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Disaster psychiatry has existed for many decades as a field but has received heightened attention since 9/11. In the last ten years, a good deal has been written about the field, but efforts to establish its evidence base or to fund appropriate services have been more variable. This article will review the current state of the science in disaster psychiatry, with particular emphasis on acute psychopharmacologic and psychotherapeutic interventions. Additionally, it will examine the systems issues that remain a challenge to establishing an effective and meaningful psychiatric response system for disasters. Particular attention will be paid to the developing literature on adolescents reactions to disaster and how these may shape psychiatric services for this population.