John Commins, for HealthLeaders Media, May 21, 2012

Tuesday, May 22 marks the one year anniversary of the devastating tornado that killed 161 people in Joplin, MO and hobbled the city’s healthcare delivery infrastructure.

In seconds, an EF5 tornado packing winds in excess of 200 mph destroyed the 367-bed St. John’s Mercy Regional Medical Center. It was the most infamous and deadly event in a spate of natural disasters that plagued the Show Me State in 2011. Floods, blizzards, and other ferocious tornadoes across Missouri resulted in fatalities, thousands of injuries, hundreds of millions of dollars in property damages, and severely strained healthcare services. 

The Missouri Hospital Association this month issued a report that suggests that hospitals that successfully overcame these disasters in 2011 depended in no small part upon the emergency preparedness plans they’ve been developing for the last decade.

“This wasn’t something that they just learned the day before the event started. This has been a labor of love for the last 10 years,” says Jackie Gatz, director of emergency preparedness at MHA.

“We have done a tremendous amount of training and staff competency development around emergency preparedness using hospital preparedness grant funding. We did training on evacuation and incident command and surge management that really improved and assisted all the hospitals as we went through the response.”

In Joplin, for example, staff at the devastated Mercy Regional no longer had the systems that they relied upon for routine communications. The tornado hit at about 6 p.m. on a Sunday afternoon, when key administrators were not at the hospital. Land lines and cellular telephone towers were inoperable.
“They had to rely on their instincts and what they had learned in the past. That is a huge takeaway and it really shows the value of training and planning for healthcare workers,” Gatz says.

Gatz says there is no way that any hospital can plan for every contingency in an emergency. However, hospitals can focus on the competencies that will be needed regardless of the disaster event. “We look at communications capabilities and their ability to operate different modes of communication, evacuation procedures and patient movement, and medical surge,” she says.

“Regardless of the event a lot of those pieces are going to come into play and the consistency is the staff will be involved regardless of the event.”

MHA says the disaster at Mercy Regional underscores the need for ongoing emergency response training, and will shape future hospital response strategies. With an emergency plan in place, Mercy Regional staff had safely evacuated patients to interior hallways before the tornado it, and in the minutes after the tornado left the hospital inoperable staff was planning patient evacuations to nearby hospitals.

“If your building is destroyed there is no plan to pull off the shelf. You have to be comfortable with your staff competencies in how to respond,” MHA Vice President David Dillon says. “They felt confident they understood how best to respond within the scope of what an incident command should look like and who should be in charge and who is available and what needs were they going to have.”

Other key takeaways identified by MHA as lessons learned include a focus on resources and assets, safety and security, staff, volunteers, and utilities. Dillon says the ongoing training that many hospitals were involved in before the disasters creates an emergency response mechanism that is not unlike muscle memory.

“The more you drill it and deeply learn it, the less you will have to think about it when it comes to engaging in that process,” he says. “I don’t think anyone, if you haven’t been to Joplin, could understand the scope of that disaster. But before that disaster I would suspect the folks in Joplin would never have thought they’d need the extent of training or resources they put aside to deal with it.”

“How do you prepare for something that is almost incomprehensible? You do it with repetition and realistic training that gives you as close and bad a scenario as you can envision with the hopes that if that comes along you are as prepared as you can be.”

John Commins is an editor with HealthLeaders Media. He can be reached at

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