Providing humanitarian relief to affected populations is a top priority following a major sudden onset disaster (SOD). The main form of medical relief to affected areas is the emergency medical teams (EMTs). These are groups of health professionals and support staff operating locally or outside their country of origin by providing healthcare to disaster-affected populations. Despite best intentions, for decades EMTs were disorganized and followed no clear standards. In the aftermath of the 2010 Haiti earthquake, the EMT Working Group of the World Health Organization‘s global health cluster initiated a global effort to standardize the EMTs system. This new system was put to the test in 2013 with the deployment of medical aid to the Philippines following Typhon Haiyan, and later on during the Ebola outbreak in West Africa and the earthquake in Nepal in 2015. This chapter reviews the history of medical aid to disaster affected areas, the process of coordinating and standardizing EMTs and the latest implementation of the new EMT coordination system.

Past experiences from uncoordinated and inefficient medical responses to disasters have prompted the WHO to formulate a system that includes minimum standards to which responding medical teams must adhere. Three levels of EMTs are identified: type 1 provides primary outpatient care, type 2 provides intermediate inpatient care, while type 3 provides specialized care. Following larger disasters, the affected country may request international EMT assistance. This assistance will be supported by the WHO. The health-care needs, and thus need for EMTs, will vary depending on type, scale of disaster, and the affected country’s vulnerability. A significant part of the EMT workload will be managing the normal burden of disease. A thorough needs assessment is vital for an effective response and should address anticipated health needs (and their variation over time), local resources available, and seek to gain intelligence on other context-specific challenges. EMTs do not function in isolation, but in a health system coordinated by the affected country. Efforts including the WHO EMT minimum standards system that verify international EMTS are important steps to ensure appropriate standards in a multitude of aspects of global disaster response.

This chapter focuses on triage management in both national and international mass casualty incidents. They be a sudden-onset natural disaster, a public health emergency of international concern, or a war or armed conflict resulting in the deployment of field level hospitals that are focused on civilians, the military, or both, and are capable of rapid deployment and expansion or contraction to meet immediate emergency requirements for a specified period of time. The goal of triage is to treat as many victims as possible who have an opportunity for survival. Triage does not exist in isolation, but represents a complex process that balances clinical requirements with resource allocation and system management where the decision operatives are the likelihood of medical success and the conservation of scare resources.

The chapter describes the training needs of international EMTs and how these might best be met and the training delivered. This is a three-step approach of first completing in country speciality training, then training to adapt that to the austere environment, and finally a full simulated operational deployment to exercise as a team. Immediately prior to a specific deployment additional “just-in-time” training may be required.