That’s the only way that I can describe what we saw as I emerged from the room where I had taken shelter during the tornado. 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 three inches of water and the power outage left the ED eerily dark. 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 all the flashlights came from I’ll never know. 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 unable to call for backup.
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 and diagnosed his pneumothorax. I gathered supplies from wherever I could locate them to insert a thoracostomy tube. I’ll never forget his courage; he allowed me to do the procedure without any local anesthetic since none could be found. 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.
I immediately moved on to the next patient, an asthmatic in status asthmaticus. We didn’t 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 for 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. 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.”
-Kevin Kikta, MD
The First Hours of Relief next
The First Hours of Relief
by Michael Lohmeier, MD
We navigated into Joplin at about 5am the morning after the tornado. The flashing blue and red lights of our emergency vehicles intermittently illuminated the debris on either side of the road. When we pulled in to the abandoned Ford dealership where the Medical Team was setting up, all anyone could say was, “Wow”. There were already a number of people on site, and the tent which would serve as our base had already been set up. Quick introductions were made and we immediately joined in, helping unload trucks, set up stretchers and arrange medical supplies in each of the tents. It was a vast array of people, with EMTs, RNs, firefighters and physicians making up the majority of the personnel. Loosely based on background and specialty, assignments were handed out. There were tables set up at the entrance of the tents, staffed by nurses and medics with a physician to “eyeball” everyone who came in to the triage area. The first room of the tent was equipped with cots lined with emergency blankets, resuscitation equipment, splints and bandages, which was designated for trauma and critical patients. The next room of the tent had softer cots that could recline, and was also set up with trauma dressings, blankets and IV fluids. This was designated for the urgent care section, and was to care for the lower acuity patients. Continuing through the back of the tent led to an exit where an ambulance was stationed, ready to transport patients out to an area hospital.
I was assigned with two other physicians to the “Trauma” area, along with about four nurses and two medics. We were told that the Search and Rescue Team was at the WalMart searching for survivors, and that we would be accepting patients at 0700. Since St. John’s was unusable and Freeman Hospital had already absorbed more patients than they could handle, our job was to serve as a temporary ER, evaluating and treating patients and then arranging transport to accepting facilities in the area. I nervously awaited the anticipated influx of wounded people.
At about 9 am the weather service issued a severe thunderstorm warning for the area, and shortly thereafter the sky turned dark. Several of the volunteers worked on gaining access to the dealership building for shelter while the rest of us tried to move the equipment under the front awning for shelter. The rain would continue for most of the day.
By noon I had seen three patients; a man with sudden onset anxiety
after loading up donations to take to a local church, and two people
from a minor traffic accidents. I grabbed some lunch and then went to
lay down in my truck to try and sleep. I returned around 2 and was told
that I would be part of the night crew, and that there had been a hotel
secured up the street for our housing. We were instructed to be back by 7
pm for our 12 hour shift.
After I checked in at the hotel, I took a quick drive up the road to
see the damage in the daylight. Even through the rain I could
appreciate the totality of the destruction. Cars looked like they had
been rolled sideways down the street and crushed up like tin cans.
Entire neighborhoods were gone, with nothing left but the foundations.
Almost everything that could have held a living person bore the orange
“X,” signifying that it had been searched. I snapped some pictures with
my camera, but none of them could capture the void I felt.
I slept briefly and then returned to the medical tent to relieve the day
crew. I learned that there had been a police officer struck by
lightning, and there were several other minor lightning related
injuries, but overall there hadn’t been many patients brought in for
evaluation. Most disappointing, no patients had been rescued from the
The rain continued through most of the night, sometimes quite heavy. I
stitched up a man who had cut his hand while moving debris, and helped
the team members assess and treat a patient with increasing confusion
after having missed dialysis for quite some time. EMS crews found a dog
wandering through the debris of a neighborhood, clearly lost and scared.
Because there wasn’t anyone from animal control around and the dog
clearly needed help, they brought him to us for the evening. Everyone
doted over the pup, giving him food, water and hugs. The team took turns
lying down on the cots in the “Urgent Care” section of the tent,
closing our eyes and resting, but anxiously awaiting the massive influx
of people we were all convinced would come.
“The Mobile Medical Unit (above) is a Missouri asset that was built by the Missouri Disaster Medical Team in response to the Joplin Tornado. This field hospital sustains 60 beds in addition to an ED and ICU section and is staffed by the local health care workers. Additional support assets such as CT scanner, MRI, cardiac cath lab, and operating rooms have been brought in from all across the country with help from the Interstate Disaster Medical Collaborative (ISDMC). The structure bridges the gap between the immediate disaster response and a final brick and mortar solution. Similar structures have been in place for as long as years in military environments.”
Brian Froelke, MD
Chief Medical Officer MO-DMT
President, CMO ISDMC