The medical approach to disasters has been always a problematic issue for emergency departments. The authors of this paper reflect on possible efficient solutions for managing a massive influx of casualties in an Emergency Department, by analysing the responses to previous local catastrophic events, such as the collision of 'Segesta Jet', the great fire of Patti, the floods of Giampilieri/Scaletta and Saponara. The authors' point to a need for providing more extensive training of medical students in clinical aspects of disaster medicine.