Losses from natural hazards, including geophysical and hydrometeorological hazards, have been increasing worldwide. This review focuses on the process by which scientific evidence about natural hazards is applied to support decision making. Decision analysis typically involves estimating the probability of extreme events; assessing the potential impacts of those events from a variety of perspectives; and evaluating options to plan for, mitigate, or react to events. We consider issues that affect decisions made across a range of natural hazards, summarize decision methodologies, and provide examples of applications of decision analysis to the management of natural hazards. We conclude that there is potential for further exchange of ideas and experience between natural hazard research communities on decision analysis approaches. Broader application of decision methodologies to natural hazard management and evaluation of existing decision approaches can potentially lead to more efficient allocation of scarce resources and more efficient risk management.