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Mass casualty events can cause patient surges within healthcare facilities. These surges can be limited to hours or continue for days or weeks. As emergency departments are the front doors to the healthcare system, it is critical that they are prepared to accept patient surges. Focusing plans on optimizing space, staff, and supplies is critical to a successful response. Boarded or non-emergent patients must be diverted, discharged, and decanted from the emergency department to expand resuscitation space. If inadequate, non-clinical space may be required for patient care. Staff call-in lists should be maintained, and in-house berthing for staff during prolonged responses may be necessary. Further, identifying the spectrum of care, from conventional to crisis, is necessary to thrive during a disaster response: staff must understand that business as usual will not be compatible with austere disaster response before levels of care begin to decline., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.