General principles of civilian triage should be familiar to all physicians. Isolated instances of mass casualties can happen in a region with only one small hospital, and any physician may be called upon to act as a triage officer. Combat triage principles do not appropriately address civilian mass casualty situations in which survival, not combat-readiness, is the main goal of medical treatment. The goals of combat medicine are to return the greatest number of soldiers to combat, and then to preserve life. Social worth may be applicable in very limited interpretations, when the particular skills of the individual are critical to managing the disaster itself. Lifeboat ethics may lead to decisions to reallocate resources away from existing hospital patients in order to provide capacity to treat disaster victims. Triage should be based on ethically sound principles, be transparent, include public input, and be developed before disaster strikes.