“A State of Chaos”: The Joplin Tornado

» EMS Response

METS (Metro Emergency Transport System) is the primary ALS ambulance service in Jasper County, which includes 90% of Joplin. Thirty paramedics and EMTs operate with 10 ambulances, two wheelchair vans and two supervisor vehicles. Their annual call volume averages 15,000. The Joplin Fire Department assists them in a tiered response system with firefighter/paramedics. The southernmost section of Joplin is in Newton County, home of the Newton County Ambulance District (NCAD). They operate from four stations with a total of 12 ALS ambulances, three supervisor vehicles and three support trailers, and they employ nearly 40 EMS providers. Their call volume averages 8,000 a year. METS and NCAD work closely together, although they have separate dispatch centers. Their cooperation on a day-to-day basis became the foundation of the response to this disaster.

Within 30 min­utes, 21 ambu­lances were mobi­lized, along with nearly 70 EMS providers and five super­vi­sors. Between ambu­lances and pri­vately owned vehi­cles, there were nearly 350 patients trans­ported in the first hour.

In the first 10 minutes after the tornado’s touchdown, there were nine ambulances and two field supervisors responding. Within 30 minutes, 21 ambulances were mobilized, along with nearly 70 EMS providers and five supervisors. Between ambulances and privately owned vehicles, there were nearly 350 patients transported in the first hour. With one of Joplin’s two hospitals out of commission, patients were taken to the only functioning facility. After the transport of multiple patients, it quickly became necessary to set up triage areas in order to begin treatment of the large number of injured. The triage areas were placed along the path of destruction, and ambulances staged at each area. Injured people, not understanding the concept of triage, began climbing en masse into the ambulances, demanding transport. EMS providers had to quickly curtail this and convince them to accept treatment where they were until transport could be arranged. Ambulances were then positioned to enable crews to quickly access the equipment on board.

The EMS command post was established at METS headquarters. From that location the on-duty field supervisor took stock of his resources. He accounted for all ambulances available for immediate response and found his personnel were not capable of responding to all requests for service. Fortunately, many surrounding agencies were calling with offers of assistance, which were gratefully accepted. The triage/treatment locations remained in service throughout the night; however, they saw only sporadic patients, as most immediate casualties had been transported and patients needing rescue hadn’t yet been found. Initial estimates recorded more than 1,300 people missing. Problematic patient tracking and people who self-evacuated to other cities contributed to this total. As more information emerged over the next several days, the number of missing was adjusted downward until everyone, dead and alive, was ultimately accounted for.

As day­light came, the extent of the dam­age became appar­ent. On first assess­ment, offi­cials esti­mated at least a third of the city was impacted.

As daylight came, the extent of the damage became apparent. On first assessment, officials estimated at least a third of the city was impacted. The tornado’s path essentially divided the city in two. At the EMS command post, decisions had to be made: Do we continue triage and on-scene treatment or just transport? Where do we stage ambulances for response? How do the multiple ambulance services that came to assist communicate with each other? There was no shortage of problems to be solved.

Because the damage stretched from west to east, effectively cutting the city in two, we decided to create north and south response plans. Since the main EMS headquarters (and EMS command post) was situated north of the damage zone, METS handled that sector, and NCAD, already positioned to the south, covered the south sector. We positioned ambulance staging areas along these geographic lines. Dispatch only had to ascertain the sector from which a call for assistance came and relay it to the EMS officer at the EOC. As far as responses within the disaster area, both services were already involved in multiple rescue operations. Triage areas set up the previous night continued due to ongoing rescue operations and the continuing influx of patients at Freeman West. Medical staff from St. John’s began emergency operations at Joplin Memorial Hall. They constructed a makeshift emergency room there, and patients began arriving. A morgue facility was established at a local university with the coroner and personnel from local mortuaries. In addition to the dead, a total of 146 sets of remains were recovered for eventual identification.

The on-duty EMS supervisor remained at the EMS command post while another was stationed at the EOC. The officer at the EOC received all radio traffic from dispatch and relayed it to the appropriate staging area. The staging officer then dispatched an available ambulance. In all, nearly 100 different EMS agencies from seven states responded to Joplin over the next week. METS and NCAD communicated by shifting all radio traffic to a mutual frequency; however, outside agencies did not have this capability. This made placing the ambulances at the staging areas important. It turned out to be a workable solution for the lack of a common radio system.

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