Mass casualty incident (MCI) education has long been a cornerstone of EMS preparedness. Across the United States, agencies dedicate significant time and resources to tabletop exercises, functional drills, and large-scale training events designed to prepare responders for low-frequency, high-consequence incidents. Yet many real-world MCIs unfold very differently than the scenarios responders routinely train for. While traditional exercises often focus on organized scenes with clearly defined command structures, patient counts, and resource requests, actual incidents are frequently characterized by incomplete information, communication failures, resource limitations, evolving hazards, and operational uncertainty. This presentation will examine the gap between traditional MCI training and the realities of prehospital mass casualty response through the combined perspectives of an EMS medical director and an EMS operations officer. Using lessons learned from real-world Wisconsin incidents such as the Millers Coors shooting, Milwaukee Mother’s Day Fire, and Bucks Championship shooting, attendees will explore common themes observed during actual MCIs, including challenges with scene size-up, patient distribution, hospital coordination, communications, triage consistency, resource allocation, responder accountability, and incident command integration. Attention will be paid to how operational realities, human factors, and system limitations often influence outcomes more than the triage algorithms or command structures emphasized during training. The session will critically evaluate how current MCI training models may inadvertently create unrealistic expectations for responders and leadership. Examples will highlight situations where agencies successfully adapted despite deviations from established plans, as well as opportunities where preparedness efforts failed to address the challenges encountered during actual events. Attendees will learn how after-action reviews, operational data, and lessons learned from previous incidents can be used to refine preparedness efforts and improve resilience. Finally, the presentation will provide practical recommendations for EMS systems seeking to enhance MCI readiness. Topics will include designing more realistic exercises, incorporating communication and resource limitations into training, strengthening interagency coordination, improving hospital integration, and developing system-level approaches that better reflect the realities of contemporary mass casualty response. Presented by an EMS medical director and EMS operations officer with extensive experience in disaster preparedness, response, and system leadership, this session will challenge attendees to rethink traditional MCI training and provide actionable strategies to improve operational readiness for the incidents that are most likely to occur, not just the ones that are easiest to simulate.