Mass casualty events that result from conventional terrorist attacks have become more common in recent years. These events are characterized by major chaos and a large number of injured victims that overwhelm local resources and personnel. Mass casualty protocols and management are often based on theoretical models adapted from the military experience and literature. Over the last few years the medical system in Israel has had to deal with multiple mass casualty events resulting from terrorist events. This has led to the development of novel strategies that may run contrary to traditional teachings. The current report summarizes the experience and lessons learned by the Israeli Emergency Medical Services and its hospitals over the last few years. Although each hospital and Emergency Medical Service agency will need to tailor its management plan to its particular needs, it is our hope that the lessons learned in Israel will assist others in optimizing the care of mass casualty events.