In April and May, multiple tornados struck the U.S. Areas in and around Tuscaloosa, Ala., Joplin, Mo., and Knoxville, Tenn., were heavily hit, with hundreds of people being killed or injured. Tornados also struck in other places, and although these did not always cause numerous injuries, we can still learn much from some of the operations in these areas.
The St. Louis metropolitan area suffered not one, but two significant tornado strikes in a short period. The first was a rare winter tornado, which occurred on New Year’s Eve. The second hit April 22. This particular tornado damaged an estimated 2,700 buildings in St. Louis County and also did significant damage to Lambert International Airport. Pattonville, Mo., was hit hard. Asstistant Chief Matt LaVanchy of the Pattonville Fire Protection District (FPD) shared with us some unique aspects of their operations that can prove useful if we face a similar situation in the future.
The tornado that hit the Pattonville area cut a half-mile wide path, damaging numerous residential and commercial areas. The first EMS call was received around 7:15 p.m. and seemed relatively minor—for a “collapsed garage.” When entering the subdivision, however, the on-duty battalion chief realized it was more than an isolated building collapse.
The damage to the neighborhood was widespread, and the potential for injuries was great. This is a great reminder for EMS providers that initial dispatch may not always provide any indication that you’re responding to a potential mass casualty incident (MCI). So it’s essential that first-arriving EMS providers can quickly shift from the role of caregiver to incident manager.
In this case, two ambulances had been dispatched on the initial call. After seeing the devastation, and as more calls were being received by the local dispatch center, concerns grew that there may be numerous injured patients trapped in the collapsed and damaged buildings. Within 20 minutes of the first dispatch, the battalion chief requested an ambulance strike team, which consisted of five ambulances and a strike team leader.
Fire and EMS personnel had no idea of the geographical scope of the disaster until they started viewing aerial video. Seeing the magnitude of the incident, a second ambulance strike team was requested. Although a large number of injured were never found and the ambulance strike teams weren’t used, this decision provides a good lesson.
Incident commanders must anticipate the potential for numerous patients in such incidents. Obviously, the resource needs will increase if more patients are discovered. Another complicating factor is the debris generated by the storm. Roadways in and near the strike area may be clogged, and response times may be lengthy. Therefore, provided sufficient resources are available and aren’t needed for other incidents, it’s better to request more resources early and have them staged near the scene. If you wait until later in the incident, you may not be able to get needed resources for some time. Designate an area-wide staging location so strike teams can be assembled in staging and then moved into various forward operating areas.
Another challenge encountered was communication between fire districts. Many departments exist within St. Louis County, but there’s no single countywide communications center. Therefore, one agency may not know what resources other neighboring fire districts have requested, and requests for duplicate resources may occur. In the case of this tornado, a neighboring fire district who operates the area’s urban search and recovery equipment had requested a heavy rescue task force respond because of the anticipated need for multiple building collapse rescues. Although this request wasn’t a bad decision, other area fire and EMS agencies weren’t aware of this. In one case, the first clue this request occurred came when a department saw an engine from a long distance away in the area.
To avoid further confusion, a decision was made to switch to an area command structure. This decision allowed all agencies involved to make better use of resources, avoid duplicity of requests and share information. Granted, most events wouldn’t use the area command concept, but it’s good to think about this option early with events that affect multiple geographic areas and jurisdictions.
Around 2 a.m., Pattonville FPD command personnel realized the number of anticipated injuries weren’t present and it wasn’t likely to find more patients. So Pattonville FPD made the decision to stand down operations until the morning. However, the ambulance strike teams were kept on standby because they were already in the area.
What we learn from this experience goes beyond the initial response operations that occurred shortly after the tornado touched down. In the days that followed, clean-up and debris-removal operations began. Also, residents returned to the affected neighborhoods to go through what was left of their homes, trying to salvage what they could or find irreplaceable family memorabilia.
Anyone who has ever operated at a tornado or hurricane disaster site is well aware of the many dangers that exist in the debris piles. Being proactive, Pattonville FPD decided to set up a medical aid station in one of the most damaged areas of their district. This arrangement placed medical services closer to the tornado touch-down site. Other ambulances didn’t have to respond into the area for minor injuries or medical issues. Also, the ambulance and crew could first respond to a nearby call, assess the situation and then decide if transport was needed. If transport was needed, a second ambulance was called. This allowed the ambulance assigned to the aid station to remain available to provide medical assistance and to respond to other calls.
The medical aid station was established at a major intersection to allow for easy access to and from various damaged neighborhoods. Initially, an ambulance staffed with two paramedics was used as the aid station. Shortly after it went into operations, Maryland Heights Fire Protection District (a neighboring department that also houses the area urban search and rescue equipment) offered a large tent that could function as the aid station. This proved to be a wise move as the aid station remained in operation for 7 days.
Here again, we learn a good lesson related to MCI management. Keep in mind that MCIs come in various forms. We usually think of a single event that creates a large number of patients in a short period of time. But other events, such as mass gatherings, can also create the same set of problems.
In this case, most residents in the area escaped injury when the tornado struck. However, the thinking behind this arrangement proved beneficial. As the recovery operations proceeded, literally thousands of volunteers came into the area in the days that followed. One day 2,000 worked amid the debris and rubble. This situation presented significant potential for injuries to occur.
MCIs come in various forms. Pattonville FPD’s response emphasizes that the same management strategies we use when operating at an actual incident can be applied proactively when large numbers of patients are anticipated.