Teaching the lessons learned from a killer tornado

Dr. D. Sean Smith, president of Mercy Clinic-Joplin (Mo.) and Kansas Division, said that, in his more than 30 years in emergency medicine as both a paramedic and physician, he knew the importance of hospitals participating in disaster drills, but he never was part of a drill where the hospital itself was the scene of a disaster.

That is what occurred May 22, 2011, when Mercy St. John's Regional Medical Center in Joplin took a direct hit from a tornado that leveled most of the town.

Smith and Donn Sorensen, Mercy Clinic chief operating officer, spoke at the American Medical Group Association's annual conference in San Diego and talked about the destruction of the tornado, what Mercy did in the aftermath and its plan to rebuild St. John's.

The 347-bed, nine-story hospital somehow remained standing, but the 200 mile-per-hour wind blasted through the windows destroying everything in its path. The tornado killed 161 people, including five patients and one visitor at the hospital. Sorensen credits the hospital's "hero nurses" who evacuated the patients from the building in darkness and driving rains for keeping the death toll from being higher.

"The wind came in the west and blew out the east," Sorensen said. "I can't convey to you the destruction."

Sorensen showed pictures of the devastation at the hospital and surrounding area, noting how the tornado tossed cars around as if it was a leaf-blower and the heavy vehicles were leaves. In one picture, he showed the wreckage of the hospital's leveled administration building including a desk on top of which a prayer book and an AMGA compensation survey had landed.

There were 183 patients inside the hospital that Sunday evening, including 24 in the emergency department and one that was in the middle of an orthopedic surgery. The tornado hit soon after a "Code Gray" had been initiated, in which patients in exterior rooms were being moved into the interior, though Smith said it wouldn't have mattered even if they had time to complete that mission because "every room in the building had storm damage."

Injured Joplin residents saw the hospital still standing and started heading toward it, not knowing that its interior--which was filling up with leaking natural gas--was uninhabitable. "They looked like zombies coming in," Smith said.

Meanwhile, he said, the medical staff on the scene had run short of antibiotics, painkillers and tetanus shots.

A mobile hospital was established for 200 patients in the gymnasium of the local civic center, where Smith said they practiced "ditch medicine" and treated everything from minor scratches to a cardiac arrest. There was one bit of good fortune for Joplin in that a disaster drill was being conducted two hours away in Branson, Mo., where a temporary hospital had been assembled as part of the event. The facility was quickly disassembled and put back together in Joplin, complete with a 20-bed emergency department, catheterization laboratory and diagnostic-imaging equipment.

"They were not the nicest digs I've ever been in, but we were damn glad to have it," Smith said, adding that the other bit of good fortune was that Mercy had just completed a system-wide electronic health-record rollout a few weeks earlier, so the medical histories of residents who were patients of the Mercy system were accessible.

Smith said Mercy kept issuing paychecks to the hospital's employees and offered "turn-key" integration contracts to independent physicians who had practiced at the hospital. While this started as an "altruistic" initiative, Smith said it was also an excellent business plan because staff stayed in the area, unlike in New Orleans where "staff had dissipated to the four winds" in the aftermath of Hurricane Katrina and were unavailable when some facilities were reopened or replaced.

He added that it was a big boost to morale when, on Aug. 18, a new temporary "modular" facility opened that had air conditioning, running water and indoor toilets. A two-story, temporary, concrete-and-steel 180-bed structure is set to open in April that will serve the community until a permanent replacement hospital is completed.

Smith said a new 327-bed hospital (with room to expand to 424 beds) has been designed and is scheduled to open in the first quarter of 2015.

Among the lessons that were learned or reinforced, Smith said, were the need to have a secure "bunker" for communication equipment and medical supplies, that having mobile emergency medicine personnel treat injured patients at their location was more efficient than trying to transport them all to hospitals, and that it's vital to maintain good relations with other hospitals in the region--even those considered competitors.