Background: 
The current study outlines some of the main particularities of both real and simulated mass casualty incidents (MCI) and disasters in Romania as reported by medical and paramedical participating personnel.
Methods:
 A non-profit organization in Romania trained 1250 doctors, nurses and paramedics for proper MCI interventions through a dedicated programme for the last part of the year 2013. Half a year later, an email with a unique link to an online questionnaire was sent to each participant to assess their opinion over the participation on real or already simulated MCI or disasters. The questionnaire consisted of 25 specific topics, out of which only a fraction were considered for the current study.
 Results: 
Out of all participants, 145 doctors, 184 nurses and 115 paramedics provided valid answers, totaling 444 responders. Most of the participants were satisfied with the information about the location and type of the incident they would respond to. The amplitude of a given event is generally well anticipated under simulation conditions as compared to real events, where the amplitude tends to be higher rather than lower than expected (p=0.0082). About three quarters of participants under real or simulated events repeated or demanded repeating the information trafficked through mobile radios, almost a quarter misinterpreted the information, and almost a half reported delayed operations due to miscommunication. Conclusions: 
Simulations are a proper method of communication evaluation for mass casualty incidents and disasters, which can also stress the common communication issues encountered during a real MCI unfolding.