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First Response Mode
    A 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
StormDoctor.com
  904-343-4325

   Free Service
   Confidential

 Always Available

In-Season Available
     in the Field
Storm Chasing




Storm Chasing
Updraft
Clear Slot
                                                         Rain-Wrapped Wall Cloud
                                                                                          Vault
    RFD


                        Condensation Funnel




                                                 Horizontal Swirl

             Debris Cloud




                                                                                    FFD
Inflow Jet
                                                                         Cow
                                        “Suck Zone”
              Tornado

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




  Sometimes It’s Hard To Know
Emergency Preparedness Parts 1 & 2 -  Joplin - Persoff
Emergency Preparedness Parts 1 & 2 -  Joplin - Persoff
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.”
Emergency Preparedness Parts 1 & 2 -  Joplin - Persoff
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 Command
                     Assess Impact
                     ONE PERSON
                   ONE 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       • Trauma Bag
    –   Gloves (box)           – Emergency Medical
    –   Gowns                     Products
    –   Face masks             http://www.buyemp.com/
    –   Sharps              • Communications
•   Utility Gloves             – Amateur radio
•   Ropes                   • Waterproof Paper /
•   Axe                       Marking Pens
•   Blankets                • FOOD, MEDICATIONS,
                              and WATER for you for
•   Spray Paint               2+ days
•   Torches / Flares        • Bug Spray
•   Rescue Knife            • 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
Emergency Preparedness Parts 1 & 2 -  Joplin - Persoff

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Emergency Preparedness Parts 1 & 2 - Joplin - Persoff

  • 1. First Response Mode A 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
  • 3. StormDoctor.com 904-343-4325 Free Service Confidential Always Available In-Season Available in the Field
  • 5. Updraft Clear Slot Rain-Wrapped Wall Cloud Vault RFD Condensation Funnel Horizontal Swirl Debris Cloud FFD Inflow Jet Cow “Suck Zone” Tornado Near Republic Cty, KS, 5/24/04. Photo by Jason Persoff, M.D. Sometimes It’s Hard To Know
  • 8. 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
  • 9. 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.”
  • 11. 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
  • 12. May 22, 2011 May 22, 2011 • The tornado intensifies, bearing down on St. Johns Hospital
  • 13. May 22, 2011 May 22, 2011
  • 14. 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
  • 15. St. Johns Hospital Photos copyright Google and Michael Schiefenbaum St. Johns Hospital
  • 16. 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
  • 17. 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
  • 18. 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?
  • 19. 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?
  • 20. 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 Command Assess Impact ONE PERSON ONE SUPERVISOR Triage Area Surveyor (Team) Responder (Team)
  • 21. 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
  • 22. Recommended Equipment • Personal Protection • Trauma Bag – Gloves (box) – Emergency Medical – Gowns Products – Face masks http://www.buyemp.com/ – Sharps • Communications • Utility Gloves – Amateur radio • Ropes • Waterproof Paper / • Axe Marking Pens • Blankets • FOOD, MEDICATIONS, and WATER for you for • Spray Paint 2+ days • Torches / Flares • Bug Spray • Rescue Knife • 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
  • 23. 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