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BackgroundTsunamis most commonly occur in the ???Ring of fire??? in the Pacific due to frequency of earthquakes and volcanic activity. Damaging tsunamis occur 1???2 times yearly. On September 29, 2009, an earthquake on the Pacific floor caused a tsunami that struck American Samoa, Samoa and Tonga, with only 20 minutes warning.ObjectiveTo evaluate the disaster response in American Samoa by emergency medical services (EMS), the territorial hospital, and the Department of Health.MethodsA retrospective review of EMS logs, public health records, hospital emergency department charts, and key-informant interviews over a 2-week period. Descriptive statistics were used to evaluate data.ResultsThree 5-meter waves struck the American Samoan islands, with land inundation as far as 700 meters. Many low- lying villages, including the capital city Pago Pago were affected. A total of 33 people (8 male, 23 female, including 3 children) were killed by the water, with approximately 150 significantly injured. EMS runs increased 250% from normal daily averages, with island-wide responses significantly delayed by flood damage. The hospital in Pago Pago, situated near the shore and only 10 meters above sea level, utilized 75 staff to evacuate 68 in-patients to high ground as soon as tremors were felt. This process was completed in 20 minutes with no associated morbidity or mortality. Patient injury patterns for the event are similar to recent literature reports. Mobile clinics and alternate care sites established at outlying dispensaries were used to decentralize healthcare from the hospital. DMAT/DMORT teams from Oregon and Hawaii supported local healthcare initiatives. Post-disaster public health surveillance focused on identifying and limiting food/water-borne illnesses, dengue fever, and influenza-like-illness outbreaks, as well as disaster related PTSD.ConclusionThe disaster response to the tsunami in American Samoa was effective. Disaster planning was appropriate and rapidly implemented. Post-disaster public health emergencies were minimized.