On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham examine how large-scale events expose weaknesses in Canada’s health care capacity. The discussion draws on the CMAJ editorial Mass gathering events underscore serious vulnerabilities in health care capacity in Canada, which argues that Canada’s hospitals lack the flexibility to absorb even modest surges in demand. With the FIFA World Cup approaching, the episode asks how prepared the system really is.

Dr. Catherine Varner, deputy editor of CMAJ and an emergency physician, explains why she wrote the editorial now. Drawing on her frontline experience during major events in Toronto, she describes hospitals that routinely operate over capacity, with little ability to create space when demand rises. She distinguishes between mass casualty events and mass gatherings, noting that while catastrophic incidents are rare, sustained influxes of visitors predictably increase emergency department use. Varner also describes how prolonged overcrowding worsens patient outcomes and contributes to moral distress among clinicians forced to triage care daily.

The conversation then turns to national surge planning with Dr. Rob Fowler, chief of the trauma program at Sunnybrook Hospital and director of critical care at the University of Toronto. Fowler describes insights from tabletop exercises, including Canada Paratus, which examined how civilian and military health systems might respond to a large influx of casualties. He explains how hospitals already operating at or near capacity struggle to respond to sudden surges, particularly when care depends on moving patients across the system.

For physicians, the takeaway is stark: Canada’s health care system is already operating at or beyond its limits. Without meaningful capacity to flex or coordinated mechanisms to redistribute patients, even predictable increases in demand risk tipping routine strain into crisis.

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