They were ready. Are you?

For Orlando Regional Medical Center, the moment came June 11 when a gunman opened fire at a nightclub, eventually killing 49. Thirty-five victims were operated on at Orlando Regional, and all survived.

“They had wounds like I had never seen before,” a nurse at the Florida hospital said.

In our cover story on Page 8, Marty Stempniak describes how Orlando Regional, Parkland Memorial Hospital in Dallas, Massachusetts General Hospital in Boston and Loma Linda University Health near San Bernardino, Calif. — all in communities recently struck by mass violence — responded to tragedy.

What let these hospitals successfully treat large numbers of badly wounded patients? Preparation, practice and flexibility to react in a rapidly unfolding crisis. For example, area hospitals and emergency management leaders had developed a coordinated plan to deal with a mass casualty event before the 2013 Boston Marathon bombings took place.

But in some quarters, the belief that “it won’t happen here” still exists.

If you want your hospital to be ahead of the curve, experts have a few tips. Preparation starts with recognizing that the worst can happen, then moves on to thorough, ongoing training and drills for staff across all areas, and includes a mass casualty protocol. And, yes, it involves reaching out beyond the hospital’s walls.

The American Hospital Association is working to foster this kind of training and disseminate best practices through its Hospitals Against Violence initiative, which brings together webinars, podcasts and community action programs. Related stories from Trustee and sister publication Hospitals & Health Networks can be found on a page online

Hospitals Against Violence is intended to combat all forms of violence, in the understanding that violence is a public health issue affecting all communities and health care systems.

Trustees have an important role to play, too. They and top leadership can make sure their hospital has plans in place to respond to a mass casualty event; they can target gaps in preparedness; and they can connect with other organizations and the community so everyone is involved in planning for a possible attack. Above all, board members can ensure that the issue of mass violence isn’t put on the back burner.

Our recent history shows that attacks triggering mass casualties are no longer unthinkable — if they ever were. Violence is something that every hospital and health system, everywhere, needs to prepare for.