The trauma of a mass casualty event in Fort Hood, TX very quickly impacted the imaging departments of 3 healthcare facilities in central Texas. In the aftermath,there was an opportunity to reflect and learn. When a mass casualty event or disaster takes place, radiology administration needs to be visible, lead staff, manage media attention and law enforcement presence,all while maintaining a high level of quality patient care. Issues of particular concern are training, coping mechanisms, and the impact of leadership. Military and civilian healthcare facilities have different capabilities in terms of training and operations when it comes to managing such an event.