Erlanger Health System’s response to April 27 tornadoes

Everyone knew severe weather was approaching the Tennessee Valley on the morning of Wednesday, April 27, 2011. For several days, the National Weather Service and local meteorologists had been tracking the possibility of violent storms for the area on Wednesday evening.

But, no one really knew the extent of the severity of those approaching storms—or the invaluable role that the region’s emergency medical services and Level One Trauma Center would play in the coming hours.

Morning storms

It all began shortly after 9 a.m., when storms rolled through the Chattanooga area and quickly became much more violent than expected, causing power outages and reports of widespread damages. These storms would later be categorized as tornados, ranging from EF-1 to EF-4 in severity.

Erlanger’s Corporate Preparedness Officer was immediately called to the Hamilton County Emergency Operations Center for a briefing with local authorities, local EMS, and other area hospitals. It was agreed that any severe trauma cases would be sent to Erlanger, the region’s Level One Trauma Center, while other area hospitals would receive less serious emergency cases.

Erlanger Health System immediately launched its All Hazards Emergency Operations Plan. This process included opening a Command Center for directives and communications and launching backup plans for necessary equipment issues, such as generators and phone service, in the event of power outages.

Code Black

By mid-day, it was evident that the threat of severe weather would include multiple deadly supercells with tornadoes and damaging hail that were not only threatening the region, but Erlanger itself. With five campuses throughout the region, Erlanger’s facilities and employees were increasingly in harm’s way as the day progressed.

As tornado watches turned into tornado warnings, Code Black (severe weather) warnings were issued throughout Erlanger Health System. Erlanger’s security force sprang into action, clearing out all waiting areas with windows and blocking all exits, not allowing employees, patients, or visitors, to step outside, during the hazardous weather. Security personnel were also on alert to take care of any overflow in the ED waiting room and escort any unseated family members to other areas.

The Command Center initiated alerts to Erlanger managers and key personnel via internet postings and e-mail and Blackberry messages, keeping everyone updated, minute by minute, on the severe weather. Moreover, Erlanger also issued Code Triage Standby to emergency personnel. All elective surgeries were cancelled to clear operating rooms for anticipated trauma injuries.

Supercells arrive

Closely watching the weather radar, Erlanger leadership in the Command Center could see the paths of the deadly tornadoes and realized the severe weather was encompassing the entire tri-state area of Northwest Georgia, Northeast Alabama, and Southeast Tennessee. But calling in extra hospital personnel at the time was not an option. “We had to protect our own crews and personnel,” said Roger Forgey, Chief of the Erlanger Command Center and Erlanger Senior Vice President of Acute Care and Regional Services. “We knew we couldn’t call in our people and put them in harm’s way until the storms subsided.”

During the late afternoon and early evening, multiple deadly tornadoes barreled through the region. Erlanger began to receive frantic calls for help and “mutual aid” from other facilities and EMS personnel scattered from Cleveland, Tenn., to Ft. Payne, Ala., to Trenton, Ga. “In all, nine communities in the tri-state region called on us for help,” Forgey explained. “But they weren’t calling for one ground ambulance or one air ambulance. They were saying, ‘Send me all the ambulances and aircraft that you can’ to assist in search and rescue efforts. It was a sobering situation.”

The severe weather conditions had grounded LIFE FORCE, Erlanger’s air ambulance service with four helicopters. But the LIFE FORCE emergency crews soon set out in ground ambulances to render aid and assistance. The LIFE FORCE Communications Center serves as the Regional Medical Communications Center (MedComm) for Southeast Tennessee, providing daily communications support to EMS services transporting patients within the region, and coordinating medical resources during a disaster or mass casualty incident.

Since the MedComm Center is housed in a metal building adjacent to the LIFE FORCE helipad at Erlanger’s downtown campus – a structure vulnerable to deadly winds – Erlanger operates a backup mobile communications unit in an emergency vehicle. After a tornado swept through Trenton, Ga., at 6 p.m., Dade County requested help from area EMS agencies. Within 15 minutes, Erlanger had dispatched its mobile unit to Trenton, Ga., so LIFE FORCE crews could assist in search and rescue. But as soon as the team arrived, they were immediately sent to City Hall to take cover for another approaching storm. Once the storm passed, they assisted Dade County authorities in searching a remote area for an injured pediatric patient. The mobile emergency communications unit remained in Trenton for three days, providing communications assistance as crews struggled to render aid in the absence of electrical power.

By 10 p.m., the weather had cleared enough for LIFE FORCE to fly missions. Two helicopters were dispatched for pediatric patients in DeKalb County, Ala., and Apison, Tenn.

Emergency Treatment

Throughout the evening, Erlanger’s Level One Trauma Center received a steady inflow of patients. Though Erlanger expected an overflow of mass casualties, arrivals were slow due to the challenges of locating, accessing, extricating and transporting patients who were trapped in their homes or whose roads were blocked due to fallen trees and storm debris. Moreover, many ambulances arrived with five or six patients with varying degrees of injuries. “Four or five of those may have been walking wounded, with one or two trauma cases from a group,” Forgey said. The reality of the situation meant the Level One Trauma Center treated all types of casualties and not only trauma cases, as previously planned.

Many of the trauma cases, however, required immediate attention. One trauma surgeon on duty reported that he performed about 30 emergency procedures throughout the night at Erlanger, with cases ranging from impalements to broken bones. The Command Center remained open until 8 a.m. the next morning.

By 2 p.m. on Thursday, April 28, the Erlanger Health System had treated 169 adults and children for weather-related injuries at our five area Emergency Departments. Of these 169, 94 were treated at our Level One Trauma Center located on the main Baroness Campus; 20 at Erlanger Bledsoe; 6 at Erlanger North; 19 at Children’s Hospital; and approximately 30 at Erlanger at Hutcheson in North Georgia.

Aftermath

Tragically, one pediatric patient with storm-related injuries died at Children’s Hospital. Every adult patient admitted to Erlanger survived their injuries.

Four weeks after the storms, Erlanger reported to local media that two adults were being treated for storm-related injuries in the surgical intensive care unit and one child remained in the pediatric intensive care unit. As of May 26, 2011, no storm-related cases are being treated in any of Erlanger’s nine intensive care units.

Although one of Erlanger’s physician office buildings in Ooltewah, Tenn., received minor roof damage from the storms, Erlanger did not encounter any major structural damage to its five campuses located throughout the region.