International collaboration in disaster medicine--it is time for the "big step" in disaster preparedness.

In the last few decades, we have witnessed global disasters that rendered national medical systems helpless. A few examples are the tsunami in southeast Asia, and earthquakes in Turkey, Pakistan, Indonesia, Iran, and India. 1–8 A large-scale disaster occurs when a nation cannot cope with the tragedy by itself and needs help from other nations. This is due to a lack of resources in face of the situation's magnitude and the lack of knowledge or preparedness. Preparedness for a large-scale disaster is expensive, and in most cases, unachiev-able even for modern countries. International collaboration has a great impact on the successful medical preparedness and management of a large-scale disaster. Brennan and Waldman addressed a key success factor in the management of large-scale disasters— " The art of coordination ". 1 Cooperation and coordination between nations is needed during a global disaster. Preparations for international collaboration might improve the function of the systems in the disaster area. International preparedness will not be upgraded without implementation of a continuous, comprehensive preparedness process. The preparedness process must include the creation of an international " common language " and development of an international doctrine for disaster medicine. This doctrine should: (1) create an international structure and functional organization of all the response forces; (2) establish an international management system for operating response force personnel during a disaster; (3) prepare plans for an effective international use of existing resources including infrastructure and equipment; (4) create effective international command and control systems; and (5) apply international education and drill programs. Few steps forward, including the excellent work of Hadef et al were conducted in recent years by several countries and organizations that promoted some elements of international disaster preparedness. One of the examples of international collaboration is the terrorist event in Tabba and Ras-EI-Satan, 11 on 07 October 2004, when a terrorist bombing attack resulted in 185 casualties and required the collaborating efforts of Egyptian and Israeli rescue and medical teams. The medical response to this complex event was based on a few elements: (1) the rapid recruitment of forces to the bombing sites and international collaboration; (2) emergency assistance to the borderline hospital; (3) rearrangement of the border hospital as an " evacuation hospital " that does not admit patients (all of its personnel and resources are concentrated in the emergency department site); and (4) secondary distribution of the casualties to remote-circle trauma centers around …