Lessons Learned From the Joplin Tornado

The tornado that struck Joplin, MO, a year ago this month was a monster by any definition. With winds up to 250 miles an hour and a funnel at times topping a mile wide, it carved the city in half, destroying fire stations and a hospital en route to killing 160 and injuring around 1,000.

As the local EMS medical director, Jim Morgan, DO, got a front-row view of the disaster, response and aftermath. Here he distills eight key lessons learned; for his firsthand account of the entire experience, see EMSWorld.com/10649563 or download our iPad app.

1. Maintain a close relationship with your neighbors

When a community’s emergency responders face disaster, chances are they will be overwhelmed with calls for service. Having a firm relationship with organizations nearby can assure assistance. Formal memoranda of understanding are good but don’t replace friendly face-to-face discussions. After a major event, not surprisingly, dialogue between EMS leaders usually isn’t a problem. Carry things a step further with disaster exercises involving agencies that have adjacent or bisecting jurisdictions.

2. Train on the art of triage

In the early stages of our disaster, EMS providers learned that triage and treatment on scene can be much more effective than transport. With the extent of destruction and loss of a complete hospital (St. John’s Regional Medical Center, one of only two hospitals in Joplin), this was a big decision. It’s rare, but the loss of such a prime medical facility in a disaster is something EMS agencies should plan for. The field triage we used was START, which allows the provider to assess a minimum of vital functions and respond in defined ways to any abnormality. After the initial triage, as treatment continued, we constantly reassessed patients while coordinating transportation.

All agencies that may be involved should discuss a common triage tagging system. The simpler a tag is to access and use, the more likely providers will use it correctly. Our EMS crews quickly ran out of triage tags and had to document patient information in other ways. When stocking tags, have a sufficient number to ensure you will not run out.

3. Integrate an Incident Command System (ICS) and review it regularly

An ICS will help keep your system structured. There will be less confusion of individual responsibility with a unity of command. EMS agencies generally do not have prolonged scene presences and so do not implement this on a daily basis. Its nuances can be lost on crews that do not plan for it. It’s important to field units to know someone is in charge, and a properly executed ICS assures this.

Also, people and positions frequently change. Regular review of ICS structure with agency personnel is important to reduce confusion during a disaster.

4. Implement regular disaster drills

Disaster drills are one of the least favorite aspects of the job. They take a lot of time to plan and implement, and never seem to approach situations seen in real life. But the tornado made believers of many providers in our area. Without all those fake-blood exercises, EMS crews might have delayed in setting up triage areas. While the loss of a hospital had not been foreseen, the experiences of this disaster may be useful when planning the next drill. Methods of triage, treatment and transportation must be continually assessed and changed as needed.

5. Formulate plans for patient tracking and supply requisition

There are many different methods to track patients during a disaster. The easiest is to keep a logbook in each ambulance. This will facilitate tracking patients wherever the ambulance may be, and a provider or reliable bystander can obtain basic information from patients. A minimum amount of data is preferable, so multiple patients can be logged quickly. For patients who can’t speak, documenting an identifying feature along with obvious injuries may help with subsequent identification.