When disaster strikes, the nation depends on the emergency response community. No events demonstrated this truth as dramatically as the catastrophic terrorist attacks of September 11, 2001. But the same holds true every time the nation faces a major natural disaster or industrial incident. Emergency responders are an indispensable part of the country’s homeland security system. To ensure that this system can meet the challenges of major disasters, the nation must take every measure to protect emergency workers from the safety and health risks inherent in their work. In the aftermath of the September 11 terrorist attacks, the National Institute for Occupational Safety and Health (NIOSH) and the Science and Technology Policy Institute (S&TPI), formerly managed by the RAND Corporation, organized a conference in New York City on the protective equipment needs of emergency responders during responses to terrorism. Over the course of this meeting, participants repeatedly emphasized that, in addition to protective equipment, responders need effective safety management to ensure their well-being as they bring these devastating situations under control. As a result, NIOSH and S&TPI undertook this study to develop a better understanding of safety management in major disasters, both manmade and natural, and to develop recommendations for improving safety management for emergency responders. Through an extensive literature review, interviews with members of the response community, and workshop discussions including more than 100 participants, the research team determined areas for improvement and developed recommendations to guide needed changes. This report provides a comprehensive set of strategies and tactics for enhancing the safety of responders by preparing thoroughly before an event and managing effectively afterwards.