Memoirs of an ED Physician in a Tornado

A small child of approximately 3-4 years old 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 RNs 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 the patients 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.

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 news footage from bombings in Baghdad. 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 Hospital, the trauma center literally across the street. It had sustained only minimal damage and was functioning (although I’m sure it was 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 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 more than 100 EMS units showed up from various towns and counties in four different states. Considering the circumstances, their response time was miraculous. Roads were blocked with downed utility lines and 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 RNs, Shilo Cook and Julie Vandorn, to a makeshift MASH center that was being set up miles away at Memorial Hall, a large entertainment venue in Joplin. 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 whimpering 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 – everything 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, in slightly better controlled – but still less than optimal – conditions this time.