Surge in volunteers without overall coordination can make devastating situation worse instead of better

A surge in volunteers following a major disaster can overwhelm a response system, and without overall coordination, can actually make a situation worse instead of better. The outpouring of medical volunteers who responded to the devastating earthquake that rocked Haiti in January provides a roadmap for health care providers during future disasters, say the authors of a New England Journal of Medicine "Perspectives" piece that will be published online February 24. Thousands of doctors and nurses stepped up to help following the quake, but many were frustrated by difficulties connecting with a system that could immediately take advantage of their skills in the disaster zone. But lead author Raina Merchant, MD, an emergency physician and Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania School of Medicine, says that volunteers can enhance their effectiveness by preparing for a disaster before it occurs and thinking critically about their ability to respond.

Among Merchant and her colleagues' recommendations for health care workers who wish to volunteer during global disasters:
•Seek formal training in disaster medicine to prepare for working with limited resources under hazardous conditions. Short courses are offered by the American Medical Association, the American Red Cross, the Federal Emergency Management Agency and various surgical and trauma medical specialty associations.
•Register with existing volunteer organizations, which often offer specialized training and advance verification of credentials and licensure to speed deployment to needy areas.
•Have a clear understanding of what working in the disaster area will require, from working in severe temperatures with poor sanitation and risk of violent crime and exposure to infectious diseases. Underlying medical conditions and the emotional challenges of witnessing extreme pain and suffering of victims are also important considerations.
•Seek counsel from travel medicine experts who can provide advice and access to immunizations, prophylactic medications, and education on protection from infections including HIV, tuberculosis, Hepatitis A and mosquito-borne illnesses such as malaria and dengue.

The authors also urge volunteers to consider where in the disaster cycle - early response, when the bulk of volunteers tend to come forward, or recovery and reconstruction - their skills would be most appropriate, and to be mindful of the need to support relief efforts even after the world's attention has turned to other news. "Once immediate needs are addressed, the recovery phase begins, and there is often a prolonged delay before local health care systems can function even minimally," they write. "Health care volunteers are often less numerous during this time although the need for medical assistance remains vast."