Disaster experiences shared?

[Mabel Adams]

Thanks for sharing with us. This must be really raw right now. My heart goes out to you and all of those affected by this terrible storm. Where are you now operating St. Johns from? Will the hospital building be repaired? Please let us know if there is anything we Blood Bankers can do to help.

[DeeMc]

My heart goes out to you and your community as you try and recover from your disaster. And, like Mabel stated, let us know if there is any way we can help. I hope you keep us informed of your trials and tribulations and positive steps forward in your recovery. We can all learn so much from what you are going through.

[macarton]

After 9-11 our former blood supplier was constantly on the news here in Alabama asking for donors, esp O negative & O positive. I was getting calls from the public and I asked them to wait a couple of weeks and go to our LifeSouth center in the hospital and that we will really need the blood later as there won't be donors available during the shortage that will follow.

[ChrisH]

I am getting to this topic late.

My first real disaster years ago, was a mad man that went on a shooting spree, between two shopping malls. They called everyone in, including the midnight shift. What I learned was

1) Let the people coming in know where the event is happening, we got techs stuck in traffic jams.

2) do not call in night shift in to early, because once all is over and done with, they (sometime it is one person) are the ones having to clean it all up.

3) If they are going to lock the facility down, know how which doosr they will allow employee in at.

4) It is amazing how a disaster will bring everyone together. Without much words, we had a tech in the ER with emergency release blood, making sure all went well down there. We were our own supplier of blood, but the neighboring blood banks called and offered us all we could use. Because if we had to draw and process it all it would have slowed us down so much.

[KKidd]

I received this e-mail last week -

45 Seconds: Memoirs of an ER Doctor from May 22, 2011.

My name is Dr. Kevin Kikta, and I was one of two emergency room doctors who were on duty at St. John’s Regional Medical Center in Joplin , MO on Sunday May 22,2011.

You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: waking up, eating, going to the gym, showering, and going to my 4 00pm ER shift. As I drove to the hospital I mentally prepared for my shift as I always do, but nothing could ever have prepared me for what was going to happen on this shift. Things were normal for the first hour and half. At approximately 5:30 pm we received a warning that a tornado had been spotted. . Although I work in Joplin and went to medical school in Oklahoma , I live in New Jersey , and I have never seen or been in a tornado. I learned that a “code gray” was being called. We were to start bringing patients to safer spots within the ED and hospital.

At 5: 42pm a security guard yelled to everyone, “Take cover! We are about to get hit by a tornado!” I ran with a pregnant RN, Shilo Cook, while others scattered to various places, to the only place that I was familiar with in the hospital without windows, a small doctor’s office in the ED. Together, Shilo and I tremored and huddled under a desk. 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. We suffered this in complete darkness, unaware of anyone else’s status, worried, scared. We could feel a tight pressure in our heads as the tornado annihilated the hospital and the surrounding area. The whole process took about 45 seconds, but seemed like eternity. The hospital had just taken a direct hit from a category EF-4 tornado.

Then it was over. Just 45 seconds. 45 long seconds. We looked at each other, terrified, and thanked God that we were alive. We didn’t know, but hoped that it was safe enough to go back out to the ED, find the rest of the staff and patients, and assess our loses.

“Like a bomb went off. ” That’s the only way that I can describe what we saw next. Patients were coming into the ED in droves. It was absolute, utter chaos. They were limping, bleeding, crying, terrified, with debris and glass sticking out of them, just thankful to be alive. The floor was covered with about 3 inches of water, there was no power, not even backup generators, rendering it completely dark and eerie in the ED. 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 ? I’ll never know, but immediately, and thankfully, my years of training in emergency procedures kicked in. There was no power, but our mental generators, were up and running, and on high test adrenaline. We had no cell phone service in the first hour, so we were not even able to call for help and backup in the ED.

I remember a patient in his early 20’s 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. I immediately moved on to the next patient, .an asthmatic in status asthmaticus. We didn’t even have the option of trying a nebulizer treatment or steroids, but I was able to get him intubated using a flashlight that I held in my mouth. A small child of approximately 3-4 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. We felt paralyzed and helpless ourselves. I didn’t even know a lot of the RN’s I was working with. They were from departments scattered all over the hospital. It didn’t matter. We worked as a team, determined to save lives. There were no specialists available-- my orthopedist was trapped in the OR. 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 could blow up at any minute.

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. All around us was chaos, reminding me of scenes in a war movie, or newsreels from bombings in Bagdad . Except this was right in front of me and it had happened in just 45 seconds. My own car was blown away. Gone. Seemingly evaporated. We searched within a half mile radius later that night, but never found the car, only the littered, crumpled remains of former cars, and a John Deere tractor that had blown in from miles away.

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. At one point I had placed a conscious intubated patient in the back of a pickup truck with someone, a layman, for transport. The patient was self- ventilating himself, and I gave instructions to someone with absolutely no medical knowledge on how to bag the patient until they got to Freeman.

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, smashed up cars in piles, and they still made it through.

We continued to carry patients out of the hospital on anything that we could find: sheets, stretchers, broken doors, mattresses, wheelchairs—anything that could be used as a transport mechanism.

As I finished up what I could do at St John’s , I walked with two RN’s, Shilo Cook and Julie Vandorn, to a makeshift MASH center that was being set up miles away at Memorial Hall. We walked where flourishing neighborhoods once stood, astonished to see only the disastrous remains of flattened homes, body parts, and dead people everywhere. I saw a small dog just wimpering in circles over his master who was dead, unaware that his master would not ever play with him again. 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.

By this time news crews and photographers were starting to swarm around, and we were able to get a ride to Memorial Hall from another RN. 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. I sutured multiple lacerations, and splinted many fractures, including some open with bone exposed, and then intubated another patient with severe COPD, slightly better controlled conditions this time, but still less than optimal.

But we really needed pain meds. I managed to go back to the 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.

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 EF4 tornado, one of the worst in history, whipping 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.

How can one describe these indescribable scenes of destruction? The next day I saw news coverage of this horrible, deadly tornado. It was excellent coverage, and Mike Bettes from the Weather Channel did a great job, but there is nothing that pictures and video can depict compared to seeing it in person. That video will play forever in my mind.

I would like to express my sincerest gratitude to everyone involved in helping during this nightmarish disaster. My fellow doctors, RN’s, techs, and all of the staff from St. John’s . I have worked at St John’s for approximately 2 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 immediateresponse 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% the way that you all did, even in your own time of need. St John ‘s 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

For all of the injured who I treated, although I do not remember your names (nor would I expect you to remember mine) I will never forget your faces. I’m glad that I was able to make a difference and help in the best way that I knew how, and hopefully give some of you a chance at rebuilding your lives again.

For those whom I was not able to get to or treat, I apologize whole heartedly.

Last, but not least, thank you, and God Bless you, Mercy/St John for providing incredible care in good times and even more so, in times of the unthinkable, and for all the training that enabled us to be a team and treat the people and save lives.

Sincerely,

Kevin J. Kikta, DO

Department of Emergency Medicine

Mercy/St Johns Regional Medical Center, Joplin , MO

[PalmerSil]

My lab manager gave me a copy of this a couple weeks ago. Quite the insight of this doctor to write down his thoughts and experience.

Our hearts go out to St. John's from Silverton Hospital. The administrator, Gary Pulsipher, was one our VP's before he went to Joplin. He is missed here, as he was very well thought of.

Good luck with the rebuilding, and I hope all goes well in your position as Blood Bank coordinator.

[mollyredone]

I worked at St. John's before transferring out to Mercy in Roseburg, Oregon 1-1/2 years ago. It was a great hospital, but it will not be rebuilt there. From talking to some other lab techs there, they are working out of trailers in the parking lot. It will be a year at least before they have a permanent home. I read that article as well, and it really gives you a personal insight.

[EDibble]

At a hospital that I worked there was an electrical outage do to a lightning strike of a transformer across the street from the hospital. Only emergency lighting was working in the lab located in the basement of the hospital and therefore the hallways outside the lab were completely dark as this incident occured on 3rd shift. Location was northern suberb of Philadelphia. We came to find that our Helmer blood bank refrigerators where not hooked up to emergency power. As time wore on we became concerned that all of our inventory would expire as a result of being out of temp. Myself and a co-worker went to other parts of the hospital, which was also on emergency lighting, to try to round up ice for transport boxes stacked in the blood bank from previous deliveries. We ended up in the hospital kitchen with flashlights in hand retreiving ice from freezers and ice machines. The Helmers, as we came to find, are designed to hold their temps with doors remaining closed for 2 hours without power. Not bad. The conclusion was that we watched the Helmer temps closely and luckily the power was returned in about an hour and a half. The boxes that we had collected ice in would only have been able to hold about a third of our inventory, O Pos and O Neg PC's. I did not see any immediate changes in the desaster policy after this incident. Life resumed as normal, but there were some very tense moments. As far as the thought of anyone needing blood during this time we just maintained a state of readiness and were prepared to do all necessary work to produce compatible units; flashlights in hand.

No changes in the policy? Was the Helmer at least put on the emergency circuit? What about your FFP inventory?

[EDibble]

I said I'd come back if I thought of anything else.

This may sound a bit obvious, but it wasn't that obvious in some cases with which I have dealt!

For the external major incidents, make sure that the Blood Bank is stood down when the rest of the hospital is stood down! I rememebr that, in one incident, we were still on red alert for four hours after everyone else had "gone home"!!!!!!!!!!!!

Yes, we have a saying in the Blood Bank here, about many situations, "The Blood Bank is the last to know." Quite sad really.

[Mabel Adams]

I've been working on our disaster response plan and in the process came up with a list of questions useful for planning for disasters affecting transfusion services (blood centers may need their own list). I will attach it here (if it works right) and I hope others will improve upon it. Sort of like a wiki where we can have an end product from our collective brains that is better than anything we could come up with alone. Feel free to copy the attachment, revise it completely and repost it or just suggest in a post things that should be added to it.[ATTACH]505[/ATTACH]

Disaster_planning_checklist_for_transfusion_services.doc

[AMcCord]

I've been working on our disaster response plan and in the process came up with a list of questions useful for planning for disasters affecting transfusion services (blood centers may need their own list). I will attach it here (if it works right) and I hope others will improve upon it. Sort of like a wiki where we can have an end product from our collective brains that is better than anything we could come up with alone. Feel free to copy the attachment, revise it completely and repost it or just suggest in a post things that should be added to it.[ATTACH]505[/ATTACH]

Nice starting point for a disaster plan. Thanks for sharing.

[L106]

That's a really great checklist, Mabel. Thanks!

A stash of flashlights, extension cords, and fans can be very important during certain disasters, especially if you have to temporarily relocate to a different area.

[Dr. Pepper]

Great job Mabel.

[khalidm3]

Excellent listThanks

[NANCY F]

I work at the other hospital in Joplin, MO;  I really don't know how one prepares for a diaster like our town went through.  We have a diaster plan, and even had a diaster drill the previous week, but you don't plan for things like , no phones, no power, no computers, the other hospital in town being hit, it was a weekend, and staffing was minimal.<BR>It was very difficult for staff trying to get in to help, to get through because of roads being closed or impassible; I know several employees who literally walked that last 2-3 miles(and this was not safe, power lines and debris were down everywhere) --no way even to know which roads to attempt, because the city of Jopin was basically shut down--ie no phone/TV/radio stations to give information.<BR>Patient ID was difficult, many patients had no identification with them, and were unable to communicate.  We do have a system, but were not prepared for hundreds of unknown patients.<BR>Our pathologist ended up going and picking up the entire blood supply form our neighboring hospital, which was hit in the tornado, and Thank God someone kept track of all inventory received from where (remember it was all manual, because we had no computer) and it's temperature upon arrival, because we did receive a visit from FDA wanting to see our paperwork, and verify the temperature upon receipt.<BR>In order to order blood products from our supplier, the same pathologist got in his car, and drove until he could get a signal on his cell phone. (Not sure how he figured out which direction to try to drive)<BR>Another thing to consider, is how long will workload be increased,  we are now into August, and our workload is still significantly increased.<BR>Ok, I am done venting, and most of this probably won't help anyone with a diaster plan,

[Mabel Adams]

Glad to give you a place to vent. Your information is still useful. You bring up a point that our last disaster drill made us consider: what do we do when we run through our whole alphabet-based list of unidentified patient names? Also we have multiple facilities so realized we can't have separate lists using the same identifiers in case the patients get moved between facilities--won't do to have 2 patients going by Yankee, Male.

Also, it is good for us all to remember that disasters don't end once they quit making the news. The effects of something like Joplin suffered will go on for years. My heart goes out to you all.

[Malcolm Needs ☆]

This is in no way to belittle what you have gone through; what you went through was terrible, but a "natural disaster", and involved many casualties.

I attach a couple of photographs taken at the end of my road (maximum of 50 yeards from where I live) to show the destruction that humans can inflict on one anothers property during one night's rioting in Croydon last week. All of these buildings were old, but sound in structure, before the riot.

What a world we live in.[ATTACH=CONFIG]520[/ATTACH][ATTACH=CONFIG]521[/ATTACH]

[AMcCord]

Nancy - Having visited Joplin about a year ago, I just can't get my head around all that happened to your town and the people who live there. I also live in tornado alley and know that this could happen to us. We can definitely learn from your experiences and we can also listen when you need to vent...any time. Thanks for sharing. The info about the FDA visit is definitely valuable. That never even crossed my mind.

Malcolm - WOW, scary! to be so close to that kind of human violence! What kind of world indeed.

[L106]

NANCY F - You weren't "venting".....you were "telling it like it is." What a tragic situation for all of you. What a challenging experience.

Malcolm - Yikes!! That's way too close for my comfort!! Thanks for the pictures. Thank goodness you & your family are OK.

[Dr. Pepper]

I agree, those were impressive pictures and we're glad you escaped harm. We all know that random violence, accident or illness can happen to any of us at any time, but that was indeed way too close for comfort!

[EDibble]

Malcolm, how horrible! To think that the wonderful peaceful places I visited in April are now under such duress! Glad your nearest and dearest are OK.

[Malcolm Needs ☆]

Good luck to all of you with the forecast hurricane.

We will be thinking of you.

:raincloud:raincloud:raincloud:raincloud:raincloud

[Dr. Pepper]

[ATTACH=CONFIG]524[/ATTACH] We were planning on taking my mother and father-in law out to this charming dockside restaurant on Sunday but we might have to make some other plans..........like telling them we'll meet them there. Thanks for the wishes, they are warning us this could be the storm of a lifetime.

[Deny Morlino]

The predicted storm surge of 5 to 10 feet is enough to submerge much of the islands within the outer banks. Spent time as a teen on Ocracoke island and remember the fact that the lighthouse was built on the highest point on the island. That point was only 8 feet above sea level! Hang in there east coasters!!

[Dr. Pepper]

Some of us are still hanging in there - we're on our 4th day without electricity at home. Nearly a third of Rhode Island lost power, joining some 4 million other Americans. We didn't get all the rain that caused the devastating floods that areas to the west incurred, but coastal flooding from the surge and wind damage took its toll. We hunkered down for several hours on Sunday as the trees danced and leaves and branches flew through the air. Our house was not damaged, but we went outside after things calmed down a bit and saw that there had been a micro-burst or mini-tornado just a few hundred yards down the street. In a hundred yard strech there was a line of some two dozen large oak trees and telephone poles that were snapped like toothpicks. Amazingly, most of the houses and cars escaped major damage, although a garage, a car and a boat suffered direct hits and were smashed like paper cups. The neighborhood rallied, though, going to work with chain saws to try to clear some of the mess up. I gave out some extra flashlight batteries, a neighbor gave me ice and another with power offered freezer space. So we have our Coleman camp stove and propane lamps out and we're getting by. This morning I saw most of the downed trees and poles had been cut up, the there's still a lot of new poles needed and wires to be replaced so I'm not optomistic that we'll be enjoying hot showers at home anytime soon. At least we have water; anyone with a well and no generator (like our daughter) is still out of luck. She also had a freezer full of breast milk that she had to bring in to store at the school where she works. A little treat for the students at the middle school!

Also quite fortunately Rhode Island did not have any deaths and (I'm assuming) few injuries. I did hear one story on the radio (to add to your list of things not to do during a hurricane, like surfing or standing on a seawall to watch the waves) of a guy who wanted to experience the storm up close and personal and talked 19 of his friends to go camping in the woods. At the height of the storm a large tree fell on his tent. His female companion next to him was unharmed but he was squashed flat.

As for our lab, work went on as usual. Our disaster plan was pretty simple: whoever was at work when the hurricane hit stayed there until the next shift could come in. The timing of the storm (~ 8AM-3PM) worked well for this. The only late arrival was a third shifter who turned into unknown territory at a detour sign and didn't see another sign thereafter and wandered lost for 2 hours until she found something familiar. We had plenty of blood if needed and it turned out to be rather routine day.

And we had a CAP inspection yesterday. It's been an eventful week. I'm hoping that the rest of the easterners are doing well.