Orangeville Ontario, 1985 12 dead, 155 injured F3? Joplin - - PowerPoint PPT Presentation

Orangeville Ontario, 1985 12 dead, 155 injured F3?

Joplin Missouri, 2011 166 dead F5 wind speeds greater than 200 miles/hour

“…On a Sunday afternoon in May, our world turned upside down. Time stood still and nothing would ever be the same again…The forces of nature passed through Joplin, passed through history and in the days that followed Joplin and the four states formed an unbreakable bond beyond time, beyond tragedy, beyond comprehension…”

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Via Christi Hospital-Pittsburg & SE KS Hospitals: Lessons Learned Medical Surge and Collaboration for the May 22, 2011 Joplin Tornado

Karry Moore -Liaison

Via Christi Hospital-Pittsburg 1 Mt. Carmel Way, Pittsburg KS 66762 620.704.7200 karry.moore@gmail.com

How long is 30 seconds?

http://www.youtube.com/watch?v=asgs3Ky0mJ Y&feature=feedf_more

• Keep your eye on the light post as the tornado

approaches and passes it to get a feel for the speed of the storm.

www.youtube.com

http://www.youtube.com/watch?v=nXjiWaQBXjs&feature=feedf

U2 - Where the Streets Have No Name – Joplin Tornado Version KillBoxFilms Released June 9, 2011 Viewed 308 times June 9, 2011 Viewed 38,274 times June 24, 2011 Viewed 80,506 September 21, 2012

Joplin Fire Department, May 22, 2011

Map of the trauma center regions-

• ur proximity to St John’s

X

31 miles from St. John’s to Via Christi Hospital, crossing the Kansas/Missouri state line.

This presentation will:

• Discuss community hospital (VCH-P) medical

surge response and lessons learned

• Discuss general lessons learned by the public

and area businesses

• Discuss the media coverage of the event

• 1. Self Deployment of Staff

VCH-Pittsburg examples Regional Concerns Media examples

Lessons Learned SE KS Regional Hospitals

3 opportunities for improvement:

• 1. Self deployment, self deployment, self

deployment!

A. Vulnerability B. Accountability C. Liability

• 2. Triage System

Opportunity for improvement Needed system at every door, multiple entrances, people presenting at many doors, self presenting and ambulance signage

• 3. Fundamentals

“Practicing the plan gets us to the event, adjusting the plan gets us through the event.” Dr. Tim Stebbins

Meanwhile across the state line:

• Incident command set up
• Patients begin to arrive in personal

vehicles

• Triage set up at all 3 main entrances
• Registration set up (moved servers)
• Food set up for staff/EMS/ED
• PSU police set up car and flashers at

end of ambulance entrance

• Call backs for needed clinicians

26

Via Christi Tornado Response

• By 7 p.m., Sunday, May 22, it was all hands
• n deck at Via Christi Hospital.
• An hour and a half earlier an EF5 tornado

hit Joplin, Missouri.

• The storm cut a swath of damage nearly a

mile long.

• Via Christi Hospital activated its Incident

Command Center and prepared for a medical surge.

27

Via Christi Tornado Response

• More than 140 Via Christi employees

voluntary showed up to help care for patients currently at the hospital and arriving from Joplin.

• Initial reports were unclear about how

many patients the Emergency Dept. should expect

• Incident Command discussed logistically

how many helicopters and ambulances could deliver patients at one time.

28

Via Christi Tornado Response

• Once word about the severity of

the situation in Joplin and news of the devastation spread, it was clear Via Christi Hospital would have a part in caring for those injured in the storm. The mission

• f Via Christi came to life, as it was

a time to serve as a healing presence with special concern for

• ur neighbors who are

vulnerable.

29

Via Christi Tornado Response

• After the initial medical surge from

Sunday night into Monday morning, additional patients were treated at

• ur ministry throughout the course
• f the week.
• More than 100 patients who were

directly affected by the tornado were treated at Via Christi Hospital.

• Nine had been patients at St. John’s

Regional Medical Center when the tornado hit.

30

Via Christi Tornado Response

“In times like these, the character of

communities and individuals are revealed,” said Via Christi Pittsburg President & CEO Randy

• Cason. “I would personally like to thank each of

you for the extraordinary effort put forth over the past week. On countless occasions during the week, I have witnessed excellence in care amidst the calamity and tragedy of the tornado.”

DOUG HEADY, CHIEF METEOROLOGIST KOAM TV, JOPLIN MO http://www.koamtv.com/

“When I look at this tornado, it wasn't an unusual tornado by any means. We get very strong tornadoes like this all of the time. In fact the Picher, OK tornado in 2008 was almost as strong as this tornado. What makes this tornado stand out, is because it tore through a very populated area, which is rare. Chances are it will be in a field or glance towns. But the chances of actually plowing through a city aren't that great. That is what made this tornado stand out. Besides that, I was amazed how fast the tornado developed. Most tornadoes take a good 4 or 5 minutes to go from the beginning stages into a monster, at least 5 minutes. This one was just ready to go and went to a monster in under 60 seconds. This was a big tornado. It was about 3/4 of a mile wide. St. Johns did get hit, but they were on the side of the tornado. If it went directly over the building, I think it would have had even more damage. I hope all of this helps,” Doug

Before and After Photos

http://www.youtube.com/watch?v=s 7Fdsp5YnKE&feature=feedf

The Joplin Globe

One month later…Two months later…

• $3 billion preliminary damage estimate
• 597,500 cubic yards of debris removed
• 1,273,471 cubic yards of debris removed
• 18,000 cars destroyed
• (remove your license plate if it happens to you!)
• 6,954 homes destroyed
• 5,000 jobs affected
• 1,150 injuries
• 875 homes damaged
• 500 business affected
• 155 deaths
• 160 deaths
• 1,300 animals at the Joplin Humane Society
• All tornado animals reunited or adopted out
• 10,288 disaster survivors registered with FEMA for

Individual disaster assistance

Other related events/concerns:

• Identity theft
• Looting
• Curfews
• Officer from KS City, responding to the event, struck by

lightening and killed

• Responding National Guard vehicle flips injuring occupants

when clipped by another driver who left the scene

• Mucormycosis (rare fungal infection) developed in wounds
• f victims and responders
• Threats of picketing the memorial services
• Numerous resources unavailable in the midwest due to

demand, rental cars, freezers, tents…

• Tent City

Dr Dodson, Trauma Surgeon St. Johns/Mercy Hospital Notes:

• Generator didn’t start
• People trying to get in/out of the building at

the same time

• Many came in to get out of the storm
• 183 patients at the time/367 licensed beds
• 25 patients were in the Emergency Dept.
• Tornado was 45 seconds over head
• Other notes……

39

Via Christi Tornado Response

• Via Christi Hospital helped gather

and arrange for donations for victims, including hospital patients who arrived with only the clothes they were wearing.

• A number of businesses and
• rganizations put together

impromptu clothing and supply drives.

• Via Christi staff took sizes of

clothing of tornado patients to ensure they had clean clothes when returning home, and also put together care packages for them.

40

Via Christi Tornado Response

“It’s like staying in a hotel,” one patient from Joplin said. “That’s what it feels like to me; the way everyone looks after me and makes sure I have what I need. I’ve never been treated this well before.”

Lessons Learned Via Christi Hospital-Pittsburg

3 things we did well:

• 1. Stood up Incident Command
• 2. Staff worked where needed
• 3. Planned for physician rotation should the

event be on going

Lessons Learned Via Christi Hospital-Pittsburg

3 opportunities for improvement:

• 1. Failure to use job action sheets. We

followed many of the rules of incident command designating and handing off

• positions. We did not use the job action

sheets to double check ourselves that we had everything covered. Use of vests – remind staff to hand off positions.

Lessons Learned Via Christi Hospital-Pittsburg

3 opportunities for improvement:

• 2. Assessing the location of the current

selected triage areas-bottleneck issue, needs to have a specific nurse or doctor assigned to triage only-so not to slow down the process by providing treatment.

Lessons Learned Via Christi Hospital-Pittsburg

3 opportunities for improvement:

• 3. Identification of volunteers and specific

positions by vests –beyond those in the ICS (Incident Command System) vest kit we currently own. Identification of patients using standardized triage tags.

Neither Good Nor Bad….

We did not implement a formal call back system for hospital staff. We had no idea what to expect. We were anticipating a surge of 300 people at one point. As it turned out the right number of staff arrived…the right number of volunteers arrived…it just worked out!

Preliminary Lessons Learned Crawford County, KS

3 things that went well:

• 1. Hospital emergency coordinator received a

call from the County Emergency Manager

• 2. Hospital emergency coordinator received a

call from the Crawford County Health Department

• 3. EMS responded to the call for mutual aid

Preliminary Lessons Learned Crawford County, KS

3 opportunities for improvement:

• 1. Failure to do an initial assessment of the

scene and anticipate cascading events.

• 2. Cell towers were sparse we failed to stay in

contact with county emergency manager by 800 MHz radio.

• 3. ACS-Alternate Care site disagreement

Preliminary Lessons Learned Crawford County, KS

3 opportunities for improvement:

• 3. Vulnerability of the hospital had the

incident escalated. Red Cross, Salvation Army, Emergency Manager not available to support medical surge. Note: Hotwash not yet conducted

Crawford County Health Department Lessons Learned

• Volunteer coordination is one of the most urgent needs in a disaster of

any size. Volunteer coordination in itself may need to be subdivided to make it more manageable.

• Portable vaccine refrigerators are a necessity in a disaster.
• Volunteers need to wait to be requested (no self deployment).
• Pre-event registration on a volunteer data base is essential.
• Child care is needed at a distribution center.
• Implement a method of identification of parents and their children when a

child is left for care at the distribution center.

• Warehouse is a preferable distribution point over a church or otherwise
• ccupied building.
• All volunteers should be self sufficient (not require food or lodging).
• You can never have enough contact information from neighboring

municipalities, counties or states.

Joplin School District

• The Joplin School District was especially hit

hard as one teacher and seven students were killed in the tornado. The school’s infrastructure was severely damaged with the total destruction of three buildings, and damage to seven others. Two hundred sixty teachers have lost their classroom supplies, and 3,000 students were in the destruction path of the tornado.

Lessons Learned SE KS Regional Hospitals

3 things we did well:

• 1. Updating of EMResource (online bed

availability system).

• 2. Volunteered and supported surrounding

KS medical surge hospitals.

• 3. Coordination with EMS

Lessons Learned SE KS Regional Hospitals

3 opportunities for improvement:

• 1. Self deployment, self deployment, self

deployment!

A. Vulnerability B. Accountability C. Liability

Vulnerability:

The town/county with the receiving hospital who experienced a medical surge were often left unprotected while medical teams and emergency partners were in the town of the disaster. Towns were also left unprepared for an additional disaster in their own area.

Accountability:

Volunteers such as physicians are not trained in search and rescue, and can often become

• victims. Gas leaks and loss of power (lights)

made rescue efforts extremely difficult. Lack of communications as most phone, cell, radio systems were down, difficult to track good intentioned rescuers.

Liability:

Licensure and out of state issues Represent the hospital you are employed at whether intentional or not Represent the hospital you are employed at whether approved by administration or not

Lessons Learned SE KS Regional Hospitals

3 opportunities for improvement:

• 2. Grantees understood the protocol for

requesting resources and staff – not to self deploy. Administrators did not. We need to develop a flow chart to explain this process and disaster declarations. Something standardized across the state.

Lessons Learned SE KS Regional Hospitals

3 opportunities for improvement:

• 3. Have more MOUs (Memorandums of

Understanding) in place across the state

• lines. Advance understanding of

reimbursement process.

Other points of interest:

• Staff-stress, exhaustion, must make them

leave

• Dental offices-wiped out-lack of dental

records

• DMORT-bits and pieces
• Responders
• Donations
• VIPS

Continued:

• Go Bags
• Media-CNN
• Home Depot-simultaneous rebuild and

search and rescue efforts

• Need to have appropriate debriefing for

heavy equipment operators

What a month…

• An unusual and potentially deadly fungus is found

in victims and rescuers of the tornado

• Environmental Protection Agency announces

concerns about air quality

• Blue Green Algae hits the neighboring waterways
• The parents of the Joplin Emergency Manager are

killed in a car accident

• Temperatures reach up to 109 F with heat index-

for the next 2 months

• Drought (high wildfire risk)

…..cascading events

Lessons Learned SE KS Regional Hospitals

3 opportunities for improvement:

• 3. Failed to prepare for potential VIP patients.

Emphasized at Via Christi TJC (The Joint Commission) accreditation review. Not all hospitals have a Very Important Persons response plans. Regional Coordinator should have located templates and examples. Hospitals should have reminded staff of the need to know regulations on patient files. Review of security and media plans.

Ways to help Joplin:

• http://rebuildjoplin.org/donate
• http://brightfuturesjoplin.org/adopt-an-eagle
• http://brightfuturesjoplin.org/adopt-a-

classroom/

www.youtube.com

http://www.youtube.com/watch?v=nXjiWaQBXjs&feature=feedf

U2 - Where the Streets Have No Name – Joplin Tornado Version KillBoxFilms Released June 9, 2011 Viewed 308 times June 9, 2011 Viewed 38,274 times June 24, 2011 Viewed XXXX October 3, 2011

Karry Moore KS-SE Region Hospital All Hazards Preparedness Coordinator Via Christi Hospital- Pittsburg

karry.moore@gmail.com

620.704.7200 cell

Adele Orgeron Siler