In season of storms, physicians rise to occasion

Kenneth Stewart, DO, was driving back from a trip to Branson, Mo., on May 22 when he saw "the blackest, widest thing" he had ever seen -- a huge wall of dark clouds covering Joplin, Mo. Arriving safely at home, Dr. Stewart rode out the deadliest American tornado since 1947 -- a mile-wide, EF-5-rated tornado that killed 158 people.

St. John's Regional Medical Center, where he worked as an emergency physician, had taken a direct hit as the tornado left a trail of devastation through the southern part of the city of about 50,000 people. Dr. Stewart did not know yet that the 372-bed hospital was damaged beyond repair. He, like other physicians affected by the deadliest U.S. tornado season since 1953, knew only that he had to help.

"As an emergency physician, my calling is that you don't run from a disaster, you run to it," Dr. Stewart said.

But the roads quickly clogged with traffic and many streets were made impassable by flipped cars, fallen trees and downed power lines.

Dr. Stewart made it to Wildwood Baptist Church, nearly 6 miles from the hospital. There he saw people bringing injured patients in cars and pickup trucks to the church -- one of the only buildings on the block still standing.

Seeing a friend from his neighborhood who works as a youth pastor at the church, Dr. Stewart decided to set up a triage area there. Then a critical care nurse, Vickie Peterson, came on the scene and offered to help. Next came emergency medical technicians, who brought airway equipment, medications, intravenous-fluid bags and other supplies. Their convergence at the church was a kind of miracle, Dr. Stewart said.

As nightfall came, they at first worked by flashlight until backup power arrived, caring for nearly 20 patients, clearing airways and treating fractures. The first patient Dr. Stewart saw was unconscious and a piece of wood was lodged in her pelvis.

The woman's sister pleaded with Dr. Stewart: "She can't die. She can't die."

They were able to stabilize the woman. After the church parking lot was cleared for a helicopter to land, the patient was moved to another hospital for further lifesaving treatment.

Deadly season

Across the country, tornadoes killed 536 people from March through June, according to a preliminary count from the National Weather Service. That is compared with 31 tornado deaths in 2010.

There were 55 killer tornadoes during the height of the 2011 tornado season, more than four times as many as last year. April alone had a record monthly total of 875 tornadoes, more than 300 above the May 2003 record of 542, according to the weather service.

Wherever they were when destructive storms barreled through their towns this spring, physicians across America's tornado alley responded in the wake of the devastation to treat the thousands of patients who were injured, their bodies lacerated or impaled by foreign objects blown by winds of greater than 200 mph.

"We had physicians showing up who aren't even on staff, retired emergency physicians and retired surgeons who came to do what they could," said Jeremy Pepper, MD, associate director of the emergency department at DCH Regional Medical Center in Tuscaloosa, Ala.

A 1.5-mile-wide tornado that traveled 80 miles struck Tuscaloosa at 5 p.m. April 27, killing 65 people, the weather service said.

Nearly 700 patients were treated that night in the hospital's ED, and more than 1,000 patients were cared for in the hospital, running on limited backup power, in sweltering conditions. Fewer than 10 patients died after they were treated or transferred elsewhere, Dr. Pepper said.

The doctors who showed up on their own initiative "meant a ton. We could not have done it without them. There was no way to care for the volume of patients we saw that night with the 12 to 14 ER physicians we have on staff. We didn't make a single phone call. Everyone just came."

Sound of a train, effect of a bomb

Kevin Kikta, DO, huddled with a nurse under a desk at St. John's in Joplin when the tornado hit at 5:40 p.m. He heard what sounded like a train roaring through the hospital as it shook violently. Walls collapsed, pipes burst and glass shattered. It was as if a bomb went off.

"Patients were coming into the ED in droves," the emergency physician wrote in an essay published in Missouri Medicine, the Missouri State Medical Assn.'s journal. "They were limping, bleeding, crying, terrified, with debris and glass sticking out of them, just thankful to be alive."

Dr. Kikta and his colleagues also worked with no power and had only flashlights to illuminate the wounds they treated, including a child about 3 years old whose gaping wound revealed his cervical spine and upper thoracic skeletal bones. They were able to immobilize the child and start intravenous fluids and pain medication before moving him to another hospital for treatment.

St. John's "looked like buildings you used to see in the news from Beirut, with debris hanging out of the windows, every piece of glass broken, curtains fluttering in the wind," said D. Sean Smith, DO, an emergency physician at the hospital.

Hospital workers safely moved 183 patients within 90 minutes and sent them to other area hospitals. The tornado killed five patients and a hospital visitor, officials said.

Dr. Smith rushed to St. John's after the tornado only to find it destroyed. He helped at two local facilities designated as emergency triage areas, working with colleagues to attend to nearly 1,000 patients and prioritize patients for medical rescue by helicopter and ambulance.

Lingering images

With St. John's destroyed, physicians at Freeman Hospital West -- the other hospital in town, only eight-tenths of a mile from St. John's, but for the most part undamaged -- had their work cut out for them.

They treated nearly 1,000 patients the day after the tornado, seeing more than 500 patients within a six-hour period and performing 22 surgeries.

"We had 110 Freeman doctors come to the hospital," said Raymond Vetsch, MD, a cardiothoracic surgeon who huddled in the hospital's hallway away from the windows when the tornado blasted through town.

"As soon as they knew there was a devastating tornado, they made their way into the hospital, even though the electricity was out and we were on generators."

For him, one case stands out. He treated a 10-year-old girl who was in a car when the tornado hit and was impaled through the chest by an angle iron, cutting through several ribs. The people who removed her from the car had to saw off either end of the metal bar to get her out. Dr. Vetsch and his colleagues were able to surgically remove the impalement.

"She is home now," Dr. Vetsch said. "She's enjoying swimming in the lake, and recovering very nicely."

Other children were not so fortunate. The first three patients brought to DCH Regional Medical Center in Tuscaloosa after the tornado were children, dead on arrival, Dr. Pepper said.

Several patients he treated said they had no idea where their young children were -- they had been separated by fierce winds or the rubble of destroyed buildings.

There are sights that Kurtis Cox, MD, a general surgeon at Freeman Hospital West, said he will not soon forget -- such as a man with a penetrating wound whose abdomen was eviscerated.

After coming up from his basement to discover the rest of his Joplin home destroyed, Dr. Cox checked on his neighbors. The phone lines in the area were down and cell phone service was not working, but Dr. Cox did what all his colleagues did -- he headed for the hospital, where he worked until the next day.

"The awesome thing is that everybody came," Dr. Cox said of his colleagues. "They didn't come because they were called. They came because they knew that was something they needed to do."