2017 was a record year for disasters and disaster response in the U.S. Redefining and differentiating key response roles like “immediate responders” and “first responders” is critical. Traditional first responders are not and cannot remain the only cadre of expected lifesavers following a mass casualty event. The authors argue that the U.S. needs to expand its understanding of response roles to include that of the immediate responders, or those individuals who find themselves at the incident scene and are able to assist others. Through universal training and education of the citizenry, the U.S. has the opportunity increase overall disaster resiliency and community outcomes following large-scale disasters. Such education could easily be incorporated into high school curriculums or other required educational experiences in order to provide all persons with the knowledge, skills, and basic abilities needed to save lives immediately following a disaster.

Atlanta-area hospitals participated in an innovative regional exercise that pushed facilities beyond traditional scopes of practice and brought together numerous health care community response partners. Using lessons learned from this exercise coupled with subsequent real-world events and training exercises, participants have significantly enhanced preparedness levels and increased the metropolitan region's medical surge capacity in the case of a multiple casualty disaster.

The watershed events of September 11, 2001; the anthrax attacks; Hurricane Katrina; and H1N1 necessitated that the United States define alternative mechanisms for disaster response. Specifically, there was a need to shift from a capacity building approach to a capabilities based approach that would place more emphasis on the health care community rather than just first responders. Georgia responded to this initiative by creating a Regional Coordinating Hospital (RCH) infrastructure that was responsible for coordinating regional responses within their individual geographic footprint. However, it was quickly realized that hospitals could not accomplish community-wide preparedness as a single entity and that siloed planning must come to an end. To reconcile this issue, Georgia responded to the 2012 US Department of Health and Human Services concept of coalitions. Georgia utilized the existing RCH boundaries to define its coalition regions and began inviting all medical and nonmedical response partners to the planning table (nursing homes, community health centers, volunteer groups, law enforcement, etc). This new collaboration effectively enhanced emergency response practices in Georgia, but also identified additional preparedness-related gaps that will require attention as our coalitions continue to grow and mature.

Introduction:The US, as well as many countries, are being beseeched by more natural and man-made events; both small (e.g., shootings) and geographically vast (e.g., floods). Due to a myriad of issues, traditional first responders i.e., EMS, fire department, and police cannot be expected to be the only trained lifesavers on the scene. In the US (as in many countries), it is imperative to begin the discussion to better understand the role of the “injured” and “immediate” responders and how they interact with the “first” responders.Aim:To open a discussion amongst disaster experts about the merits of training and subsequent promotion of a curriculum for “immediate” responders.Methods:Literature review.Discussion:After recent evaluations of events, it is postulated that there are three categories of responders: the injured, the immediate, and the first (EMS, fire department, police). The premise upon which disaster risk reduction and building community resilience are achieved begin with strengthening, empowering, and equipping local populations with the appropriate tools. This would involve education, skills, and training. With the average general public trained, and if they are one of the first two categories, then the community would not only be better able to assist themselves, but also be able to integrate into the recovery process much more quickly and fully. By doing this, they will be empowered to take care of themselves, neighbors, and community, which in turn increases local resilience.