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Volunteers from Altus Air Force Base and residents of Joplin, Mo., search through the rubble for survivors and personal belongings on May 28, 2011.
Courtesy of DVIDS

AAOS Now

Published 8/1/2011
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Jennie McKee

Orthopaedists respond to disaster in Joplin, Mo.

Medical community comes together after one of the deadliest U.S. tornadoes on record

Early in the evening of May 22, Jonathan L. Grantham, MD, was shooting baskets with one of his sons in the driveway of their home in Joplin, Mo. As they enjoyed the calm, spring evening, they were unaware that a ferocious tornado would soon bore straight through their town, leaving a trail of destruction more than 22 miles long.

When Joplin sounded its tornado sirens, Dr. Grantham called to his other son, who was swimming in a neighbor’s pool, and all three went inside to watch the televised weather coverage. Within seconds, the electricity went out, and they headed down to the basement.

“The basement windows face north,” he said. “We have tall trees and a large hill between us and Freeman Hospital, one of the two local hospitals, so we couldn’t see anything.”

But soon, they could hear the howling tornado.

“It wasn’t close enough to sound like the roof was going to come off the house, but it sounded like a freight train was passing about 100 yards away,” he said.

“We knew it was a tornado,” he said. “We didn’t know how big it was or where exactly it had hit.”

Soon after, they heard a radio reporter describe the destruction.

“He couldn’t recognize the buildings,” said Dr. Grantham. “The Home Depot was, in his words, ‘just gone.’ That’s when we knew this was really serious.”

“As though a 2,000-lb bomb exploded”
Dr. Grantham emerged from his home to find it almost entirely unscathed, having been protected by the nearby hill. As residual thunder and lightning from the tornado continued, he drove to nearby Freeman Hospital and learned it had sustained only minor damage. But the story was different at the other hospital in town—St. John’s Regional Medical Center—and that’s where he headed next.

“The first thing I noticed was the trees,” said Dr. Grantham, as he drew near the hospital. “Their leaves, branches, and bark had been torn off. I didn’t realize at first that the reason I could see the trees so clearly was that there were no buildings left.

“As a former member of the Navy, I can tell you that it looked as though a 2,000-lb bomb exploded about 200 feet off the ground, right next to St. John’s,” he added.

The hospital’s emergency department (ED) was dark. An inch of water covered the floor, wires hung from the ceiling, and the sliding glass doors had been blown out. Dust and debris were everywhere.

“Anything that wasn’t bolted down was knocked down,” he said. “We couldn’t get through many of the hallways because they were blocked by debris.”

Later, Dr. Grantham learned that one of his partners, James D. “Dusty” Smith III, MD, had been performing surgery when the tornado struck. According to Dr. Grantham, hospital personnel had to hold the operating room doors closed while Dr. Smith finished closing.

Minor to horrific injuries
Dr. Grantham helped evacuate patients from St. John’s to Freeman Hospital as the lightning and thunder continued. Firefighters ordered everyone to back away from the hospital because two large gas mains were venting gas and could have exploded.

“Even though St. John’s was by far in the best shape of any building in the tornado’s path, it was a complete loss,” he said. “We didn’t have enough ambulances, so we loaded patients onto the flatbeds of pickups driven by people in the community who wanted to help.”

After all the patients had been evacuated from the heavily damaged hospital, Dr. Grantham helped set up a temporary medical response area at the nearby Memorial Hall gymnasium.

“We had no way to communicate: cell phones didn’t work, and texting was spotty at best, but the wounded and physicians just showed up,” he said.

He drew from his military background to help manage the situation and triage patients.

“Making tough decisions about who gets treated first and who can’t be treated is something I practiced during my military training,” he said. “It helped me address things quickly and care for patients as rapidly as possible. Thankfully, I didn’t have to make the decision not to treat someone in this emergency.”

Injuries ranged from minor lacerations, bumps, and bruises to horrific wounds, including a man who had a two-by-four through his abdomen.

“We had sawhorses and cots and not much else—basically, we had whatever we could scrape together from the war zone that was St. John’s,” explained Dr. Grantham. “I sewed lacerations using O nylon suture thread on a Keith needle because that was all we had.”

The best moment of the night, he said, was when somebody brought him a surgical stapler. “That helped me close the lacerations faster and better.”

The mood at Memorial Hall, he said, “was much calmer than might be expected, especially given the fact that no one had ever dreamed of this scenario.”

Dr. Grantham and other medical personnel treated an estimated 250 to 300 patients that night at the temporary facility, while hundreds more were treated at Freeman Hospital and at other facilities, including at one of the locations of Dr. Grantham’s practice, Orthopaedic Specialists of the Four States, LLC, in nearby Galena, Kan.

“While I was inside taking care of the injured, average citizens on the outside were doing things they never expected to do, such as helping to bag bodies,” recalled Dr. Grantham. “But they did it because it needed to be done, and they wanted to help.”

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Volunteers from Altus Air Force Base and residents of Joplin, Mo., search through the rubble for survivors and personal belongings on May 28, 2011.
Courtesy of DVIDS
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The tornado that tore through Joplin, Mo., on May 22, 2011, hurled large objects through the air, breaking down the walls of this apartment building and anything else in its way.
Courtesy of DVIDS

Rebuilding Joplin
In the wake of the disaster, more than 150 people were confirmed dead and more than 1,000 were injured. The tornado, with winds of more than 250 miles per hour, ranks as the 8th deadliest tornado in U.S. history, according to the National Weather Service.

“It’s amazing that more people weren’t severely injured or killed, given the devastation and the number of people in the area,” said Dr. Grantham. “Right after it hit, I thought we could consider ourselves lucky if fewer than 1,000 people were killed.”

When Dr. Grantham finally left Memorial Hall that night, he found that the streets were completely blocked by the scattered remains of damaged homes.

“It took me half an hour to go four blocks, and that was on foot,” he said. “In a car, it would have been impossible.”

In the days following the tornado, Dr. Grantham was stunned by the complete devastation. Buildings had been pulverized and vehicles thrown hundreds of yards or wrapped around trees.

“Our town was cut in half, north to south,” he said. “It looked like something out of a movie. Everything was flattened for miles.”

The tornado, he said, “went through the most densely populated, busiest area of town, and left a path about three-quarters of a mile wide.”

Rebuilding efforts are now in full swing.

“In the days and weeks after the storm, the streets were cleared and the traffic lights were up and working again,” he said. “Some of the businesses are rebuilding pretty quickly, but homes are being rebuilt at a slower pace.”

He is heartened by the overwhelming response to the disaster.

“It has been amazing,” he said. “The medical community rallied, and the whole town has been remarkable. Many of my patients who lost absolutely everything talk about how blessed they are because they and their loved ones are alive. The community as a whole has responded in a wonderful way.”

Coming together to help
Members of the medical community quickly came to Joplin’s aid in the wake of the devastating tornado. One of those who volunteered was Dr. Grantham’s friend Michael Grillot, MD, an orthopaedist who specializes in hand and upper extremity surgery and lives in nearby Springfield, Mo.

After Dr. Grillot couldn’t reach Freeman Hospital by phone, he went to McCune-Brooks Regional Hospital in Carthage, Mo., to volunteer his services. He found a busy ED when he arrived.

“People were working really hard,” he said. “Patients were arriving in private vehicles as well as ambulances—sometimes with two or three patients in one ambulance.”

He quickly began caring for patients.

“I specialize in hand and upper extremity surgery, so I cared for patients with high energy foreign body injuries to those areas,” said Dr. Grillot. “One patient had cut his hand—I treated him in the hallway because no rooms were available. I also saw patients with high energy, dirty wounds with multiple tendon involvement and several with fractures.”

He praises the healthcare and emergency workers who risked their lives during the disaster.

“The biggest heroes were working out in the lightning trying to find people,” said Dr. Grillot, noting that Jefferson “Jeff” Taylor, a police officer from Riverside, Mo., died after being struck by lightning while helping victims of the tornado.

“I was no hero,” he added. “I just worked in a different hospital that day.”

Another one of many volunteers—a trauma surgeon from nearby Fort Scott, Kan., located about an hour north of Joplin—came to Dr. Grantham’s orthopaedic practice and surgery center to help care for patients.

“We had people coming in with some very serious injuries, and it was nice having somebody with his expertise there with us,” said Dr. Grantham.

“People in the surrounding communities were wonderful,” he continued, noting that ambulances, volunteers, and supplies came from places such as Springfield, Mo., and the Bentonville area of northwest Arkansas.

In addition, according to Brian Treece, executive director of the Missouri State Orthopaedic Association (MSOA), members of the MSOA from St. Louis to Kansas City offered to contribute medical supplies to Joplin.

“Physicians, dentists, nurses, and lay people all came forward to help,” said Dr. Grantham. “It was wonderful to see, and it showed me that Joplin will come back stronger than ever.”

Protecting patient data in a disaster
On May 1—just a few weeks before the tornado hit—St. John’s Regional Medical Center, part of the Sisters of Mercy Health System, began using the same electronic health record (EHR) system already in place at other Mercy locations. The EHR system contained current information as well as historical information scanned in from paper records.

Having a functioning EHR system helped the hospital begin treating patients in a 60-bed mobile hospital after the tornado struck and enabled it to forward patient information for those being treated at other Mercy hospitals.

“It’s unbelievable that all of those patients had paper charts until a few weeks before the tornado,” said Dr. Grillot. In many other medical offices and facilities in Joplin, paper records were completely destroyed.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org