When the catastrophic EF5 tornado hit Joplin, Mo., on that late Sunday afternoon of May 22, 2011, the paper records and x-rays from St. John's Hospital were scattered across nearby counties like ticker-tape confetti.
The building was unusable and the power system and generators were destroyed, but the hospital’s IT network connection, with access to its newly minted electronic medical record system, was miraculously still working.
Courtesy of Mercy Health System
Dr. Sean Smith
"We’d only gone live with the system on May 1, which in hindsight turns out to be a blessing because when all of the patients that were in our facility – 183 inpatients and 24 patients in the emergency department – were transferred to other facilities, they were able to access their records," said emergency physician Dr. Sean Smith, president of Mercy Clinic–Joplin.
Records were subsequently printed off-site and faxed or sent by courier to other hospitals. If patients went to a sister facility in the Mercy Health network, their new physicians had immediate access to everything from medication and allergy information to history and physical examination records. "Everything was seamless, as if they’d been at that facility all along," he said.
The Joplin tornado destroyed some 8,000 structures in the area and was the first direct hit by a tornado on an acute care hospital in this country. In late January, demolition began on the building that had been St. John’s Hospital since 1968, along with three medical office buildings and a rehabilitation facility across 47 acres. An emotional groundbreaking was also held that month for a permanent 600,000-square-foot, 327-bed hospital on 100 acres about 3 miles south of the old hospital, slated for completion in early 2015.
Photos courtesy Mercy Health
A full view of the hospital and parking lot after the tornado.
St. John’s, now known simply as Mercy-Joplin, has gone through several incarnations over the last year, including a MASH unit, a prefabricated modular hospital, and a 150,000-square-foot component hospital that just opened its doors in April, according to Mercy president and CEO Lynn Britton. The new component facility contains a full-service emergency department and is stronger than the old building, with glass that can withstand 200-mph winds.
"One thing we definitely learned is the power of the electronic medical record in this kind of situation," Mr. Britton said, but much of the credit for maintaining continuity of care lay in the resilience and dedication of the health care providers who worked 48-72 hours without stopping after the disaster, he added.
Quick thinking during triage sent patients with complex medication regimens to a Mercy facility where their records could be instantly accessed, while others were sent to facilities across the region. Within 90 minutes, a command center was set up at Joplin Memorial Hall, and within 12 hours, a portable hospital was in place and stocked with two large truckloads of supplies delivered through Mercy’s independent supply chain. Within 48 hours, arrangements had been made to have CT scanners set up in the parking lot of Memorial Hall, Dr. Smith said.
"A lot of that is due to the fact that we’re part of a larger organization," he said. "If we had been a solitary, independent hospital in Middle America, I don’t think we would have had that level of infrastructure to support our services."
That scale also allowed Mercy Health – the eighth largest Catholic health care system in the United States, with 31 hospitals – to make a promise that none of the 2,200 employees in Joplin would lose their jobs. At an annual payroll of $120 million, it was a hefty commitment.*
Courtesy Mercy Health System
Mr. Lynn Britton
"The reason we did it was a lesson learned from [Hurricane] Katrina," Mr. Britton said. "When the health care systems couldn’t or didn’t make that commitment, medical professionals not only needed income, but also had to continue to practice their skills or they lose competency, so they had to seek a place to practice. I didn’t want the medical community in Joplin to lose their competencies or disband."
The decision was also important to the economy of Joplin, a city of 50,000 and a regional hub for Kansas, Oklahoma, Missouri, and Arkansas that swells to 250,000 people during the workday. Mercy and nearby Freeman Health System are two of the big economic drivers, and without Mercy, it’s unlikely that Joplin could have recovered economically, Mr. Britton said, adding, "It didn’t make sense to take the money and run."
Although Mercy is maintaining much of its patient care, some services such as obstetrics and elective or emergent cardiac surgery have been off-line for most of the past year. Hospitals and health care providers throughout the region have had to increase services following the disaster, albeit without the same bolus of disaster funding or resources as Mercy had.
"I think what’s often missed in this is that we did take a hit and we continue to take a hit," said Freeman Health emergency physician Dr. Frank Veer. "They took a punch to the face, but we’ve taken body blows ever since then, and I’m impressed with my colleagues’ ability to continue to step up and do that job."
Because there was no electricity during the first few hours after the tornado, the exact patient count isn’t available, but Freeman officials said they treated well over 500 patients and performed 22 lifesaving surgeries. Another 1,700 patients were cared for over the next few days and weeks, and patient volume has continued to be high.
So Freeman has had to find more efficient ways to deliver care – not simply to be a better health system, but out of necessity, Dr. Veer said. The hospital added one full shift in the ED, staffed by ED docs and nurses taking on additional hours.
All three men say that flexibility is the key to any disaster response plan and that a secure back-up communication system – including analog radios and a network of ham radio operators – is invaluable. The tornado destroyed five repeater or relay towers in the Joplin area, which meant that cell phones were unusable and digital EMS channels didn’t work all that well either, Dr. Smith said. Analog radios were the only reliable way to communicate during the first several days or, for some parts of town, weeks.
St. John’s had a disaster trailer on-site that was designed to accommodate 250 patients and included emergency communications equipment. "They found the trailer a week later and it was a mile away, and all they found was the frame and the axles," Dr. Smith said. "If it had been in an underground bunker, it would have been much better, but it was parked next to the hospital, as it had been for years."
Photos courtesy Mercy Health
An artist's rendering of Mercy Health's new component hospital.
The new hospital will include a hardened structure for back-up communication systems and emergency supplies. Back-up power sources will be located 100-200 yards from the hospital, instead of right next to the ED and nearby gas lines, which ruptured during the storm and began leaking into the hospital.
Dr. Smith recommends that medical staff create personal disaster kits with whatever supplies they might need for at least 72-96 hours, such as their own medications. Some workers had such kits, but it wasn’t a policy.
"I can bet that 95% of us in Joplin now have [a disaster kit], be it in our car or our house," he added.
With the tornado season just underway in the Midwest, Mercy has yet to test many of the hard lessons learned. Fears of a mass exodus have gone unrealized. By July, there will be a net gain of 30-32 physicians in the clinic, including 15 who are new to the community, Dr. Smith said. Even the four physicians who were en route to Joplin when the tornado hit opted to stay on.
"It has reinvigorated our desire to practice medicine," he said. "I don’t know if that makes sense to you, but medicine is no longer a job. What we did before May 22 was important, but since May 22, it’s not a job, it is a mission.
"We’re here to build the infrastructure for health care in our community and to provide top-quality patient care. But we also have a mission to leave a legacy here, to rebuild Joplin, and to [affect] how health care will be delivered here for the next 50 or 100 years."
CORRECTION: 4/19/12 The original version of this story misstated the amount of the annual payroll for Mercy Health.