Preparation for mass casualty incidents has been practiced at ORMC for more than two decades and enabled a successful response. However, the importance and intensity of such training has increased since the Pulse event. Team members take drills much more seriously now. Their importance is recognized and influences a larger group, including other disciplines, administration, emergency medical services, law enforcement agencies and the community at large. Support and even excitement for training are greater than ever. This is represented by a cultural shift in increased awareness and acceptance of the importance of practice.