Hospital emergency and safety managers say they're already reviewing and updating their mass casualty plans, based on Orlando.

"Just continue to be vigilant and that time that we spend doing drills, it's worth it. It can happen anytime," said Dr. David Janicke, Buffalo General/GVI Emergency Department director.

"You get a lot of insight on what you could do better. It reinforces all the reasons we have to continue training with our staff, looking at the best possible equipment to accommodate an act like this," said Tim Kornacki, Kaleida Health corporate emergency manager.

"Our facility really looks at our responsibility to the community, and part of that responsibility is being ready for whatever happens. So, as a level one trauma center, yes, it is sometimes difficult to fit them in, but the other thing is we do them day, night, weekends, all different shifts. We make sure they're done so everyone around facility is ready 24/7," said Charlene Ludlow, ECMC chief safety officer.

In a mass casualty situation, first responders would use a smart triage program, sorting patients based on the severity of their injuries.

"They come with a tag, and it's color-coded. This gives the hospital the ability to quickly accept people who are truly critical," said Kornacki.

Hospitals would cancel elective procedures and discharge patients who are stable enough go home. Since ECMC is the level one trauma center in the area, the most critical patients would be treated there.

"I wouldn't think it unusual to go through 10 units of blood on a patient that was really wounded and needed surgery and was bleeding," said Janicke.

Non-critical patients or overflow might go to area hospitals, including Buffalo General. All hospitals say they would need to have disaster mental health professionals on hand.

"They've been trained on how to work with patients, families, as well as our own staff, helping them be ready for this but also help them through the process," said Ludlow.

"We'll have sessions where we all get together and try to talk through the cases and our feelings and so forth. We do that now," said Janicke.

In addition to treating patients after a mass casualty incident, it changes the way a hospital functions and more security is often put in place.

"Locking down our campus, knowing who is coming and who is going and making sure that everyone that needed care was getting in. People who did not need to be on the campus, we would not have them on the campus. But that's where the police departments would be helping us with our perimeter," said Ludlow.

"The absolute first thing we would have to absolutely rely on is hospital incident command. You need a system to manage something as large scale as that. Is there potentially camera coverage that we need in a high traffic area that we do not have. We participate with homeland security and work groups," said Kornacki.

Plus hospitals are training all staff on recognizing dangerous situations and persons to prevent a bad situation from getting even worse.