During the Emergency Nurses Association's annual meeting in October at the Orange County Convention Center in Orlando, 40 nurses and 100 actor volunteers simulated a mass casualty terrorist attack before 3,000 people.

The association had no way of knowing that a nearby nightclub just eight months later and 10 miles away would become the site of the deadliest mass shooting in American history, but the training illustrated the growing recognition by health care providers that treating victims of bombings and mass shootings is becoming increasingly commonplace in U.S. hospitals.

"Hospitals are preparing and recognizing the need to prepare for these kinds of events," says Dr. Jay Kaplan, president of the American College of Emergency Physicians. "It’s not a matter of if, it’s a matter of when. That’s a sad commentary in that it’s a reality."

Even Orlando Regional Medical Center, a hospital that treated 44 victims of the mass shooting that occurred at Pulse nightclub early Sunday, had been preparing for such an attack.

"We do weekly trauma simulation, regular all-hospital preps, as well as city-wide simulations that cover all possible situations," a hospital spokesperson told U.S. News via social media.

The gunman at the nightclub, identified as Omar Mateen, killed 49 people and wounded 53 others.

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