There is a worldwide spiraling risk for more frequent catastrophic events involving multiple casualties, not only in terms of acute injury and illness, but also subsequent psychological and public health concerns. Today, such events will likely be multinational in nature, even when localized to a particular venue and this require international cooperation in terms of prevention, mitigation and relief. The best approach to preparing for disasters is to expand, modify and enhance current local ∖Jobname: S34055 Batch number: 00060 infrastructures and capabilities for managing the multiple types of disaster scenarios and create a number of inter-facility cooperative agreements in advance. Aside from safer internal locations for ICUs and surgical theaters, certain structural changes will need to be installed such as modified ventilation systems, protected water supplies, decontamination mechanisms and security renovations. A key strategy will be to proliferate interoperable, multi-disciplinary, all-hazards training initiatives such as the AMA National Disaster Life Support courses. Purchases of cadres of antidotes, antibiotics and hemoglobin-based oxygen carriers should be coordinated regionally, stored in secure locations and made readily-available for the applicable disaster scenario.