You Shall Not Stand By

Abstract

Lo Ta’amod al Dam Re’ekha. This passage, from the Hebrew Bible (Va’Yikrah, or Leviticus 19:16), means “You shall not stand idly by while your fellow human is in danger of harm.” This religious injunction is held to apply to all human beings, and similar concepts underlie secular moral and ethical codes as well. In essence, we as humans accept that others’ lives are important and worth protecting, even, perhaps, at danger to ourselves. It is, perhaps, this universal human sentiment that leads health care workers and many others to spontaneously volunteer to give of themselves in disasters. The threat of pandemic influenza or other very-large-scale natural, accidental, or terrorist-caused disasters has challenged society to develop methods to provide large-scale, long-term health care surge capacity. The needs of such an effort would include a large number of health care staff, in addition to training, equipment, medications, and, perhaps most notably, organization. Issues to be settled include how to recruit, train, protect, and provide liability and workers compensation protection for health care workers who may be thrust into unusual situations, providing care at the limits of their training, in unaccustomed venues. The American College of Emergency Physicians, among others, strongly supports making such volunteer efforts possible while recognizing the difficulties. In this issue of Annals, Schultz and Stratton describe a method for tackling the difficult issue of staffing: where will the caregivers be found? Theirs is hardly the first or only method proposed for recruiting and credentialing staff to provide disaster care. As the authors note, for example, the federal government has established the Emergency System for Advance Registration of Volunteer Health Professionals. All states and several large cities in the United States are required to implement components of this system. So why do we need to even discuss the method described by this proposal? Simply because it answers problems that Emergency System for Advance Registration of Volunteer Health Professionals may be unable to address, and in a nimble, rapid, and unencumbered fashion. As they point out, Emergency System for Advance Registration of Volunteer Health