Introduction

Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners plan for, mitigate against, operate in, and lead recovery from situations where the available resources are not adequate, necessitating modifications to conventional practice. The specialty practices in all environments, from traditional hospital settings to austere locations, and supports the provision of care for all age groups and conditions. It includes administrative leadership of emergency preparedness teams and systems as well as planning and mitigation strategies across the entire disaster cycle. Disaster Medicine also includes expertise in the rational, effective, and ethical adjustment of resource allocation and treatment algorithms during times of resource scarcity to provide the optimal level of health care to the greatest number possible given the circumstances of a disaster or public health emergency.

As recent history demonstrates, disasters resulting from environmental and human activity are growing in complexity, while society’s vulnerabilities to such events are increasing due to a multitude of factors related to the modern world. These events create unique clinical situations that physicians have not anticipated, and for which they are inadequately prepared by traditional medical educational systems to address. Specifically, most training algorithms fail because they were not designed to guide management of the health care requirements of patients when these needs exceed available resources. As an example, the coronavirus disease 2019/COVID-19 pandemic demonstrated how unprepared the medical system is for large-scale medical emergencies, such as a global pandemic, particularly from the standpoint of medical practice outside of established standards of care. Equipment, pharmaceutical, and staff shortages required physicians to make difficult decisions and, in some cases, adopt scarce resource allocation protocols.

The specialty of DM incorporates knowledge and skills from multiple disparate fields including, but not limited to, emergency medicine, prehospital medicine, public health crisis response, critical care, primary care and preventative medicine, ethics, health equity, risk communication, and emergency management, among others. Within DM, elements from all these fields converge into a cohesive practice aimed at reducing mortality and morbidity by optimizing resource use in the event of a disaster. The scope of this multidisciplinary expertise and its requisite associated clinical and administrative skills defines the practice of DM as unique among existing medical specialties.

When applied to health care specifically, a disaster implies a severe imbalance in patient needs and available resources. The ability to effectively and efficiently utilize limited assets to provide maximal benefit for an affected population requires a keen understanding of resource utilization and population health. In response to such increasingly austere environments, physicians with DM specialty training are needed to transition patient care efficiently from conventional operations to progressively limited resource utilization and treatment strategies. Individuals possessing this training can plan, implement, and assess appropriate patient management in the highly variable situations and locations in which the provision of medical care may be required. Prior to disaster-related events, DM specialists guide implementation of preventative and mitigating actions to limit the impact of a future disaster, optimizing the ability to continue providing patients the conventional standard of care. However, if a patient surge is so vast, or a reduction in available resources so profound, that existing standards of care are not possible, specialists in DM are uniquely qualified to ethically guide stakeholders and leaders through the allocation of constrained resources during a crisis.

Disaster Medicine’s unique combination of clinical, administrative, and ethical expertise, in addition to its requisite skills focused on the delivery of medical care in nontraditional practice environments, is not found in any current medical specialty. Though selected elements may be found in, and are drawn from, other defined areas of medicine, no other subspecialty holistically focuses on such expertise. For example, the existing subspecialty of Emergency Medical Services (EMS) addresses mass-casualty response in a very limited capacity and viewed through the lens of the prehospital setting only. ^{Reference Sandifer, Wexler and Flamm1} Toxicology practitioners obtain expertise in treating chemical poisonings, but the core content does not address planning, preparation, or response to a mass-casualty nerve agent attack. ^{Reference Hendrickson, Bania and Baum2} While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States. ^{Reference Walsh, Subbarao and Gebbe3–Reference Koenig, Bey and Schultz5}