The purpose of the Trauma Resuscitation area is to receive, triage, assess, stabilize, and, if necessary, transfer critically injured patients. The design of the Trauma Resuscitation area should maximize efficient patient inflow, treatment, and outflow. Communication between members of the Trauma team, at all levels of patient triage and resuscitation, is critical. This chapter will discuss the overall Trauma Resuscitation area environment, including the general physical design of the area and the layout of the individual Trauma bay, the importance of preparedness, and the need to consider the daily expected patient load as well as additional surge capacity in case of mass casualty events. Finally, this chapter will discuss the issue of active shooter incidents in the Emergency Department setting.