Catastrophes, natural or man-made, are very rare events in the life of hospitals in the developed world. None of the hospitals that coped with well known recent events such as Hurricane Katrina or the Madrid bombings had actually experienced or prepared for such an occurrence. A mass casualty incident (MCI), sometimes called “MASCAL,” is a situation in which a hospital receiving multiple casualties does not have the resources to deal with the patients simultaneously. Bottlenecks may occur at any point from the trauma bays to the point of discharge. There are 2 phases in which hospitals fail to cope. In the first, treatment of some patients is delayed while the hospital continues to function. In the second, hospital-wide systems collapse. Up to now, we have been fortunate that good luck and extreme hard work by those on duty have mitigated what would otherwise be a secondary extension of the catastrophe. For the United States, the 9/11 terrorist attack in New York was the wake-up call even though catastrophic events such as the Oklahoma City bombing or the Columbine shooting had occurred before it. What, though, will it take to shake the rest of us out of our complacency?