School preparedness includes the possibility of a natural disaster, but recent events also confirm a need for preparedness and prevention efforts for intentional mass casualty incidents (MCIs). This survey examined the preparedness for the prevention and response for MCIs at public schools in Arkansas. This survey demonstrated that most school districts in Arkansas have plans for responding to a mass casualty event, but less than one half have a plan for prevention or mitigation of such an event. Since this survey was conducted, Arkansas has passed a law requiring all school districts to develop such an emergency response plan. The findings highlight a need for continued planning and preparation. For example, most schools had not conducted a mass casualty drill. Most superintendents had not met with local EMS officials, and only a few have regularly scheduled meetings. Schools should continue to plan and prepare for the unwelcome prospect of a disaster at a school. School district administrators, nurses, physicians, local emergency response agencies, and the local medical community should all be involved in formulating a coordinated plan for their local community schools.