The medical response to mass casualty terrorist bombings (MCTB) has received extensive treatment in the trauma and emergency medicine literature over the past 25 years. An effective medical response must consider four fundamental aspects: (1) the objective of the response, (2) the typical injury pattern, (3) triage, and (4) the delivery of care. This report discusses the key components of each of these aspects, identifying points of consensus and contention and articulating unresolved research questions. Particular attention is given to the triage process because of its importance to the overall response and the array of differing opinions on how, where, and by whom it should be completed. Mathematical models of the trauma system during an MCTB are limited, but this approach offers the potential to answer many of the proposed research questions.