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The hospital, Snider says, is carrying out the latest exercise in preparation for the next mass shooting, attack or disaster.

“Sadly, it’s a when, not if,” she says. “Given the current climate, we have to assume there will be a when. If there was no next time, that would be absolutely, truly wonderful.”

St. Michael’s is one of two places in Toronto where patients go when trauma hits on a large scale, the other is Sunnybrook Hospital in the city’s north. Children are sent to the Hospital for Sick Children.

The emergency department has prepared for the latest simulation for a year. During that time, it has dealt with two real-life code oranges — a shooting rampage that killed two and injured 13 in Toronto’s Greektown last summer, and the Raptors parade shooting.

The team learned from the parade shooting that patient identification is key. They’re testing improved procedures in this drill.

“You have to have a way to identify to everyone who’s coming in,” Snider says. “You have that one chance to get it right.”

A triage nurse waits at the front door with four boxes of coloured bracelets beside her as patients arrive –green for the walking wounded, red for those who need immediate intervention, yellow for everything in between, and blue for the dead or someone with no vital signs.

“The general principles in a mass casualty incident when your resources are sparse (are that) you should spend very little time trying to resuscitate somebody whose vital signs are absent because they’re extremely unlikely to survive,” says Rachel Poley, an emergency physician who was among those leading the simulation.