In June 2000, the Telemedicine Center at the Brody School of Medicine, East Carolina University in Greenville, NC participated in a simulated disaster response in Pu'u Paa, Hawaii, a lava plain without running water, electricity, or human habitation. During the five-day exercise we evaluated the ability to establish telecommunications and the effectiveness of the infrastructure, services, and applications implemented for an operational global emergency response. Scaleable technologies were configured and systematically tested to determine the ability to provide medical and health care in an austere environment. A medical communications matrix was constructed and used throughout the evaluation. Results show that telemedicine can be an important contribution to humanitarian relief efforts and medical support following disasters. Additional research is needed to build upon the lessons learned from participation in this exercise.