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The role of emergency response is central to the quality of life as increasing numbers of the world's people are exposed to disaster. This article reflects on three principle "causes for concern" for the well-being and advancement of emergency response, as a prelude to a discussion of the managerial challenges inherent in this vital process. Recent attention to these managerial realities, although sometimes set in starkly different settings, have nonetheless brought a variety of concepts to light that show promise in developing practical solutions for those commissioned with decision making in the face of disaster. Such developments are summarized here, suggesting multiple ways forward toward the substantive research, support, and improvement of the managerial process of emergency response.