Health care personnel in disaster response. Reversible roles or territorial imperatives?

Disasters frequently demand exceptional skills from medical responders. Providers work most efficiently and effectively, however, within the roles and hierarchical structures with which they are familiar. The goal of disaster medical response planners is to assign personnel to roles that are as familiar as possible and to simultaneously enhance flexibility of response to extraordinary circumstances. We have outlined the most common disaster medical response roles and the personnel types that fit most directly as a primary provider within each role. Medics excel in field operations and field care of patients, whereas the training of nurses and physicians makes them the most flexible all-around providers, if specially trained in field emergency care, and the sole providers of definitive care. None of the providers, by virtue of their basic training, is well equipped to manage the public health consequences of disasters, but nurses and physicians should be able to easily move into the role, given appropriate special training. Some of the special courses needed to make medics, nurses, and physicians capable of serving flexible roles already exist; others need to be developed or enhanced.