The readiness of our healthcare facilities to respond to terrorist acts or naturally occurring epidemics and disasters has been at the center of public attention since September 11, 2001. The many other tragic events that have occurred throughout the world since then further reinforce the need for all healthcare facilities and medical personnel to increase their level of preparedness if they wish to optimize outcomes. Maximizing survival rates and minimizing disability during any MCI hinges on rapid, seamless, and coordinated response between first responders and first receivers. The Incident Command System and the HEICS are organizational tools that form the foundation for such a rapid and coordinated response. The ICS provides a simple and adaptable management structure that is capable of being expanded or contracted to meet the needs of a specific situation. The HEICS adapts the ICS into the hospital setting and, in addition to the benefits stated above; its use of the ICS nomenclature and terminology facilitates the communication and the sharing of resources between all agencies and health care institutions involved. A basic knowledge and understanding of the ICS principles and structure is essential for all individuals participating in a disaster response. Previous efforts at disaster preparedness have focused predominantly on the pre-hospital and rescue phase of the disaster response, but a complete and coordinated community response requires creation of integrated disaster plans. True readiness can only be achieved by testing and modifying these plans through integrated simulation drills and table top exercises. Hospital-wide drills are essential to educate all staff members as to their institutional plan and serve as the only substitute at present to first hand experience. At present, there is no evidence-based literature to define what constitutes the best medical response by medical personnel within a disaster setting. This information will likely evolve over the next several decades as we now recognize Disaster Medicine as a separate scientific and medical entity. In the interim, we can develop and modify our response plans based on the "lessons learned" from past experience. Prior events have demonstrated that general surgeons and surgical subspecialists are critical components to a successful hospital response for the vast majority of all mass casualty incidents. Thus, surgeons must take responsibility for increasing their knowledge and understanding of basic disaster management principles and must play an active role in developing their institutional disaster plans.