“A State of Chaos”: The Joplin Tornado

The storms had been threatening all day, & the NWS issued a tornado warning at 5:17 p.m. At 5:41, the Joplin tornado arrived.

Article by Jim Morgan
from EMS World

May 22, 2011, Joplin, Mo. The storms had been threatening all day, and the National Weather Service issued a tornado warning at 5:17 p.m. At 5:41, it arrived. With winds clocked at well over 200 mph, it cut a swath through the city from west to east. Traveling more than 13 miles, it ranged up to a mile wide at times. Later it would be determined the tornado contained three separate vortexes. The eye was estimated at 300 yards wide. Initially rated an EF4, it was upgraded after evaluation of radar data and the pattern of destruction to an EF5, the most destructive twister possible.

Within minutes there were 8,000 structures destroyed. This included 400 businesses, two of Joplin’s five fire stations and eight school buildings, as well as an estimated 18,000 vehicles. As it incapacitated St. John’s Regional Medical Center, one of the city’s two hospitals, the storm came within a quarter mile of hitting the other, Freeman West. After going through Joplin, the tornado shifted path to a southeasterly direction. Traffic along Interstate 44 was disrupted as tractor-trailers were overturned and thrown about. This would compromise the later influx of responders.

» “Armageddon”

This can’t happen twice. That was my first thought after hearing a massive tornado had just struck Joplin. Disbelief was the only emotion I felt. Joplin, a relaxed metropolitan city in southwest Missouri where I serve as the EMS medical director, had just become a victim for the second time in recent history. In 2008, a tornado struck just south of the city, killing 11 people, including an entire family of four. A year ago, in May 2011, it happened again. I was driving home from Kansas City when the call came.

“Do you know how bad the dam­age is?” I asked. “No,” she replied, “but we’re get­ting lots of patients com­ing in the backs of pickup trucks.”

“Keep me informed” were the last words I said before hanging up. I then made multiple unsuccessful attempts to call Joplin. Most of the cell service was out. Finally I managed to reach the ER charge nurse at the hospital where I practice. She told me one of the first patients to come through the door had his intestines in his lap. “Do you know how bad the damage is?” I asked. “No,” she replied, “but we’re getting lots of patients coming in the backs of pickup trucks.” I assured her I was driving as fast as I could. The trip from Kansas City to Joplin, about 250 miles, took almost three hours. During the trip home, I tried to think of what I would do.

I work as an attending physician in the emergency department of Freeman West, a community teaching hospital. We see 45,000–50,000 patients annually in our 40-bed ED. On any regular Sunday, those beds would probably be fully occupied. I knew from the sound of the nurse’s voice that this would be anything but a regular Sunday. She was a seasoned ER nurse who’d worked there for at least two decades. The fear in her voice was evident. In nine years working at the hospital, I’d never heard it.

I serve as the EMS medical director for two ambulance services and the Joplin Fire Department. It’s a position of which I am especially proud because of my previous employment as a paramedic with these services. I knew what their people would be going through and felt I should be there with them. To get home, I had to drive south of Joplin to get around the damage. It was already dark as I changed clothes and, with radio in hand, headed to the local Home Depot parking lot, where a triage area was set up.

Local radio coverage was spotty and lacking facts. Nobody had had any time to assess the damage to make any meaningful reports. “Devastation” was a common word heard. While listening to the EMS and fire traffic on the radio, I pulled into the Home Depot lot. The building itself was nothing more than rubble. At that moment I knew I would be living an experience like virtually none other. As one city council member said, we were in “a state of chaos.”

The paramedics manning the triage area walked up to me with blank stares. I knew the last few hours had been Armageddon for them. As true professionals they had a triage/treatment area set up and operating. A couple of doctors from nearby Miami, Okla., joined them. I was glad to see them there. I only remember seeing a few patients getting treated, and I wondered where the rest of them were. Then I realized this was just the beginning. A fire captain told us one of the two hospitals in the city had been demolished. St. John’s Regional Medical Center had a large medical complex, and I couldn’t imagine how it could be destroyed. At least one nursing home was also completely devastated, and rescuers continued their work there. Days later we learned only six people in the medical center had perished—five patients on ventilators and one visitor.

We spent the rest of the night moving the triage area inside a neighboring business (due to another incoming storm system) and traveling through the area of destruction. I drove to EMS headquarters to speak with the field supervisors and then went to the city emergency operations center to talk with the fire chief and city manager. The EOC was just getting organized. An EMS supervisor manned the phone link with dispatch and relayed information to the supervisor at EMS headquarters. A tally was being made of on-duty crews and agencies from outside the area sending personnel.

After nearly three hours in the field, I made my way to the ED at Freeman West. It seemed as if every­one in Joplin was there.

After nearly three hours in the field, I made my way to the ED at Freeman West. It seemed as if everyone in Joplin was there. Multiple ambulances crowded the bay, with every conceivable rank of EMS provider walking around. Patients continued to stream in, and a mixture of nurses, doctors and residents met each one. I made my way through the crowd to find the people I worked with on a daily basis. They were in a flurry of activity. Bleeding patients lay on stretchers in the hallway, so I knew the rooms were also full. ER physicians stood shoulder-to-shoulder with orthopedic surgeons and neurosurgeons peering over x-rays on the PACS system. Although the trauma surgeons were initially in the ED, they had now gone to the OR, where multiple lifesaving surgeries were in progress.

Over the next several hours, staff triaged and treated multitudes of patients. When the hospital reached capacity, patients were transferred to others in the area. Some went by ambulance, and many “walking wounded” went on school buses. This continued into the middle of the next day. The professionalism of the EMS services that participated in these transfers cannot be overstated. More than 900 patients were treated that night at Freeman West, many with massive internal injuries, but only 11 lives were lost.

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