Quick and creative thinking needed in a disaster

August 1, 2011


Two-plus months after a mile-wide, multi-vortex tornado devastated Joplin, Mo., and ravaged its St. John's Regional Medical Center, the hospital is focused on reestablishing services in the area and on preparing to rebuild its campus.

But, leaders and associates also are taking the time to assess their response to the killer storm so that they can use what they've learned to prepare for future crises, and so that they can share their knowledge with others. A key learning for them: Disasters are by nature unpredictable, and so responders must be creative in how they handle the obstacles that arise.

The May 22 tornado that struck Joplin is believed to be the nation's seventh deadliest — it killed 159 people, including five St. John's patients and a hospital visitor. The storm leveled about a third of Joplin, and damages are expected to exceed $1 billion.

The direct hit from the F5 tornado destroyed the hospital. It exploded windows, showering glass into patient rooms, it cracked exterior walls and tore off chunks of the roof. It knocked out power and sucked the auxiliary generator clean out of the building.

In a matter of moments, computer systems, ventilation systems and electricity were gone. The tornado disrupted landline and cell phone service, toppling telephone poles and cell towers along with everything else in its path.

Dennis Manley, St. John's director of quality and risk management, was at home when the storm struck but made his way to the hospital once the tornado had passed. "Initially, I just felt disbelief, seeing this strong building of rock and concrete and steel so devastated," he said. "I had worked in that building for more than 30 years. It was both surprising and heart-breaking," he said.

An obstacle course
Concerned for patients' safety amid such destruction, and with questions about the stability of the building, staff moved quickly to evacuate the 183 patients. With the elevators out of service, they carried patients down dark stairwells — backup lights failed — using flashlights and the screen light from their cell phones to navigate around piles of debris and through storm water that stood ankle deep in some hallways.

Manley said most emergency supplies — including oxygen tanks, MedSleds for evacuation and medical basics — had been stored in a central area in the hospital, but with all the debris in the hallways, it was difficult for staff to access that supply area. Going forward, said Manley, St. John's has decided it will create emergency supply caches on or near patient units, so they will be easier to get to.

Off-the-clock employees flocked to the hospital to assist, as did community members. They and the 100-plus on-site staff evacuated all of the patients in just 90 minutes.

Preparations that pay off
Manley said responders were able to get patients out quickly and efficiently in part because of St. John's frequent disaster drilling. Several times a year, the hospital holds drills on weather and other disaster scenarios. Two years ago, it staged an evacuation in which staff used backboards and stretchers to slide or carry mock patients down the nine-story hospital's stairwells. Manley said that practice helped in the tornado evacuation, although due to the high volume of patients, staff couldn't rely solely upon the few dozen MedSleds they had that are designed specifically for stairwell transport. Some staff improvised carriers with mattresses, doors and backboards.

"The drilling and education we've had paid off," said Manley. "Staff reacted appropriately and without much panic, even amid all the devastation. They went about their duties."

Lynn Britton is president and chief executive of St. John's parent, Sisters of Mercy Health System of Chesterfield, Mo. He said that as essential as drills are, none can fully replicate a disaster. He said that in the wake of the experience, associates told him, "You can never really prepare for that moment. You can't really practice what it's like to stand in five inches of water" in the dark.

Smooth handoffs
Once out of the hospital on the day of the tornado, patients were treated at a makeshift triage area on campus or were transported by ambulance or school bus to other care sites off campus. (Hospital staff used dedicated frequency radios to communicate with ambulance and emergency crews.)

Some patients went to Mercy-affiliated facilities, some to other sites. Just three weeks before the storm, the Joplin hospital went live on Mercy's electronic health records system and, as a result, the hospital's patient medical records were backed up 250 miles away at Mercy's secure central data center in Washington, Mo.

All Mercy hospitals, and the vast majority of physician offices, now are connected to the electronic record system.

So staff at other Mercy hospitals had instant computer access to Joplin patients' medical records. For those transported to non-Mercy hospitals, staff at a Mercy hospital in Springfield, Mo., printed off the patients' medical records and faxed the information to the patients' new location.

Having this system in place proved to be a lifesaver in the case of at least one patient, said Britton. The man had a complex medication schedule, and because his records were immediately available, clinicians knew which drugs to administer and when. "He told us he wouldn't have been alive, save for those records being there," said Britton.

Broken connections
Reaching and communicating with coworkers and others was a persistent frustration in the immediate wake of the storm, said Britton and Manley.

Without reliable phone coverage it was virtually impossible to use call lists to contact associates, particularly just after the tornado. St. John's staff turned to texting and social media outlets like Facebook and Twitter (#Joplin). Texts can be transmitted using cell towers from farther away than what's required for cell phone call transmission. Texts were relayed by cell towers outside the damage zone. People whose internet connections survived the storm were able to access the social media sites.

St. John's placed electronic road signs at intersections, with messages such as, "If you are a Mercy coworker, please call this phone number."

Some employees couldn't be reached with these methods; St. John's dispatched managers to travel around town talking to people and, in time, accounted for every employee.

Immediately after the storm, Mercy established command centers at several locations around Joplin, and within 24 hours Mercy IT staff wired those sites with phone and computer connections that have eased the communication barriers. Also, early on, Mercy brought in handheld emergency radios that bridged gaps in phone communication.

Landline and cell phone communication continues to be somewhat spotty and unreliable today, said Manley.

Britton said that Mercy has been learning as it responds to the disaster. The system is documenting its work carefully and already is sharing its knowledge within the Mercy system, for instance with regards to how to communicate when phone service is limited. It also is preparing to share its experience with outside health systems and other groups that are clamoring for such information.

Britton said that some of the most important lessons gleaned from the disaster response have to do with the courage, ingenuity and professionalism of employees who proved indomitable under enormous pressure. Citing the scores of St. John's employees who flocked to the hospital to help immediately after the tornado struck, he said, "I've come to believe through this experience that every coworker is a hero."

"As I talk about this to our other Mercy hospitals, I tell them, 'You have heroes here too — you just may have not been thrust in that situation yet.'

"But our staff are all heroes and would respond in the same way as the St. John's staff did," Britton said.

Mercy keeps its staff gainfully employed

Sisters of Mercy Health System has gone a long way toward fulfilling its promise to keep all of St. John's Regional Medical Center's 2,200 employees on its payroll and in meaningful jobs as it recovers and rebuilds in Joplin. Eighty percent of its Joplin workforce is back to work. Some work at a temporary hospital on the campus of the destroyed hospital or in command center operations. Some are at other Mercy sites, including facilities in Oklahoma, Kansas, Arkansas and Missouri. And some now work at non-Mercy facilities through an innovative Mercy program called Talent Sharing. Through this initiative, Mercy enters into agreements with other nearby health care facilities so that they can employ St. John's staff members. Mercy pays the staff members their pre-tornado salary. It negotiates with each of its agreement partners for the rate they will pay Mercy for each worker's time.

Mercy maintains services in Joplin

Sisters of Mercy Health System is expediting the planning process for reconstruction of a permanent replacement hospital in Joplin, and it hopes to break ground in January. The system is scouting out potential locations now for the campus that is expected to open in early 2014.

In the meantime, Mercy is preparing to erect a temporary, code-compliant, hard-sided facility. The 120-bed modular unit will house an operating room, heart catheterization lab and other specialty services. As Catholic Health World went to press, Mercy was planning to begin receiving the component units and had planned to open the facility by early 2012, with additional units being added on and opening for several months thereafter. That facility will take over emergency and inpatient care from a tent hospital Mercy is now operating. Some Mercy services — including mental health services, rehabilitation and radiation oncology — will be available elsewhere on St. John's property, rather than at the modular site.

Mercy has sustained some level of services since immediately after the storm. Within minutes of the tornado, the system was triaging patients in a tent on the hospital parking lot and it moved quickly to open a triage center and emergency care area at a hall in downtown Joplin.

Within a week of the storm, Mercy had set up a 60-bed tent hospital — with a shape similar to a convex greenhouse — on the St. John's campus. That facility now sees about 20 to 24 patients a day. Some patients are able to be treated there, others with advanced needs, such as for heart or neurosurgery, are transferred to nearby hospitals. This unit is very sturdy, according to Dennis Manley, St. John's director of quality and risk management. But, he said, Mercy has storm shelters nearby in case high winds pass through the area and threaten the tent hospital.

Mercy has partnered with Wal-Mart to open a clinic at the Joplin Sam's Club that will handle minor illnesses and preventive care. Mercy also is leasing office space to provide outpatient services.

St. John's coworkers benefit from donations

Hundreds of St. John's coworkers lost homes, cars and other property in the spring tornado. People nationwide have responded to their needs by donating hundreds of thousands of dollars in aid.

In the first 10 days after the storm, Mercy funneled $108,200 of this aid to employees for basics like food and clothing. It also has provided for transportation needs, for instance by providing short-term rental cars for employees to drive to and from work and to assist with tornado recovery. In the weeks that have followed, Mercy human resources personnel have been providing additional funds — amounting to $490,000 — to hundreds of coworkers with significant losses, including uncovered costs of home, appliance and car damage. The system will continue to allocate funds to those in need, said Scott Watson, vice president of human resources and support services.

Lynn Britton, president and chief executive of Mercy, said ministry members were among the donors who are making this aid possible. "We are grateful for the generosity of those in Catholic health care."

To contribute to Mercy's help fund, visit www.mercy.net, and click on the "Donate Now" icon.

Ascension Health launches network of volunteer responders

This summer, St. Louis-based Ascension Health compiled a database of employees from throughout its 20-state network who are willing to volunteer their time to assist when an Ascension Health campus is hit by a natural or man-made disaster.

The database lists the employees' skill set and certifications.

Now, Ascension Health facilities can let the system know what workers they need in the immediate aftermath of a crisis or natural disaster, and the system can find those employees quickly in its database and dispatch them to the disaster site.

Currently the network is focused on clinical staff roles, but Ascension Health plans to expand the database to other roles over time.


Copyright © 2011 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2011 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.