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EMS Corner
Tornado tests preparedness
Vol 26 Summer

Since the beginning of the major spring storms (March 31st) tornado outbreaks are well above the normal. Tornado Alley is usually limited to about seven to eight states located in the middle of the U.S.  Nearly half of the U.S. has been struck by tornadoes and the northeast has seen spring storms unlike anything in more than 60 years. 

As a child, I envisioned God’s finger reaching down out of the sky and stirring the air to make tornadoes. Have you ever watched a tornado form out of the clouds?  The science behind it is quite interesting. Air shooting up meets colder, dryer air and a strong updraft meets winds in varying directions. Winds interact and spin like a child’s top. 

Having just finished a Community Emergency Response Team (CERT) Instructor Course, I have a backpack with a hard hat, flash light, gloves, dust mask and goggles. According to the course, I am prepared. With nearly 35 years as a professional firefighter and paramedic, I would think I am prepared too. I have worked the aftermath of a tornado twice, but nothing prepared me for the details provided by physician Kevin J. Kikta. 

Dr. Kikta was working in the Department of Emergency Medicine at Mercy/St. John’s Regional Medical Center, Joplin, MO, on Sunday, May 22, 2011. His story begins with an EF5 multiple-vortex tornado that hit the southern part of the city and ranks as one of Missouri and America’s deadliest storms.  Dr. Kikta’s story, outlined in italics, needs no explanation.

 

45 Seconds of…

At 5:42 p.m., a security guard yelled to everyone, “Take cover! We are about to get hit by a tornado!”

We heard a loud horrifying sound like a large locomotive ripping through the hospital. The whole hospital shook and vibrated as we heard glass shattering, light bulbs popping, walls collapsing, people screaming, the ceiling caving in above us, and water pipes breaking, showering water down on everything…

It was like a bomb went off. That’s the only way that I can describe what we saw next. Patients came into the ED (emergency department) in droves. It was absolute, utter chaos. They were limping, bleeding, crying and terrified, with debris and glass sticking out of them, just thankful to be alive.

Frightening Aroma

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 did all the flashlights come from?

Gasping For Breath

I remember a patient in his early 20s 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, made the clinical diagnosis of a pneumothorax (collapsed lung) and gathered supplies from wherever I could locate them to insert a thoracostomy tube in him. He was a trooper; I’ll never forget his courage. He allowed me to do this without any local anesthetic since none could be found. With his life threatening injuries 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; fortunately, I was able to get him transported out.

Gaping Wounds

A small child of approximately three-to-four 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 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.

Paralyzed and Helpless

There were no specialists available — my orthopedist was trapped in the operating room. 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 to blow up at any minute.

Crushing Chaos

Things were no better outside of the ED. I saw a man crushed under a large SUV, still alive, begging for help; another one was dead, impaled by a street sign through his chest. Wounded people were walking, staggering, all over, dazed and shocked.

Revealing Human Goodness

Tragedy has a way of revealing human goodness. As I worked, surrounded by devastation and suffering, I realized I was not alone. The people of the community of Joplin were absolutely incredible. Within minutes of the horrific event, local residents showed up in pickups and sport utility vehicles, all offering to help transport the wounded to other facilities, including Freeman, the trauma center literally across the street. Ironically, it had sustained only minimal damage and was functioning (although I’m sure overwhelmed). I carried on, grateful for the help of the community. Within hours, I estimated that over 100 EMS units showed up from various towns, counties and four different states. Considering the circumstances, their response time was miraculous. Roads were blocked with downed utility lines and smashed up cars in piles. They still made it through.

I saw a small dog just whimpering in circles over his master who was dead, unaware that his master would not ever play with him again.

What Should I Do?

At one point we tended to a young woman who just stood crying over her dead mother who was crushed by her own home. The young woman covered her mother up with a blanket and then asked all of us, “What should I do?” We had no answer for her, but silence and tears.

Makeshift MASH Unit

The chaos was slightly more controlled at Memorial Hall. I was relieved to see many of my colleagues, doctors from every specialty, helping out. It was amazing to be able to see life again. It was also amazing to see how fast workers mobilized to set up this MASH unit under the circumstances. Supplies, food, drink, generators, exam tables, all were there—except pharmaceutical pain meds.

We really needed pain meds. I managed to go back to St John’s with another physician, pharmacist, and a sheriff’s officer. Luckily, security let us in to a highly guarded pharmacy to bring back a garbage bucket-sized supply of pain meds.

Spray Painted X’s

At about midnight, I walked around the parking lot of St. John’s with local law enforcement officers looking for anyone who might be alive or trapped in crushed cars. They spray-painted “X”s on the fortunate vehicles that had been searched without finding anyone inside. The unfortunate vehicles wore “X’s” and sprayed-on numerals, indicating the number of dead inside, crushed in their cars, cars which now resembled flattened recycled aluminum cans the tornado had crumpled in her iron hands.

An EF5 tornado, one of the worst in history, whipped through this quiet town with demonic strength. I continued back to Memorial hall into the early morning hours until my ER colleagues told me it was time for me to go home. I was completely exhausted. I had seen enough of my first tornado.

Thanks

I would like to express my sincerest gratitude to everyone involved in helping during this nightmarish disaster, including my fellow doctors, RNs, techs, and all of the staff from St. John’s. I have worked here for approximately two years, and I have always been proud to say that I was a physician at St John’s in Joplin, MO. The smart, selfless and immediate response of the professionals and the community during this catastrophe proves to me that St. John’s and the surrounding community are special. I am beyond proud. To the members of this community, the health care workers from states away, and especially Freeman Medical Center, I commend everyone on unselfishly coming together and giving 110 percent the way that you all did, even in your own time of need. St. John’s Regional Medical Center is gone, but her spirit and goodness lives on in each of you. EMS, you should be proud of yourselves. You were all excellent, and did a great job despite incredible difficulties and against all odds.

Estimated costs are as high as three billion and 141 people were killed by this tornado.  While we cannot stop the finger of God, we can learn how to take action in an impossible situation. 

Business and industry should consider having employees attend CERT training. When faced with all that happened in Joplin, the hard hat, flashlight, gloves, dust mask and goggles would have provided only protection for the responders, but the training and knowledge would be invaluable. CERT training is the only course that teaches the common sense, knowledge and preparedness for what is impossible to completely prepare for in reality.

An impossible situation is the first ingredient for a miracle. Learn how to be a part of miracles in America. For more information, go to www.fema.gov. Look under Citizen Corp or CERT.

Love, honor and appreciate your hard working employees, but, most important, teach them how to be a part of the miracle of recovery. 

 
 

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F: (979) 690-7562

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