Some New Twists Tornadoes Spur New Chapters in Hospitals’ Books on Preparedness

Ann Carroll spent most of the morning on June 1 preparing a PowerPoint presentation on, of all things, tornadoes and what hospitals should be thinking about to be fully ready in case one strikes.

This work, which falls under her job description as emergency preparedness coordinator at Mercy Medical Hospital, was inspired by the events in Joplin, Mo. eight days earlier, when a mile-wide tornado devastated that community, killing at least 155 people. It hit the nine-story St. John’s Regional Medical Center head-on, and many of the stories of out of Joplin detailed how the hospital’s staff scrambled to safeguard patients during the few moments of warning they had, and how they carried on, despite great adversity, after disaster struck and cleared the hospital in less than 90 minutes.

Believing there were poignant lessons from Joplin, Carroll started logging information about that event and tornadoes in general to add to Mercy’s database on such matters. What she learned, or had reinforced, among other things, was the fact that tornadoes can ‘hop’ — touching down in one area, rising off the ground for what could be a few hundred yards or several miles, and then touching down again.

“Another thing I learned is that they generally take on the color of the ground,” she said. “If they’re coming just over grass, they’re green, but when they’re black, it means they’re picking up debris.”

Little did Carroll know that, by day’s end, she would have some first-hand knowledge of these phenomena and many others to add to her presentation — which remains a work in progress — and perhaps a few new pages for the binder on the bookshelf behind her desk titled ‘Weather Emergencies.’

Indeed, the series of tornadoes that hit Western Mass. late that afternoon, and especially the one that arrived in downtown Springfield around 4:30, gave new meaning to the phrase ‘learning experience’ for all involved, said Carroll, and in this case provided just one of the myriad ironic twists that fateful day.

Tom Lynch agreed. He’s the director of Security at Baystate Health, and he, too, was going over material written about Joplin in the days leading up to the Massachusetts tornadoes. And while doing so, he put special focus on how St. John’s and its parent system, based in Springfield, Mo., handled the broad matters of information management and communication.

“One of the things that becomes critical is how you communicate with your staff and how you communicate with the community,” he said, “because, if there’s a need to access services or if there’s a question of whether you should come to work and, if so, how you should do it, then the ability to get that information out becomes a challenge.”

Like Carroll and most everyone else at Baystate and Mercy, he would have some personal accounts to add to his base of knowledge by the time the sun went down on June 1, and some thoughts about where changes or improvement may be needed in disaster readiness. Like Carroll, he said the collapse of cell-phone service was unexpected and problematic. Meanwhile, he said, overall, things could have been much worse that day if, for example, the tornadoes had done considerable damage to one of the arteries it passed right over, including I-91, Route 5, and the Memorial Bridge. And he believes plans should be made for such specific calamities.

For this issue, HCN looks at how Joplin put tornadoes on the radar screen here and elsewhere, in a figurative sense, and how this region’s own experiences brought those lessons home in ways no one could have imagined on May 31.

Getting Wind of It

Recalling the events of that fateful Wednesday, Dan Moen, president and CEO of the Sisters of Providence Health System, which includes Mercy Medical Center, said there wasn’t much talk of tornadoes that morning, and very little in the way of what would be considered heightened alert of additional preparedness other than people “being aware of what could be a pretty significant storm.

“I think that, sometimes, we don’t pay enough attention to those types of storm warnings,” he continued, adding that it’s fair to say that the word ‘tornado’ will never be regarded the same way in this region. “I don’t think anyone will underestimate those storm warnings in the future.”

Although the first tornado touched down in Westfield, and then again in West Springfield, there was very little warning to speak of at Mercy Medical Center, said Carroll, whose basement-level office at Mercy has no windows. She added that there was a warning around 1 p.m. that conditions were ideal for severe thunderstorms and perhaps a tornado, and the first real warning — but for possible tornadoes much further north, in the Amherst/Belchertown area — came at 4:23 p.m., just seven minutes before the funnel cloud then making its way across the Connecticut River showed up on a camera fixed atop the hospital’s roof.

No one at Mercy really knew about the tornado until they heard about that image from the roof camera or saw the funnel for themselves, said Carroll, adding that she was walking through a tunnel between the hospital and Memorial House when the tornado crossed the river into Springfield, and first saw it when she emerged at the other end. She immediately told staffers to seek shelter, and within seconds, warnings had been sent to the pagers and cellphones of employees, and Mercy swung into what’s known as a ‘Medical Alert Code 1,’ the lowest of four levels, with a ‘4’ translating into full-scale evacuation of the hospital.

In the Code 1 scenario, personnel at the hospital were asked to work beyond their traditional shifts (which vary with the position in question), and additional personnel were placed on standby. Meanwhile, patients were moved away from windows — a step already in the response book but reinforced by the events at Joplin — and Moen took up a command post in the hospital’s ER with the mindset that a tornado in an urban area like Springfield could result in a large number of injuries.

“We anticipated that there would be many more victims than what we actually experienced,” he said. “We started to work on the staffing piece — asking people to stay beyond their shifts and calling some people whose skills we knew we’d need, not knowing whether they could get in at that point.”

At Baystate, very much the same thing was happening as that hospital shifted into what it calls a Plan D (for disaster), said Lynch, noting that the facility first went into standby mode for that particular response scenario, and then, when the tornado officially touched down in Springfield, went into the actual Plan D.

There have been a few occasions over the years when this has happened, he said, adding that, in his 16 years at the hospital, the only direct comparison he could draw to the tornado in terms of the type and degree of response and general level of mobilization was the Jahn Foundry explosion in February 1999 that sent 12 workers to Baystate with burn injuries; three of them would later die as a result.

“The similarities are the spontaneity of it, the fact that we had some self-drives — not everyone came by ambulance — and the level of preparation activity,” he said, adding that the nature of the foundry injuries, severe burns requiring that patients be stabilized and then moved to burn centers, made that case different in some respects.

Baystate does not have a specific contingency plan for a tornado, said Lynch, adding that such a development would be covered under what’s known as hazard-vulnerability analysis, which looks at 35 to 40 different things that can happen — from a terrorist attack to a severe blizzard — and prioritizes them in terms of the likelihood of their occurrence, the kinds of damage each might cause in terms of operation, and preparedness level. Tornadoes do not appear on the list (although ‘severe weather’ does), he told HCN, and they’re certainly not a high-priority consideration, or at least they weren’t before June 1.

“When you design a weather-emergency plan, there’s a certain amount of flexibility in there,” he explained. “It might be snow, ice, or severe thunderstorms that take things out of play.”

Imperfect Storm

Given the population density in downtown Springfield and the neighborhoods surrounding it, personnel at both Mercy and Baystate were preparing for a high volume of injuries that, thankfully, never materialized.

At Baystate, for example, the hospital moved into what the system calls ‘mass casualty mode.’

“With the damage you’re hearing about — with the collapses, the closed-off neighborhoods, and the closed-off streets, the anticipation is that you’re going to get large numbers of wounded people here,” Lynch explained. “So you move into the mass-casualty mode, which then ramps up different aspects of the operation, particularly the clinical things.”

Elaborating, he said that Dr. Reginald Alouidor, attending physician in Baystate’s Level One trauma unit, the only facility of its kind in Western Mass., was forming trauma teams, and the Emergency Department staff were moving patients and creating room for a crush that was far less severe than it could have been.

Baystate eventually treated 25 people, 10 of them in the trauma unit; seven were admitted. Mercy, meanwhile, treated a total of 35 people, none of them with life-threatening injuries, and all were treated and released.

Many of these individuals transported themselves to the hospital, which made this situation unique in some ways. “I remember this one car that drove up … the roof was V-shaped,” said Carroll. “A tree had fallen on top of it, and the windows were blown out; there was a baby in the car, and they needed two wheelchairs to get the occupants out and into the emergency room.”

While dealing with the injured from the first tornado, both hospitals soon went on alert for more twisters, especially one that was reportedly moving southwest from Chicopee, right into the path of the two facilities.

Moen said these reports prompted staffers to once again move patients away from windows and consider additional steps to ensure both patient safety and efficient handling of large numbers of injuries.

When asked what lessons Mercy and other hospitals could take away from the events of June 1 — just as they are all learning from Joplin — Carroll started with the need to pay a little more attention to the weather, a need she’s already addressed.

“Someone told me Radio Shack was having a special on hazard-alert radios, for $29.99,” she said. “They were getting rid of last year’s models, so I went and bought five of them; we’re going to place them at the security booth, the front desk, at the switchboard, which is also in the basement, and the fourth floor of the Weldon Center, because they saw it out the window about the same time I did.”

Beyond that, she and Lynch said much of the focus has been on the ineffectiveness of cellphones — again, something that wasn’t anticipated — and steps that may be taken in the future as a result.

“I received only one call in two hours, and every call I tried to make didn’t go through,” she said, adding that backup contingencies, ranging from land lines to two-way radios to texting, kept most of the lines of communication open.

In the wake of the tornadoes, Mercy will look into having more ham radios tuned to the SkyWarn channel, another stormchasers’ outlet. “Many times, they’re the first to see the first touchdown.”

Said Lynch, “It’s a stunning thing for people to dial something on a cell phone and get busy circuits all the time. You have to look at what that impacts. It didn’t affect our operations, but when you live though it like this, you ask questions about what happens next time.”

As is typical with such events and the drills that replicate them, he added, there is a comprehensive debriefing exercise, at which those involved discuss what went well and what didn’t. In this case, most all matters fell into that first category.

“But in this particular case, we’re going well beyond that, because it was an actual event, and we’re really soliciting information from our clinical people,” Lynch said. “They did fabulous work, and they organized this so rapidly; it’s not a surprise, but it’s always great to see. People take the training, and they take the understanding, and they do what they have to do, and do it remarkably well.”

Lasting Impressions

Caroll is still working on that PowerPoint presentation she talked about. The pictures and accounts of the Joplin disaster offer some important lessons for Mercy and all hospitals.

“We wanted to look at the types of damage done to the hospital in Joplin, and the things that we would need to consider in our planning,” she said, “such as the safest places to seek shelter in the buildings, warning systems, and so on.”

All that will still go on, but now there are other, far more personal accounts of what to do when a tornado strikes. They are one of the more positive things to take away from a day that won’t ever be forgotten.