‘A State of Chaos’: The Joplin Tornado

The paramedics manning the triage area walked up to me with blank stares. I knew the last few hours had been Armageddon for them. As true professionals they had a triage/treatment area set up and operating. A couple of doctors from nearby Miami, Okla., joined them. I was glad to see them there. I only remember seeing a few patients getting treated, and I wondered where the rest of them were. Then I realized this was just the beginning. A fire captain told us one of the two hospitals in the city had been demolished. St. John’s Regional Medical Center had a large medical complex, and I couldn’t imagine how it could be destroyed. At least one nursing home was also completely devastated, and rescuers continued their work there. Days later we learned only six people in the medical center had perished—five patients on ventilators and one visitor.

We spent the rest of the night moving the triage area inside a neighboring business (due to another incoming storm system) and traveling through the area of destruction. I drove to EMS headquarters to speak with the field supervisors and then went to the city emergency operations center to talk with the fire chief and city manager. The EOC was just getting organized. An EMS supervisor manned the phone link with dispatch and relayed information to the supervisor at EMS headquarters. A tally was being made of on-duty crews and agencies from outside the area sending personnel.

After nearly three hours in the field, I made my way to the ED at Freeman West. It seemed as if everyone in Joplin was there. Multiple ambulances crowded the bay, with every conceivable rank of EMS provider walking around. Patients continued to stream in, and a mixture of nurses, doctors and residents met each one. I made my way through the crowd to find the people I worked with on a daily basis. They were in a flurry of activity. Bleeding patients lay on stretchers in the hallway, so I knew the rooms were also full. ER physicians stood shoulder-to-shoulder with orthopedic surgeons and neurosurgeons peering over x-rays on the PACS system. Although the trauma surgeons were initially in the ED, they had now gone to the OR, where multiple lifesaving surgeries were in progress.

Over the next several hours, staff triaged and treated multitudes of patients. When the hospital reached capacity, patients were transferred to others in the area. Some went by ambulance, and many “walking wounded” went on school buses. This continued into the middle of the next day. The professionalism of the EMS services that participated in these transfers cannot be overstated. More than 900 patients were treated that night at Freeman West, many with massive internal injuries, but only 11 lives were lost.

EMS Response

METS (Metro Emergency Transport System) is the primary ALS ambulance service in Jasper County, which includes 90% of Joplin. Thirty paramedics and EMTs operate with 10 ambulances, two wheelchair vans and two supervisor vehicles. Their annual call volume averages 15,000. The Joplin Fire Department assists them in a tiered response system with firefighter/paramedics. The southernmost section of Joplin is in Newton County, home of the Newton County Ambulance District (NCAD). They operate from four stations with a total of 12 ALS ambulances, three supervisor vehicles and three support trailers, and they employ nearly 40 EMS providers. Their call volume averages 8,000 a year. METS and NCAD work closely together, although they have separate dispatch centers. Their cooperation on a day-to-day basis became the foundation of the response to this disaster.

In the first 10 minutes after the tornado’s touchdown, there were nine ambulances and two field supervisors responding. Within 30 minutes, 21 ambulances were mobilized, along with nearly 70 EMS providers and five supervisors. Between ambulances and privately owned vehicles, there were nearly 350 patients transported in the first hour. With one of Joplin’s two hospitals out of commission, patients were taken to the only functioning facility. After the transport of multiple patients, it quickly became necessary to set up triage areas in order to begin treatment of the large number of injured. The triage areas were placed along the path of destruction, and ambulances staged at each area. Injured people, not understanding the concept of triage, began climbing en masse into the ambulances, demanding transport. EMS providers had to quickly curtail this and convince them to accept treatment where they were until transport could be arranged. Ambulances were then positioned to enable crews to quickly access the equipment on board.