CHDS State/Local / This thesis addresses the role of the emergency department in planning for mass casualties during an emergency. The demand on hospital emergency departments has stretched the capacity for normal operations beyond their original design. Hospital surge capacity is not only complex, but affects every hospital emergency department in the country. Factors, such as hospital bed capacity, surge levels, staffing and the use of volunteers in time of emergency, all play a critical role in the ability and accessibility of the hospital to react during times of need. The recommendations provided are based on the analysis of county, state and federal plans along with case studies that provide a varied approach to emergency preparedness and the role of the hospital, focus on some of the facets of preparedness and the immediate need for emergency planning, training/exercising and communication in hospitals across America, and specifically, in hospitals in South Carolina.