Articles in the Supplement to this issue of CHEST2 provide some answers to the queries presented. A multidisciplinary taskforce of >35 experts in the fields of pulmonary, critical care, hospital medicine, military medicine, public health, palliative care, ethics and law, critical care nursing, and respiratory therapy convened at American College of Chest Physicians headquarters in January 2007; after an exhaustive review of the disaster medicine literature, they identified areas of shortcomings in disaster preparedness. The panel incorporated input from organizational bodies whose interest and expertise were in both disaster management and guideline development. Bedside clinicians provided “true north” aspects to guide patient-centric consensus. Complexities of optimizing health-care, acute care, and critical care provision during a disaster event are discussed. Specific subjects include critical care triage, hospital and ICU surge capacity, and ethical care issues in mass casualty events. These basic, potentially contentious matters are best handled outside the emotionality of an acute occurrence of disaster and within the purview of a multidisciplinary consensus voice.