The email letter below describes the events in the St. John's Hospital Emergency Department during and after the tornado of May 22, 2011. In response to a previous email, I questioned how patients could die due to power failure for their ventilators. Given the description below, I now get a better picture of the chaos and terror.
Response Personnel Unit Manager
Emergency Medical Services Authority
Disaster Medical Services Division
10901 Gold Center Drive Suite 400
Rancho Cord ova, CA 95670
Phone: 916-322-4336 ext.467
Cell: 916-217-4270
Fax: 916-323-4898
...I was one of two emergency room doctors who were on duty at St.
John's Regional Medical Center in Joplin , MO on Sunday, May 22, 2011.
You never know that it will be the most important day of your life until the day is over. The
day started like any other day for me: waking up, eating, going to the gym, showering, and going
to my 4:00 pm ER shift. As I drove to the hospital I mentally prepared for my shift as I always
do, but nothing could ever have prepared me for what was going to happen on this shift. Things
were normal for the first hour and half. At approximately 5:30 pm we received a warning that a
tornado had been spotted. Although I work in Joplin and went to medical school in Oklahoma , I
live in New Jersey , and I have never seen or been in a tornado. I learned that a "code gray"
was being called. We were to
start bringing patients to safer spots within the ED and hospital.
At 5:42 pm a security guard yelled to everyone, "Take cover! We are about to get hit by a
tornado!" I ran with a pregnant RN, while others scattered to various places, to
the only place that I was familiar with in the hospital without windows, a small doctor's office
in the ED. Together, she and I tremored and huddled under a desk. We heard a loud horrifying
sound like a large locomotive ripping through the hospital. The whole hospital shook and
vibrated as we heard glass shattering, light bulbs popping, walls collapsing, people screaming,
the ceiling caving in above us, and water pipes breaking, showering water down on everything.
We suffered this in complete darkness, unaware of anyone else's status, worried, scared. We
could feel a tight pressure in our heads as the tornado annihilated the hospital and the
surrounding area. The
whole process took about 45 seconds, but seemed like eternity. The
hospital had just taken a direct hit from a category EF5 tornado.
Then it was over. Just 45 seconds. 45 long seconds. We looked at each other, terrified, and
thanked God that we were alive. We didn't know, but hoped that it was safe enough to go back
out to the ED, find the rest of the staff and patients, and assess our losses.
"Like a bomb went off. " That's the only way that I can describe what we saw next. Patients
were coming into the ED in droves. It was absolute, utter chaos. They were limping, bleeding,
crying, terrified, with debris and glass sticking out of them, just thankful to be alive. The
floor was covered with about 3 inches of water, there was no power, not even backup generators,
rendering it completely dark and eerie in the ED. The frightening aroma of methane gas
leaking
from the broken gas lines permeated the air; we knew, but did not dare mention aloud, what that
meant. I redoubled my pace.
We had to use flashlights to direct ourselves to the crying and wounded. Where did all the
flashlights come from? I'll never know, but immediately, and thankfully, my years of training
in emergency procedures kicked in. There was no power, but our mental generators were up and
running, and on high test adrenaline. We had no cell phone service in the first hour, so we
were not even able to call for help and backup in the ED.
I remember a patient in his early 20's gasping for breath, telling me that he was going to die.
After a quick exam, I removed the large shard of glass from his back, made the clinical
diagnosis of a pneumothorax (collapsed lung) and gathered supplies from wherever I could locate
them to insert a thoracostomy tube in him. He was
a trooper; I'll never forget his courage. He
allowed me to do this without any local anesthetic since none could be found. With his life
threatening injuries I knew he was running out of time, and it had to be done. Quickly.
Imagine my relief when I heard a big rush of air, and breath sounds again; fortunately, I was
able to get him transported out. I immediately moved on to the next patient, an asthmatic in
status asthmaticus. We didn't even have the option of trying a nebulizer treatment or steroids,
but I was able to get him intubated using a flashlight that I held in my mouth. A small child
of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and
spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could
actually count his vertebrae with my fingers. This was a child, his whole life ahead of him,
suffering life
threatening wounds in front of me, his eyes pleading me to help him.. We could
not find any pediatric C collars in the darkness, and water from the shattered main pipes was
once again showering down upon all of us. Fortunately, we were able to get him immobilized with
towels, and start an IV with fluids and pain meds before shipping him out. We felt paralyzed
and helpless ourselves. I didn't even know a lot of the RN's I was working with. They were
from departments scattered all over the hospital. It didn't matter. We worked as a team,
determined to save lives. There were no specialists available -- my orthopedist was trapped in
the OR. We were it, and we knew we had to get patients out of the hospital as quickly as
possible. As we were shuffling them out, the fire department showed up and helped us to
evacuate. Together we worked furiously, motivated by the
knowledge and fear that the methane
leaks could cause the hospital could blow up at any minute.
Things were no better outside of the ED. I saw a man crushed under a large SUV, still alive,
begging for help; another one was dead, impaled by a street sign through his chest. Wounded
people were walking, staggering, all over, dazed and shocked. All around us was chaos,
reminding me of scenes in a war movie, or newsreels from bombings in Bagdad . Except this was
right in front of me and it had happened in just 45 seconds. My own car was blown away. Gone.
Seemingly evaporated. We searched within a half mile radius later that night, but never found
the car, only the littered, crumpled remains of former cars. And a John Deere tractor that had
blown in from miles away.
Tragedy has a way of revealing human goodness. As I worked, surrounded by devastation
and
suffering, I realized I was not alone. The people of the community of Joplin were absolutely
incredible. Within minutes of the horrific event, local residents showed up in pickups and
sport utility vehicles, all offering to help transport the wounded to other facilities,
including Freeman, the trauma center literally across the street. Ironically, it had sustained
only minimal damage and was functioning (although I'm sure overwhelmed). I carried on, grateful
for the help of the community.
Within hours I estimated that over 100 EMS units showed up from various towns, counties and
four different states. Considering the circumstances, their response time was miraculous. Roads
were blocked with downed utility lines, smashed up cars in piles, and they still made it
through.
We continued to carry patients out of the hospital on anything that we could find: sheets,
stretchers, broken
doors, mattresses, wheelchairs-anything that could be used as a transport
mechanism.
As I finished up what I could do at St John's , I walked with two RN's to a makeshift MASH center that was being set up miles away at Memorial Hall. We
walked where flourishing neighborhoods once stood, astonished to see only the disastrous remains
of flattened homes, body parts, and dead people everywhere. I saw a small dog just wimpering in
circles over his master who was dead, unaware that his master would not ever play with him
again. At one point we tended to a young woman who just stood crying over her dead mother who
was crushed by her own home. The young woman covered her mother up with a blanket and then
asked all of us, "What should I do?" We had no answer for her, but silence and tears.
By this time news crews and photographers were starting to swarm around, and we were able to get
a
ride to Memorial Hall from another RN. The chaos was slightly more controlled at Memorial
Hall. I was relieved to see many of my colleagues, doctors from every specialty, helping out.
It was amazing to be able to see life again. It was also amazing to see how fast workers
mobilized to set up this MASH unit under the circumstances. Supplies, food, drink, generators,
exam tables, all were there-except pharmaceutical pain meds. I sutured multiple lacerations, and
splinted many fractures, including some open with bone exposed, and then intubated another
patient with severe COPD, slightly better controlled conditions this time, but still less than
optimal.
But we really needed pain meds. I managed to go back to the St John's with another physician,
pharmacist, and a sheriff's officer. Luckily, security let us in to a highly guarded pharmacy to
bring back a garbage bucket sized supply of pain
meds.
At about midnight I walked around the parking lot of St. John's with local law enforcement
officers looking for anyone who might be alive or trapped in crushed cars. They spray-painted
"X"s on the fortunate vehicles that had been searched without finding anyone inside. The
unfortunate vehicles wore "X's" and sprayed-on numerals, indicating the number of dead inside,
crushed in their cars, cars which now resembled flattened recycled aluminum cans the tornado
had crumpled in her iron hands, an EF5 tornado, one of the worst in history, whipping through
this quiet town with demonic strength. I continued back to Memorial hall into the early morning
hours until my ER colleagues told me it was time for me to go home. I was completely exhausted.
I had seen enough of my first tornado.
How can one describe these indescribable scenes of destruction? The next day I saw
news
coverage of this horrible, deadly tornado. It was excellent coverage, and Mike Bettes from the
Weather Channel did a great job, but there is nothing that pictures and video can depict
compared to seeing it in person. That video will play forever in my mind.
I would like to express my sincerest gratitude to everyone involved in helping during this
nightmarish disaster. My fellow doctors, RN's, techs, and all of the staff from St. John's . I
have worked at St John's for approximately 2 years, and I have always been proud to say that I
was a physician at St John's in Joplin , MO. The smart, selfless and immediate response of the
professionals and the community during this catastrophe proves to me that St John's and the
surrounding community are special. I am beyond proud.
To the members of this community, the health care workers from states away, and especially
Freeman Medical
Center , I commend everyone on unselfishly coming together and giving 110% the
way that you all did, even in your own time of need. St John's Regional Medical Center is gone,
but her spirit and goodness lives on in each of you.
EMS , you should be proud of yourselves. You were all excellent, and did a great job despite
incredible difficulties and against all odds.
For all of the injured who I treated, although I do not remember your names (nor would I expect
you to remember mine) I will never forget your faces. I'm glad that I was able to make a
difference and help in the best way that I knew how, and hopefully give some of you a chance at
rebuilding your lives again. For those whom I was not able to get to or treat, I apologize
whole heartedly.
Last, but not least, thank you, and God bless you, Mercy/St John's for providing incredible care
in good times and even more so, in times of the
unthinkable, and for all the training that
enabled us to be a team and treat the people and save lives.
Sincerely,
..., DO
Department of Emergency Medicine
Mercy/St John's Regional Medical Center, Joplin , MO
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