Montreal hospitals practise Code Orange, simulating catastrophe

It's 7:30 a.m. Calls are flooding into Montreal's Children's Hospital's emergency ward.

There's been a major incident in the city. Someone has plowed a vehicle into several pedestrians and then opened fire. There are multiple casualties.

It's a Code Orange.

Minutes later, the first "patient" is wheeled in on a stretcher. "Elliott" is a 10-year-old suffering from a gunshot wound to the stomach.

"Is this a penetrating trauma?" Dr. Brett Burstein asks the paramedic while looking at the blood-soaked T-shirt. "Take him down to the third room."

Burstein is in charge of co-ordinating where the patients are to be treated. He's like a general, giving quick commands and asking for information in a calm, steady voice while constantly moving from room to room, speaking to staff.

The atmosphere in the emergency ward is one of controlled chaos.

Fortunately, this is just a simulation. Elliott is just a mannequin. But the dozens of staff on hand are treating it like it's the real deal.

In all, 20 mannequins and actors are wheeled into the emergency room with various injuries. Five of them are critical.

Elliott is handed over to Dr. Hussein Wissanji's team. Nearly a dozen staff members in yellow gowns spend several minutes trying to stabilize the mannequin before wheeling him off to the operating room.

"We are going to continue the resuscitation, but we're going to see if he's stable enough to go with or without intubation," Wassanji tells his team.

"Does anybody else have some input?"

Watch hospital staff run the Code Orange drill below.

Rehearsal for mass casualties

The Children's Hospital is one of seven Montreal hospitals taking part in the exercise.

For the first time, Héma-Québec is involved, as well. Emergency physician Elene Khalil is one of the main organizers. She says people spent months organizing this Code Orange.

"One of the goals of the simulation was to test the regional response of the blood banks and Héma-Québec and to see, if there ever was a large event in Montreal and the surrounding area, whether we could respond to it to save as many lives as possible," she says.

Khalil deems the exercise a success.

Montreal has seen its share of mass-casualty situations, from the 14 women gunned down at École Polytechnique in 1989 to the shooting at Dawson College in 2006, which left two dead (including the shooter) and injured 19 others.

Those types of incidents are a major test for the city's emergency response teams.

Wissanji explains that the point of this exercise is to get everyone working together.

"The parallel I can make is it's like asking professional musicians to perform a symphony in unison without having ever practised together as an orchestra."

"So today, this is our rehearsal for massive casualties."

Working out kinks

By 9:30, the simulation is over. Then comes the debrief, where health workers discuss what worked and what didn't.

There will never be a perfect response to such a catastrophe, Burstein says, but the point is to work out the kinks.

"Access and time to get blood is always a difficulty in mass casualty situations."

"We learn not just about the things that we're missing, but how we can operate better with what we have."