History of Disaster Medicine

Disaster medicine is a unique subspecialty of emergency medicine (EM) that has evolved in response to humanity's long-standing confrontation with mass casualty incidents (MCIs), both natural and manmade. While physicians have cared for victims of disasters for centuries, the formalization of disaster medicine as a discipline began in the mid-20th century. The aftermath of World War II - particularly the bombings of Hiroshima and Nagasaki - highlighted the need for organized medical response systems capable of functioning amid chaos, radiation exposure, and infrastructure collapse. These events laid the foundation for the study of disaster health effects and the development of triage protocols suited to resource-constrained environments.¹

The 1970s and 1980s saw further advances as large-scale natural disasters and civil conflicts emphasized the need for coordinated medical response systems. The 1976 earthquake in Guatemala, the 1985 Mexico City earthquake, and the Chernobyl nuclear accident in 1986 were pivotal events that demonstrated the vital role of rapid assessment, search and rescue, and medical triage. In the United States, the federal response was institutionalized with the creation of the National Disaster Medical System (NDMS) in 1984, designed to support hospitals and deploy medical teams in times of crisis.² Around the same time, the American College of Emergency Physicians (ACEP) began integrating disaster medicine principles into EM training.³

Following the September 11, 2001, terrorist attacks and the 2005 Hurricane Katrina disaster, disaster medicine gained further prominence within the medical community in the U.S. These events exposed critical vulnerabilities in public health infrastructure and spurred legislative and academic efforts to improve preparedness and resilience. The Department of Homeland Security and the Assistant Secretary for Preparedness and Response (ASPR) were tasked with enhancing the nation's emergency medical readiness. Academic programs and fellowships in disaster medicine began to emerge across the country, aiming to train physicians in risk assessment, incident command systems, crisis communication, and humanitarian response.⁴ The first formal disaster medicine fellowship in the U.S. is widely recognized as having been established at Beth Israel Deaconess Medical Center (BIDMC)/Harvard Medical School in 2006.⁵ This fellowship was created to provide structured, post-residency training in disaster preparedness, emergency management, public health, and humanitarian response. Shortly thereafter, other institutions such as George Washington University and Emory University also began offering similar programs, often in partnership with government agencies or local public health departments. More recently, the COVID-19 pandemic and international conflicts highlight the ongoing importance of disaster medicine.

Today, disaster medicine stands at the intersection of clinical medicine, public health, prehospital systems, coordination of governmental and community resources, and emergency management. It is a dynamic field that continues to evolve with global threats such as pandemics, climate change, cyberattacks, and geopolitical instability. It also includes single events like airline accidents and natural disasters as well as preparation for large scale events like sports events and concerts. Physicians entering this discipline must not only master clinical care under austere conditions but also develop competencies in leadership, systems thinking, and interagency coordination. For residents and students interested in this field, disaster medicine offers a unique opportunity to make a broad impact across communities, systems, and even international borders.