While most hospitals in the United States have increased their focus on emergency preparedness during the last few years, some have gone a step further, developing innovative programs to help them respond more quickly and effectively to large-scale disasters, natural or otherwise.

Vanderbilt University Medical Center's School of Nursing and Department of Emergency Medicine in Nashville, Tenn., are building the Middle Tennessee Medical Reserve Corps. Funded by a federal grant, the MTMRC will consist of trained health care professionals who could respond to mass medical emergencies in the community.

"With this program, we will train people ahead of time, confirm that they are licensed, and provide them with badges to wear on the scene so they can be identified as someone who can help," says Carmen Rich, R.N., director of recruitment for the MTMRC and a nurse in the pediatric and adult emergency departments at Vanderbilt.

Corps members responding to an emergency will examine, triage and treat patients. The most critically injured would be stabilized and sent to nearby emergency departments. Those with minor injuries would likely be treated on-site.

Volunteers, including physicians, nurses, EMTs, dentists and even veterinarians are still being recruited. Because many health care workers may be called to their facilities during a large-scale emergency, the recruits are also looking for retirees, stay-at-home parents and others who are not employed full time. Rich hopes to sign up enough people to keep the Corps running for up to three days during an emergency.

The Carolinas Medical Center in Charlotte, N.C., has also developed a means to bring medical care to a disaster site: a mobile hospital dubbed Carolinas MED-1.

The vehicle, which was funded by a grant from the Department of Homeland Security, includes a fully functional operating room, general observation beds, radiology, pharmacy support, dental facilities and an awning and tent system that can accommodate up to an additional 85 beds. It also has air filtration and quarantine capabilities that can be used in bioterrorism emergencies. If a large-scale disaster occurs, MED-1 can be used to augment existing hospital facilities or to provide care at the disaster site.

About 75 health care professionals have been trained to use MED-1, but in an actual emergency only three physicians, five nurses and five EMTs would be deployed. "We wouldn't want to deplete any hospital's ER resources," says Thomas Blackwell, M.D., medical director for the Center for Prehospital Medicine at Carolinas and the Mecklenburg EMS Agency, and creator of MED-1. "We trained enough people that we should always be able to staff MED-1 while leaving hospitals fully staffed as well."

Many organizations have already taken an interest in creating or supporting similar facilities, including the U.S. armed forces and the National Highway Traffic Safety Administration.

"We have been watching this project closely," says Jeff Runge, M.D., administrator of the NHTSA. "The MED-1 takes EMS response to the next level. I don't think we've even begun to conceptualize what the MED-1 is capable of."