AMA Urges Restraint for Clinicians Seeking to Volunteer in Haiti

Martha Kerr

January 16, 2010

January 16, 2010 ( UPDATED January 17, 2010 ) — "The spontaneous volunteer has no place in disaster response," asserted James J. James, MD, DrPH, MHA, director of the Center for Public Health Preparedness and Disaster Response, at the American Medical Association (AMA), during a webinar held today for medical and public health responders to assist them in preparing for the Haitian earthquake disaster relief effort.

The webinar was held in collaboration with the National Disaster Life Support Foundation Inc, the American Public Health Association, the Centers for Disease Control and Prevention Office of Injury Response, the American Nurses Association, and the AMA's peer-reviewed journal Disaster Medicine and Public Health Preparedness.

"Volunteers must be part of the solution, not the problem," Dr. James emphasized. In addition to today's webinar, the AMA is planning to develop a clearing house for appropriate volunteers.

The Federal Emergency Management Agency, part of the US Department of Homeland Security (DHS), recently devised the National Incident Management System (NIMS). NIMS "provides a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work seamlessly to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity, in order to reduce the loss of life and property and harm to the environment."

NIMS provides the template for the management of incidents, and the National Response Framework provides the structure and mechanisms for national-level policy for incident management.

For physicians and nurses who want to volunteer, Dr. James urged, "Don't go unless you are as part of an organized team or have assurance when you arrive that you will be joining one.

"In addition, he said, "note the following:

  • You will be entering an austere environment.

  • Personal security may be an issue.

  • Resources will be very scarce.

"Volunteers must be self-sufficient or they are a part of the problem," Dr. James emphasized.

Volunteers need to know the following:

  • Their local role.

  • Their group's organizer or local contact.

  • How to incorporate local assets.

"The most important message for health professionals who wish to volunteer to help in the wake of a disaster," asserts Cheryl Peterson, Senior Policy Analyst for the American Nurses Association (ANA), "is that they should never deploy outside of an organized response system."

Health professionals, including nurses, who just show up at an accident or disaster site (called "spontaneous" or "unaffiliated" volunteers) are unknown to command and control personnel and cannot be used to their full potential.

Those in charge of relief efforts will not know who you are, what your abilities or educational background are, or even if your license is valid, the webinar organizers pointed out. There is no on-site procedure for validating your professional status. In some cases, it merely creates more work for those leading the response operation to deal with spontaneous volunteers.

Organized response registries for healthcare professionals exist at both the state and federal levels.

This earthquake already has a high mortality rate, with estimates of around 100,000 already being reported. Médicins sans Frontièrs/Doctors Without Borders is also reporting incidences of looting and threats to the security of their personnel, causing them to change the site of one temporary hospital and hampering relief efforts in general.

The Sphere Project provides the handbook Humanitarian Charter and Minimum Standards in Disaster Response, which contains guidelines for handling disasters.

Those who wish to volunteer should check with their respective professional organizations for specific advice. There is also this message from Partners in Health (PIH):

"We are deeply grateful for the multitude of people who have contacted us wanting to provide medical assistance, medicine and supplies. While we wish we could use all of the support so generously offered, we urgently need the following: orthopedic surgeons, trauma surgeons, anesthesiologists, nurse anesthetists, OR nurses, post-op nurses, and surgical technicians."

"Unfortunately, we are unable to accommodate any volunteers without significant surgical or trauma training and experience. If your qualifications match our needs, please fill out this form."

PIH is also requesting orthopaedic supplies, surgical consumables (sutures, bandages, nonpowdered sterile gloves, syringes, etc) and large unopened boxes of medications. The group is unable to accept small quantities or unused personal medications.

Blankets, tents, and satellite phones with minutes are urgently needed. People with private planes willing to fly medical personnel and/or large quanities of supplies are also greatly needed. To donate any of these goods and services, complete this form.

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