DO recalls overnight shift at Joplin hospital during deadly tornado

On in-house call in the intensive care unit of Freeman Hospital in Joplin, Mo., Geoffrey G. Graham, DO, phoned his wife as soon as he arrived Sunday evening for his overnight shift. Worried that hail would damage her car, Dr. Graham cautioned her not to leave home to go shopping in the escalating thunderstorm. Little did he know that he may have been saving the lives of his wife and 2-year-old daughter, for a tornado—deemed the country’s fiercest in more than six decades—was about to lay waste to a mile-wide swath of Joplin, including the city’s largest business and shopping district.

Though Dr. Graham knew that a twister had touched down a few miles away, and that tornado warnings had been issued for towns north of Joplin, his first premonition of the impending destruction came when he looked out a hospital window. “Rain was pounding the window horizontally, large trees were swaying, and several flags flying over the hospital’s helipad suddenly vanished,” he remembers.

At 5:17 p.m., tornado sirens blared. Dr. Graham and other hospital staff began moving patients out of their rooms toward the windowless central areas of the hospital. They rolled the beds of patients on life support as close as possible to corridors.

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Freeman Hospital, which is accredited by the AOA’s Healthcare Facilities Accreditation Program, sustained relatively minor damage from the multivortex tornado that struck the evening of May 22. But the storm destroyed major portions of St. John’s Regional Medical Center, located just a quarter mile to the north in Joplin. “The town is gone. It looks like a bomb went off at St. John’s,” people said as they brought the injured to Freeman.

One hundred thirty-four people died in the tornado. At least 900 individuals were injured in the disaster, and thousands of people have been left homeless.

While Dr. Graham, his family and home escaped harm, several of the dozens of DOs and osteopathic medical students who live in Joplin were less fortunate. A student from the Kansas City (Mo.) University of Medicine and Biosciences’ College of Osteopathic Medicine (KCUMB-COM) was injured in the disaster, the Missouri Association of Osteopathic Physicians and Surgeons reports. Two students from the A.T. Still University of Health Sciences-Kirksville (Mo.) College of Osteopathic Medicine, as well as a DO resident with a wife and three children, lost their homes. And two DOs saw their practice sites destroyed.

The Missouri association, which has established a relief fund, is still gathering information on other DOs and osteopathic medical students who may have been significantly affected. The A.T. Still Foundation also has a fund to assist members of the profession who are victims of natural disasters (see the accompanying article).

Massive triage

As Freeman began taking in critically ill and injured patients from St. John’s, as well as a throng of others wounded in the disaster, the atmosphere was “organized chaos,” says Dr. Graham. Good Samaritans, many driving pickup trucks, dropped off victims and transferred patients from St. John’s.

“We had to downgrade and clear out many of our own patients who were well enough to go home,” recalls Dr. Graham, a second-year resident in internal medicine. “We transferred stable patients from our ICU to other units.”

The massive triaging effort resembled “a MASH unit on concrete,” as he describes it. Without enough beds, physicians treated patients on the floor, several to a room.

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St. John’s evacuated 183 patients in 90 minutes, according to Adam Fahrenholtz, DO, a first-year resident in internal medicine at Freeman.

Patients were treated for lacerations, eye injuries, broken bones and crushing injuries from falling walls and trees. “We couldn’t get some people to stop bleeding,” Dr. Graham laments. “I lost several patients that night.”

“I took care of a woman who was lying in a bathtub during the tornado, which tore the roof off her house,” Dr. Fahrenholtz says. “Her 6-year-old and 10-year-old children died. It was awful.”

Recovery begins

In the days following the tornado, stabilized St. John’s patients were transferred from Freeman to St. John’s Hospital in Springfield, Mo., which has access to the patients’ electronic health records. And St. John’s established a treatment site in a Joplin auditorium.

With many KCUMB-COM students having ties to Joplin, Darin L. Haug, DO, the college’s dean, has helped out at the makeshift site, as has John J. Dougherty, DO, the school’s associate dean for clinical education and medical affairs.

Dr. Fahrenholtz has been amazed by the “outpouring of well-wishes from strangers” he has seen in the wake of the disaster and is pleased with the generosity of donations. While it will take the city of 50,000 people years to fully recover, Joplin is already rising from despair, he says.