key: cord-009181-23w2r74p
authors: Burstein, Jonathan L.
title: You Shall Not Stand By
date: 2007-04-21
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2007.01.001
sha: 
doc_id: 9181
cord_uid: 23w2r74p

nan

The threat of pandemic influenza or other very-large-scale natural, accidental, or terrorist-caused disasters has challenged society to develop methods to provide large-scale, long-term health care surge capacity. The needs of such an effort would include a large number of health care staff, in addition to training, equipment, medications, and, perhaps most notably, organization. 1 Issues to be settled include how to recruit, train, protect, and provide liability and workers compensation protection for health care workers who may be thrust into unusual situations, providing care at the limits of their training, in unaccustomed venues. The American College of Emergency Physicians, among others, strongly supports making such volunteer efforts possible while recognizing the difficulties. 2 In this issue of Annals, Schultz and Stratton 3 describe a method for tackling the difficult issue of staffing: where will the caregivers be found?

Theirs is hardly the first or only method proposed for recruiting and credentialing staff to provide disaster care. As the authors note, for example, the federal government has established the Emergency System for Advance Registration of Volunteer Health Professionals. All states and several large cities in the United States are required to implement components of this system. So why do we need to even discuss the method described by this proposal? Simply because it answers problems that Emergency System for Advance Registration of Volunteer Health Professionals may be unable to address, and in a nimble, rapid, and unencumbered fashion. As they point out, Emergency System for Advance Registration of Volunteer Health Professionals depends on pre-event volunteers who are willing to submit information and remain involved for years, perhaps without ever being called to help. In addition, as a bureaucratically driven system, it is only slowly being implemented; the current and tentative federal expectation is that this program, started in 2002, may not be fully functional until 2010 (C. McLaughlin, written communication, November 2006; available from the author on request). Under the Emergency System for Advance Registration of Volunteer Health Professionals, those not enrolled pre-event have no way to offer their services once a disaster strikes. In contrast, by enrolling all hospitalcredentialed staff, a database can provide a large list of potential volunteers who may not even know themselves whether they want to help until an event occurs. The 2 systems are complementary, not competitive, and both may be needed in the event of a society-wide disaster.

And we have seen, after TWA Flight 800, the September 11 attacks, and Hurricanes Katrina and Rita, that thousands of health care workers have spontaneously volunteered. We can reasonably expect that if an earthquake, or numerous simultaneous bombings, or even a flu pandemic, or the next severe acute respiratory syndrome epidemic strikes, physicians, nurses, emergency medical services (EMS) personnel, and many others will step forward, freely, spontaneously, and willingly. We can expect people to help; it's a basic human desire. The systems we design now should allow for and expect that to happen. For example, in a true pandemic, it is hard to imagine that a willing and knowledgeable person would be turned away, but that may occur if he or she did not sign up for the Emergency System for Advance Registration of Volunteer Health Professionals program, perhaps "years ago." We need to accept, plan for, and support the universal impulse of health care personnel to help. Perhaps our society should consider paying completely for nursing, EMS, and physician education, in return for expecting help in a disaster; it is reasonable to expect that many would help anyway, and the more who are trained, even if nonpracticing, the more resilient we will be as a society. Perhaps we should require that all high school graduates throughout the nation have completed training as a basic emergency medical technician, or basic patient-care and first-aid skills, or even just cardiopulmonary resuscitation training! Now is the time to expend money and effort for the benefit of all, in return for greatly increasing our capacity and strength as a society. To judge by recent events, planners can rely on spontaneous volunteerism and can expect it to occur. It seems we do indeed live by the principle of Lo Ta'mod; perhaps that is what makes us truly human.

Murder or mercy? Hurricane Katrina and the need for disaster training

American College of Emergency Physicians. ACEP policy statement on disaster response

Improving hospital surge capacity: a new concept for the emergency credentialing of volunteers

Supervising editor: Michael L. Callaham, MD Funding and support: The author reports this study did not receive any outside funding or support.Reprints not available from the author.