First Response ModeA Storm Chasing Physician’s First Person

Account of the Deadliest Tornado in US

History: May 22, 2011

Jason Persoff, M.D., S.F.H.M.

Assistant Professor of Internal Medicine

University of Colorado School of Medicine

http://stormdoctor.com/

Acknowledgements

• The People and the City of Joplin

• Tim Vasquez

• The Chasing Community

• Robert Balogh, MD, and Bill Hark, MD

• My Family

About Me

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904-343-4325

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Storm Chasing

Storm Chasing

RFD

Clear Slot

FFD

“Suck Zone”

Inflow Jet

Horizontal Swirl

Condensation Funnel

Debris Cloud

Tornado

Cow

Vault

Updraft

Rain-Wrapped Wall Cloud

Near Republic Cty, KS, 5/24/04. Photo by Jason Persoff, M.D.

Sometimes It’s Hard To Know

May 21, 2011

• 18z NAM

– Surface—intense 990mb low in South Dakota with long draping cold front

– Intense pooling moisture along the front in SE KS with associated CAPE >5000 J/kg

– Left exit region at 250mb over KS/MS/OK areas

– Target: Coffeyville, KS

May 22, 2011

May 22, 2011

• 12z RUC

– Suggests mesolow formation over SE KS by 21z

– Very large dewpoint depressions throughout the

region (80s/60s), but with forecast increase in dewpoints in advance of front

• 21z Analysis

– Prominent intersects the cold front (draped ENE to

WSW)

• “This storm will do amazing things.”

May 22, 2011

• 1:30pm--NWS issues Tornado Watch 325

May 22, 2011

• 5:17pm a Tornado Warning is issued for

Joplin

• 5:41pm the first tornado touches down

May 22, 2011

May 22, 2011• The tornado intensifies, bearing down on St. Johns Hospital

May 22, 2011

May 22, 2011

May 22, 2011• St. Johns Hospital emergency response for MCI

– “Anticipate Condition Gray” (organize for MCI)

– “Execute Condition Gray” (MCI imminent, patient

safety)

• Shortly before 6:00pm, the tornado intensifies to EF5

strength

– Staff busy at St. John’s moving patients to hallways

– Five patients and one visitor killed when tornado hits

• St. John’s became a wind tunnel

– Similar to Ft. Worth tornado in 2007

St. Johns Hospital

St. Johns Hospital

Photos copyright Google and Michael Schiefenbaum

St. Johns Hospital

St. John’s Hospital

May 22, 2011• All MCI drills in Joplin

involved mutual aid of 2 hospitals

• Cell service, phone

service, and power all

down

• St. Johns issues SOS and all call for mutual

aid

• Several fire stations and

ambulances hit by tornado

May 22, 2011

May 22, 2011

• Staggering immediate death toll

– 162 dead

• Deaths in healthcare facilities unprecedented:

– 21 killed at Greenbriar Nursing Home

– 15 killed at St. Johns Hospital

– 2 killed at Meadows Healthcare Facility

• 1 officer killed in line of duty

• 23 killed outside

– Source: NIST

• Staggering immediate injuries

– >1500 injured, trapped, or dying

Are You Ready?

• IMPACT…THIS IS A LIFE THREATENING SITUATION.

YOU COULD BE KILLED IF NOT UNDERGROUND OR IN A TORNADO SHELTER. COMPLETE

DESTRUCTION OF ENTIRE NEIGHBORHOODS IS

LIKELY. MANY WELL BUILT HOMES AND

BUSINESSES WILL BE COMPLETELY SWEPT FROM

THEIR FOUNDATIONS. DEBRIS WILL BLOCK MOST ROADWAYS. MASS DEVASTATION IS HIGHLY

LIKELY MAKING THE AREA UNRECOGNIZABLE TO

SURVIVORS

First Response Mode

• Storm Chasing: A Hard Duality

– Desire to see intense, rare

atmospheric phenomena

– These phenomena must occur somewhere

– Disproportionate representation of

populated areas due to

road/infrastructure

– What exactly is a chaser’s role?

First Response Mode

• First rule: your safety is paramount– Driving is the single most dangerous

activity chasers engage in• ~1.8 deaths/million miles driven—US DOT

• Average storm chasing year ~2,000-5,000 miles

• Livestock, deer

• Water on roadway, hydroplaning

– Multitasking increases risks of car accident

– Glare from electronics obfuscates view

– Hail fog

Are You Ready?

• Are you dressed for being outside?

• What equipment do you have?

• What communications do you have available?

• Who do you treat and where do you start?

First Response Mode

• Don’t just do something, stand there!

– Pull over—stop driving

• Stop your car

• Stop filming (you can resume it later)

• Stop your chase

– Capture GPS location, know where you are before you call

– Call 9-1-1, then attend to victims

• Every person can save lives

First Response Mode

Take CommandAssess Impact

ONE PERSONONE SUPERVISOR

Triage Area Surveyor (Team) Responder (Team)

First Response Mode

• DO NOT:– …Send rescuers in solo—always in groups

– …Use chainsaws or other electric gear unless you have experience with rescues

• Gas leaks are common and potentially can ignite

– …Attempt to enter debris-filled structures or move debris without safety equipment

• Utility gloves, masks, goggles

– …Leave the area until relieved of command• Once relieved, define your role and check in

First Response Mode

• DO:– …Take down all names of rescuers and where they

are going (check-ins)

– …Map the area and what you know about it

– …Perform basic first aid in the triage area• Splinting, bandaging, but limit CPR in MCIs

– …Have rescuers use spray paint to mark areas where imminent rescue is needed

– …Know your limits

– …Know who’s doing what

– …Stay put—don’t move unless necessary

Recommended Equipment

• Personal Protection– Gloves (box)

– Gowns

– Face masks

– Sharps

• Utility Gloves

• Ropes• Axe

• Blankets

• Spray Paint

• Torches / Flares• Rescue Knife

• Trauma Bag– Emergency Medical

Products

http://www.buyemp.com/

• Communications– Amateur radio

• Waterproof Paper / Marking Pens

• FOOD, MEDICATIONS, and WATER for you for 2+ days

• Bug Spray

• Regular (Non GPS) Maps

Recommended Safety

• Hunt in packs

• Hunt where you know the terrain

• Don’t hunt at night

• Wear seatbelts

• Live life outside your viewfinder—pay attention

• Have a back-up plan for communication failure

• Prepare to be isolated

Ready.Gov

Post-Trauma

• No rest for the weary– Stress cardiac syndromes (Tako Tsubo,

“Broken Heart”)

– Medication shortages

– Severe wound infections (days)

– Atypical aerosolized wounds / inhalation injury (mucormycoses)

• Posttraumatic Stress– Let’s talk