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Preparation Pays Off in Joplin

Monday July 11, 2011
An aerial view of tornado damage at St. John's Regional Medical Center in Joplin, Mo., on May 24, 2011
An aerial view of tornado damage at St. John's Regional Medical Center in Joplin, Mo., on May 24, 2011
(Photo by Valerie Mosley / News-Leader)
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At least four times a year, the staff at St. John’s Regional Medical Center in Joplin, Mo., holds disaster exercises — shutting blinds and windows in patient rooms, moving patients into the hallways, and closing doors to the rooms. Hospital visitors occasionally have complained about the disruption, especially when they looked out the facility’s expansive plate-glass windows and didn’t see a threat, said Dottie Bringle, RN, BSN, MSHSA, chief operating officer/chief nursing officer at St. John’s Joplin. “We always explained it was for everyone’s safety,” she said.

Those countless hours of preparation saved lives May 22 when the country’s eighth deadliest tornado, with winds of more than 200 mph, slammed into the hospital. In the 20 or so minutes between when the familiar “Condition Gray” announcement over the intercom and the storm hit at about 6 p.m., nurses and other hospital staff had moved all patients into the hallways and had latched the windows and doors, precisely as they had been trained.

After the tornado left the eight-story hospital in ruins, they evacuated 183 patients. Five critically ill patients and one visitor did not survive. The exact causes of their deaths is inconclusive, hospital officials said. There were about 500 people inside the hospital.

“It was kind of surreal when it was happening,” said Bobby Lea, RN, a critical care nurse from nearby Springfield, who works part time at St. John’s Joplin, and was on duty during the storm. “But I feel like we did everything we were supposed to do and needed to do. I’m glad we were there helping the people we were supposed to be helping.”

The tornado plowed a 6-mile-long, quarter-mile-wide path through southwest Missouri, leaving at least 138 people dead and countless injured. In Joplin, a town of nearly 50,000, houses crumbled, buildings collapsed and vehicles flew through the air. But in the past week, with an outpouring of support from around the country, the town is starting to recover.

Business as Usual

On the stormy evening the tornado hit, it was business as usual at the hospital, Lea said. He was working on a surgical intensive care unit with four other nurses, caring for 10 patients. When the Condition Gray announcement came, everyone remained calm. “We knew we were in ‘tornado alley,’” he said, where inclement weather alarms come with the territory.

There are two phases of Condition Gray, first being “Prepare for Condition Gray.” This is called when there is severe weather in the area that could affect the hospital. During this phase, staff close drapes, alert patients and visitors, and move chairs into hallways. The next phase is “Execute Condition Gray.” This is called when there is a report of a tornado near the hospital. When this is called, staff evacuate patients from rooms into the hallway and place them in the prearranged chairs. If patients are not ambulatory, their beds are taken to the hallway. Patients are protected by extra pilows and blankets. Visitors are alerted to the danger and asked to move into the core of the buildings.

Lea, another nurse and a tech transported one of Lea’s patients, who could walk, to a hallway two floors up because there was no rooom in the hallway outside the SICU. When they arrived, all the patients on that floor were out of their rooms, many with their IV poles, and all doors were shut, Lea said.

Lea settled his patient into a reclining chair, and the other nurse and tech returned to the SICU. Lea found an IV pump for his patient and was attaching it when he saw the fire doors closing. He heard the sound of breaking glass and someone exclaiming, “The window broke!” There was a sound “like a car in a wind tunnel,” he said, and more breaking glass. The air filled with debris, and Lea saw people being pushed down the hallway by the wind. “They looked like dust bunnies,” he said. He crouched down and held onto his patient partly to protect the man, but also because he needed something to hang onto. He heard a noise like the roar of a jet engine and felt the building shaking. Water pipes broke, plaster fell from the ceiling and the lights went out.

“Will I see my wife again?” he remembers thinking. “Will I see my kids? Am I going to die in a hospital hallway, with people I don’t even know?” Though the blast lasted no more than 45 seconds, it felt like at least five minutes, he said. Then it stopped. Emergency lights flickered and went dead. The hospital’s backup generator had been blown away.

Orderly Evacuation

As Lea got to his feet and his eyes adjusted to the darkness, he saw the hallway had been torn apart. People were on the floor and electrical wires were down or hanging from the ceiling. The floor felt damp. Soon it would be covered with 2-3 inches of water. Patients and staff were tangled up with IV poles or on beds covered with debris. Some had cuts from broken glass. Those who could were getting up slowly, asking if others were OK.

The hospital employees started evacuating immediately. “We didn’t wait for the emergency crews,” Lea said. They didn’t know whether the building was stable, and there was nothing they could do for their patients in the darkened hospital without power or supplies. There was no panic and relatively little confusion, Lea said. Each employee had his or her own area of responsibility. Lea’s was to make sure the patient rooms all were evacuated. Working by the light of mobile phones, nurses capped IV lines, disconnected pumps and clamped wound VACs.

Hospital workers cleared a path through the debris and at least one staff member escorted each of the patients who could walk — about half of the 30 in the hall — down five flights of stairs. Those who could not walk were put in wheelchairs or hard-back wooden chairs. One patient was left in a bed. Within 30 minutes, all were at the stairwell, Lea said. By this time, other people were coming into the hospital to help and flashlights had been found, he said. They began carrying patients down, step by step, to a triage area set up in front of the ED, amid smashed cars and a wrecked helicopter. Patients were transported by volunteers in pickup trucks, ambulances and any vehicle that could be found to nearby hospitals, including St. John’s Hospital in Springfield. Others went to a relatively undamaged medical building, and eventually a command center set up in a nearby community hall.

After making sure his patient was safe, Lea returned to other floors to help people get out, and retrieve supplies. He helped carry one ventilator patient out on a sheet, bagging him by hand until ambulance crews could take over.

The entire evacuation took about 90 minutes, said Bringle, who was in an Atlanta airport on her way to Ireland when she received news of the tornado. She turned around and went back to Joplin to the hospital site. She said some of her staff told her, “We were prepared, and we made you proud.”

“They are absolute rock stars,” Bringle said of the hospital employees. “The stories just go on and on. They did everything so rapidly and with no thought for their own safety.” In the ICU, after making sure patients were covered, nurses were supposed to leave to protect themselves so they could return after the tornado passed. But some stayed, including one nurse who crawled under a blanket and laid over her patient, an elderly woman. Both survived, Bringle said. (For more employee’s stories, visit mercy.net/joplin/stories-of-mercy.)


ICU of mobile hospital erected in St. John's Joplin's parking lot
(Photo courtesy of St. John's Regional Medical Ctr)
Rebuilding Underway

In the week since the tornado, St. John’s has been feverishly rebuilding, assuring its nearly 2,000 employees they will have jobs. Some already have returned to work at outpatient clinics and the command center.

The hospital just implemented an electronic health record system May 1, so no patient records were lost, Bringle said. Administrators have asked the public to destroy or return any hard-copy records, which have been found as far as 75 miles away.

Structural engineers deemed the hospital unsafe and unviable for renovation. However, a week after the disaster, St. John’s Joplin opened a 60-bed mobile hospital in the parking lot of the ruined facility. “Our hospital was destroyed last Sunday, and this Sunday it will come back up,” Bringle had promised.

The mobile hospital, made of a tent-like material, is equipped with an ED, operating suites, a pharmacy and MRI and CT scan areas. It will employ some St. John’s workers, and others will be able to work at nearby Mercy hospitals until the medical center is rebuilt, Bringle said. Hospital officials say the mobile hospital, built to withstand 100-mile-an-hour winds, eventually will give way to a more permanent structure, which also will be replaced by a completely rebuilt facility.

In the days after the tornado, Lea returned to his nursing job at St. John’s in Springfield, where his wife also works and where co-workers were overjoyed to see him alive. He plans to go back to Joplin to help friends whose houses were blown down. After seeing the wreckage the tornado caused, he still can’t believe so many at the hospital — including himself — made it through. He will never take a Condition Gray for granted again, he said. “If we had not done what we were supposed to do, people would not have survived.”

Cathryn Domrose is a staff writer.


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