Multi-casualty traumas (MCT) place significant strain on system resources unexpectedly, following either natural or human-made disasters. Timely and effective triage, as well as using validated protocols, plays a critical role in the management of MCTs in order to provide adequate care to victims. Effective allocation of scarce hospital resources and personnel, and working in a coordinated and complementary fashion, provides the best care to the greatest number of patients. Training exercises, including simulation training, involving all levels of the response team can preemptively prepare the team for the unexpected MCT and ultimately improve outcomes.