The most gravely injured were in surgery less than 45 minutes after a gunman opened fire in a Quebec City mosque just before 8 p.m. Sunday, and doctors operated non-stop on the wounded until 5 a.m.
That swift, relentless response likely saved lives, and kept the death toll from rising above six in the mass shooting, the physician who oversaw the trauma team says.
"The response of the health professionals involved in this drama, from the paramedics to the surgeons, was impressive," Dr. Julien Clément, head of traumatology at l'Hôpital de l'Enfant-Jésus said in an interview. "They really answered the call in difficult circumstances."
He said, at one point, three surgeons were operating simultaneously on one victim to stem the bleeding from multiple gunshot wounds.
Dr. Clément, citing privacy rules, would not provide any personal information on the patient.
However, he has been identified in media reports as Saïd El-Amari, a 39-year-old taxi driver and father of four children. Family members say he was shot four times at close range and suffered life-threatening internal bleeding.
A total of 20 people were treated after the shooting at four hospitals, for conditions ranging from shock to broken arms and legs. Members of about 30 families have also sought psychological care to help deal with the fallout.
The five critically injured, who all had gunshot wounds, went to Enfant-Jésus, the regional trauma centre.
"For a few hours, it was pretty intense," Dr. Clément said.
On Tuesday, four patients remained in hospital, two in critical condition, and two stable.
The two critically injured patients have both undergone multiple operations and are being kept in a medically induced coma because they have open abdominal wounds.
"We expect them to survive," Dr. Clément said. "But what we still don't know is the longer-term consequences of their injuries. It's too early to say."
Dr. Clément singled out paramedics for doing triage in chaotic conditions and getting the most gravely injured to hospital quickly.
Emergency-medicine specialists often refer to the "golden hour," the time after a traumatic injury when there is the highest likelihood that treatment can prevent death.
"We don't normally see a lot of gunshot wounds here," Dr. Clément said. "I would say roughly 15 gun-related injuries a year – suicide attempts and hunting accidents."
However, Dr. Clément himself has plenty of experience treating shooting victims, because he worked as a physician in the Canadian Armed Forces for 16 years, including three tours of duty in Afghanistan as a surgeon.
"All our surgeons are competent; they know how to treat a patient's injuries. Where my experience helped was being a band leader – if I can use that expression – overseeing our response to this unusual event," he said.
Police have yet to release any information on the weapon used in the shooting. But Dr. Clément said that, based on his knowledge, the shots likely came from a handgun, perhaps a 9 mm pistol, and not a higher-calibre weapon.