disaster teams/agencies once in the disaster area and some were not.

Nurses, especially trauma nurses, have important skills to offer, but most professional relief organizations require or give preference to those who have had formal disaster training/experience and are credentialed in advance. Volunteers with disaster training have the greatest chance of being selected. Volunteers with language fluency of the area will also be shown preference. Relief organizations initially rely on an existing pool of health care workers with selection on the basis of proactive processes of application, screening, credentialing, and vaccination maintenance. Depending on the agency, the process can take up to several months to finalize.

There are governmental, public, and private disaster relief organizations. The US Public Health Service's National Disaster Medical System has many region-based disaster medical assistance teams located around the country. When activated by the National Disaster Medical System, disaster medical assistance team members become federal employees with commensurate salaries. The Office of the Surgeon General sponsors volunteer Medical Reserve Corps teams around the country. There are public, state, and regional volunteer disaster relief teams. Many established private relief organizations provide care desperately needed by victims of disasters. These include Project Hope, Doctors Without Borders, Medical Teams International and many others.

Acute care hospitals have formalized disaster committees, structures, and defined roles. Many have adopted the model of Hospital Incident Command System (HICS). The HICS gives hospitals the ability to communicate with other hospitals and agencies, using a common language and structure. Defined roles and job descriptions help hospital staff members familiarize themselves with and assume needed roles in disasters and drills.

Where do you fit in disaster planning and responses? Many of you are already formalized members of relief teams and organizations. I hope you know how much you are appreciated and respected for your dedication and hard work. If you have had no disaster training or experience, begin by getting familiar with your own hospital's disaster plan, structure, and resident experts. The HICS will give you a helpful foundation for disaster response structure and planning at all levels. Explore the various opportunities that may become available in your workplace or region for disaster training.

Spend some time taking stock of your interests and skill sets considering such questions as follows:

What are you interested in doing? What are you qualified to do in a disaster setting: direct patient care, leadership and organization, education and training, psychosocial support, etc?

What special skills do you have? Do you speak a language fluently? Do you have prior work experience in a specific geographic area and culture?

Do you have a passport?

Are your routine vaccinations up-to-date? Are you willing to have additional vaccinations as recommended by the relief sponsoring agency or the public health service?

Are you physically fit and healthy? Do you have chronic health problems that require medications, treatments, or medical support? Could you adapt to extremes in climate or adverse weather conditions? Could you adapt to very austere and challenging living conditions?

How do you handle unstructured and dynamic environments? Are you able to deal with high levels of stress? Are you willing to accept risks to your personal safety?

How flexible is your schedule? Could you be away from your work and family for more than a few days?

How would volunteering impact your family and your personal life?

With the answers to the above questions in mind, explore the many avenues for disaster relief work. Here are a few of the many reputable relief and humanitarian agencies:

National Disaster Medical System, http://ndms.fema.gov/dmat.html.

Medical Reserve Corps, http://www.medicalreservecorps.gov/HomePage.

International Medical Volunteers Association, http://www.imva.org.

Doctors Without Borders, http://www.doctorswithoutborders.org.

American Red Cross, http://www.redcross.org.

Project Hope, http://www.projhope.org.

Medical Teams International, http://www.medicalteam.org.

My own personal experience with disaster work has been varied, challenging, and always rewarding. I encourage each of you to consider the options and possibilities and start to plan and prepare now. Training and ongoing preparation as a disaster volunteer will help you at home, at work, and in disaster locales.