Mass casualty incident represent an important reason in mortality and morbidity in the world. For a health system to respond adequate to an incident, it is important to coordinate all the stakeholders, from emergency medical services on the scene, to hospital response. Mass casualty incidents require fast and efficient response on all levels, with coordination among them. Response on the primary scene of accident has its importance in beginning a cascade of response in the whole health system, including triage and wise allocation of resources. Triage system should be coordinated at all levels, with the possibility of re-triage and evaluation of response, in which case the education of response team is of undeniable importance. Hospital mass casualty plans should be simple, enforceable and clear to all employees for optimization of response. According to evaluation after responses on mass incidents around the world, it is clear that there are certain repeating mistakes: from communication, coordination of response and lack of education for health workers. The evaluation of response is crucial here since it provides us with information which can be used for better functioning of the system as well as learning from experience, not only for the country on which the incident happened, but also for the others. All countries, according to their resources, should have plans in case of mass casualty incidents, on national, regional and local level as well as in the hospitals. Comparing Croatian system with recommendations, it is clear that there is an initiative to optimize the system for the response, in terms of recommendations, algorithms and administrative response. Similar as in the rest of the countries, there is a need to invest more resources in education and evaluation of response for better outcomes.