This report describes the initial hospital and burn center management of a mass casualty incident resulting from an aircraft crash and fire. One hundred thirty soldiers were injured, including 10 immediate fatalities. Womack Army Medical Center at Fort Bragg, North Carolina, managed the casualties and began receiving patients 15 minutes after the crash. As a result of repetitive training that included at least two mass casualty drills each year, the triage area and emergency department were cleared of all patients within 2 hours. Fifty patients were transferred to burn centers, including 43 patients to the US Army Institute of Surgical Research. This constitutes the largest single mass casualty incident experienced in the 57-year history of the Institute. All patients of the US Army Institute of Surgical Research survived to hospital discharge, and 34 returned to duty 3 months after the crash. The scenario of an on-ground aircraft explosion and fire approximates what might be seen as a result of an aircraft hijacking, bombing, or intentional crash. Lessons learned from this incident have utility in the planning of future response to such disasters.