CEO Summary: One week after one of the worst storms ever to strike a hospital in the U.S., St. John’s Regional Medical Center in Joplin, Missouri, was back treating patients. Surprisingly, the hospital’s lab was one of the first departments to get up and running again. Within hours of the storm, the lab staff was doing point-of-care testing in an emergency triage center. By the next morning, lab equipment vendors had begun sending lab equipment so that the lab was able to operate as a high-complexity facility within about two weeks without making many changes to its test menu.
IN 45 SECONDS IT WAS OVER. One of the worst tornados in U.S. history tore through Joplin, Missouri, on May 22 and St. John’s Regional Medical Center took a direct hit. In less than a minute, the hospital went from a normal Sunday evening shift to total chaos as the category EF5 tornado hit Joplin and the surrounding area with winds exceeding 200 miles per hour.
Caught in this disaster were the seven staff members on duty in the clinical lab at St. John’s, which is part of the Mercy Health System. “But this lab team knew precisely what to do,” stated Connie Wilkins, MSHA, MT(ASCP), Administrative Director Laboratory Services at St. John’s. “Our lab drills at least once a year for this type of emergency.”
Damage from the tornado was immediate and immense. It broke nearly every window in the hospital building, knocked out power, damaged the backup generator, and broke water pipes. The tornado sucked mattresses, chairs, curtains, and other debris out the windows. The building was later condemned amid unconfirmed reports that it had been knocked off its foundation.
Alert Issued Ahead of Tornado
“A code gray alert in advance of the tornado directed everyone to move to a safe place away from the windows and wait it out,” stated Wilkins. “Unhurt, the hospital lab staff moved quickly to help evacuate the 183 patients and did so in 90 minutes.”
This natural disaster is a reminder to all laboratory administrators and pathologists that attention must be given to reviewing and updating emergency plans. Regular drills for the laboratory staff are essential to prepare the laboratory to cope with emergencies and still be able to serve physicians with accurate and timely laboratory testing services.
Such emergency preparation made the difference for the laboratory team at St. John’s Regional Medical Center. With little advance warning, and in just a few minutes, their 367-bed, nine-story hospital facility suffered extensive damage and it became impossible to use the building for patient care. However, the laboratory team reacted with effective responses to this natural disaster.
“Since the storm, the hospital and our laboratory have worked steadily to restore a full laboratory testing service, with the complication that we are caring for our patients in a mobile hospital set up in our parking lot,” noted Wilkins.
In Joplin, devastation from the tornado was widespread. More than 150 people died. It was reported that among the dead were four patients and a visitor at St. John’s Medical Center. However, support from the community and vendors is helping both the hospital and its clinical lab restore clinical testing services.
In an interview with THE DARK REPORT, Wilkins said, “The lab staff had to execute a condition gray. That sent them to designated areas where they rode out the storm. As the storm hit, the power immediately went out.
“After the storm passed, the lab team determined that they were okay,” she continued. “They went to help evacuate patients. As well, some off-duty members of our lab staff managed to get to the hospital. They also assisted in moving the patients. All 183 patients were evacuated from the damaged hospital building in 90 minutes!
Patients Were Transferred
“The most critical patients went across the street to Freeman Hospital,” she noted. “Other patients were taken to Memorial Hall, a civic center here in Joplin where we did the initial triage. A local Catholic school was also used for triage and to handle arriving patients.
“From these initial locations, patients were then transferred to other hospitals, such as St. John’s Mercy Hospital in Springfield,” Wilkins stated. “Patients were also transferred to St. Louis and other cities.
“With the power out and the emergency generators damaged, we were unable to perform testing in our hospital laboratory,” continued Wilkins. “However, the lab staff immediately secured a significant capability to perform point-of- care (POC) testing.
“This allowed us to provide testing for patients at Memorial Hall,” she added. “Our POC test menu included chemistries, H&H [hemoglobin and hematocrit], several types of kit tests, and selected POC cardiac tests. If physicians needed more complex testing, arrangements were in place to send those tests to another lab.
“The point-of-care tests allowed us to offer moderate complexity testing,” she said. “We did that for about a week at Memorial Hall and then the field hospital opened the following Sunday (May 29), exactly one week after the storm hit.
“Right now, we operate a laboratory in this field hospital,” commented Wilkins. “It is not yet a full, high-complexity lab. But, we are working toward that goal.
“Right now, we operate a laboratory in this field hospital,” noted Wilkins. “It is not yet a full, high-complexity lab. But, we are working toward that goal.”
“We now have a hematology analyzer up and running,” stated Wilkins. “Freeman Hospital, across the street, supplies us with the blood products we need. Any testing we cannot do here at the hospital we can send out to other Mercy hospitals. With these arrangements, we are currently able to provide our patients with all the testing that’s required.
“Remarkably, of our entire lab staff of about 80 FTEs, all have been able to work, despite the fact that some lost their homes,” she continued. “They either work here or we arranged for some staff to work in the labs of the other Mercy hospitals because of the increased workload going to their labs.
“At the field hospital laboratory, we currently staff each of the three daily shifts with about six people,” stated Wilkins. “Our laboratory is open 24 hours every day, seven days a week. We also have some lab staff at Memorial Hall, where some patients continue to get care. In a normal routine, our lab would staff about 27 people for an eight-hour day shift.
“The entire 60-bed field hospital is about 5,500 square feet and we have 20 emergency department beds,” she explained. “Our laboratory is located right in the middle of the emergency department (ED) because that’s our busiest area. Specimens collected are processed onsite.
Referring Tests to Labs
“For any lab test that we cannot perform in our field hospital laboratory, we have arrangements that allow us to refer that test to another facility,” noted Wilkins. “All of this testing is performed by laboratories located within Joplin. Currently we are referring esoteric tests and non-urgent tests to our sister hospital in Springfield.”
As was true following the natural disasters of the multiple hurricanes in Florida in 2004, and Hurricane Katrina in Louisiana in 2005, Wilkins’ laboratory received immediate and substantial support from key suppliers. “The reason our laboratory can function at this high level of service is because our vendors stepped up with incredible support,” praised Wilkins.
“Our lab’s two biggest vendors are Sysmex America and Beckman Coulter Corporation,” she added. “Sysmex delivered a hematology analyzer here before I even had a place to put it! This analyzer was in place before we opened our field hospital.
“I also asked Beckman Coulter if there was a way to put a chemistry and immunoassay analyzer in a van for me,” noted Wilkins. “They made it happen by Saturday, June 4.
“The Sysmex hematology analyzer arrived just days after the storm and Diagnostica Stago sent a coagulation system,” commented Wilkins. “These lab testing instruments gave our laboratory a relatively complete test menu for hematology and coagulation testing.
“By the following week, we had serology testing and urinalysis,” continued Wilkins. “This means, that, since the tornado, our laboratory’s test menu has not changed much, except for microbiology. Once I secure a site for microbiology we will put that in place.”
Immediate help also came from other hospital labs in the Mercy Health System. In nearby Springfield, Missouri, the lab team at St. John’s Mercy Hospital sprang into action. “When the tornado had passed, we mobilized our blood bank and called people in because we knew we would be called on to assist,” stated Edwina L. Cook, MS, MT, SM(ASCP), Director, Laboratory Services, at St. John’s Mercy Hospital in Springfield, Missouri. “These steps were taken as part of our clinical laboratory’s disaster planning preparations.
“We notified our blood supplier about the emergency,” said Cook. “Our laboratory immediately sent point-of-care testing units and supplies to Joplin. This included iStat instruments and glucometers.
“We also sent them supplies that were already prepared and had been quality controlled,” she added. “Our laboratory sent controls and we sent procedures because, although that lab might have had the same device, it may not have been running the same tests as we do in this lab.”
Lab Testing Capabilities
All this support helped the laboratory at St. John’s Medical Center regain much of its testing capabilities. “By Monday, June 6, our laboratory had regained almost all of the capabilities that we had before the storm,” stated Wilkins. “With the exception of our microbiology department, we have a full-functioning high-complexity laboratory.
“Our various vendors have been very gracious to send lab test equipment in as fast as they can get it here and so our rebuilding has been a work in progress,” praised Wilkins. “We have equipment arriving from everywhere and we are validating, calibrating, and doing our correlations. This lab is going forward.”
The response to this devastating tornado, by the laboratory teams at St. John’s Regional Medical Center in Joplin, and other hospital labs in the region, demonstrate the value of good disaster planning. Both Wilkins and Cook agree that people are ready to respond following a natural disaster or similar crisis. What allows them to do so in a timely effective manner is a well-designed disaster plan, combined with regular drills and similar training.
When asked about the lessons learned from the response to the Joplin tornado, Wilkins said that there was not much she would do differently. Her message was that good preparation is the primary lesson. However, she did want to emphasize a couple of important insights.
“For our laboratory here at St. John’s Medical Center in Joplin, there are two key points from disaster planning that made the biggest difference,” Wilkins commented. “First, know the other laboratory testing resources in your community because, in a worst-case scenario, you may have to re-direct lab work if your laboratory is not functional.
“Keep in mind that this re-direction of lab test work may include another element,” she explained. “It is equally necessary to have a plan to train your staff to help with the increased workload in other laboratories.
Disaster Recall List
“Second, for all the staff in your laboratory, maintain an up-to-date disaster recall list,” recommended Wilkins. “Communication is critical after a disaster. Following this destructive tornado, we needed to send our lab staff to many different locations. Our disaster recall list allowed us to stay in touch with all of our staff.
“When I look back, there is nothing signicant that I think our laboratory would do differently,” she concluded. “Further, I especially believe St. John’s in Joplin is a place of grace and I am honored to work with this amazing team of healthcare providers and laboratory professionals.” THE DARK REPORT observes that the Joplin tornado and the damage it did to hospitals and the community is a reminder that clinical laboratories in every region should re-visit and update their disaster plans. Such preparation makes the difference in coping with the unexpected.
Lab Equipment Vendors Moved Quickly to Support St. John’s Medical Center Laboratory
IT TOOK JUST 24 HOURS AFTER THE TORNADO struck Joplin, Missouri, for Sysmex America, Inc., to deliver a new hematology instrument to the temporary laboratory facility at St. John’s Medical Center.
“Upon hearing of the disaster, our account manager Tim Dillon secured a hematology analyzer from Sysmex America’s demo equipment storage site and personally drove it to St. John’s in Joplin,” stated Ron Walczak, Director, Market Research & Communications for Sysmex America. “In Joplin, Tim met Ken Danowski, Sysmex’s field service representative, who assisted with the installation and calibration.
“St. John’s laboratory was equipped with the Sysmex XE-Alpha and used an XE2100 as a backup,” noted Walczak. “This equipment was destroyed as a result of water damage from the tornado. We replaced these instruments with a Sysmex XT-2000i automated hematology analyzer. We also immediately shipped reagents and other consumables to replenish the laboratory and help ensure its full operation.”
Team Sent to Joplin
“Along with the testing instruments, Sysmex sent a team to install, implement, and perform correlation studies to ensure the automated hematology analyzer was operating appropriately and reporting results,” he added. “Our employees—from senior managers and technical service representatives to our customer service department—quickly engaged once they realized the acute needs of St. John’s. We are happy to have supported St. John’s return to community service.”
Mary Luthy, a spokesperson for Beckman Coulter, Inc., said the company had a demonstration van configured for chemistry and immunoassay testing that was sent to St. John’s Medical Center. To help the laboratory restore its testing services, Terry Elder, Beckman Coulter’s regional sales manager for the Joplin area, was working closely to ensure that the lab equipment operated properly.
“Everyone at Diagnostica Stago, Inc., worked quickly to help out,” explained Robert Bachkosky, Director of Marketing for Diagnostica Stago. “We immediately shipped a STA-Compact analyzer from our facility in New Jersey to help the laboratory at St. John’s restore its coagulation testing.
The St. John’s laboratory even got help from an unlikely source—the shipping company that delivered the Stago instrument! “When we learned the equipment was to replace a damaged machine at the hospital lab in Joplin, we waived the shipping charges,” recalled Jeff Rossier of Trade Show Technologies in West Caldwell, New Jersey.
“It requires a specialized carrier to transport diagnostic equipment,” noted Rossier. “Anything our company could do to help the people in Joplin is well worth it. The news pictures of the destruction from the tornado are heart-rending.”
Lesson Learned from the Joplin Tornado: Keep Electronic Patient Records Offsite
ONE LESSON LEARNED from the Joplin tornado involves the importance of storing electronic patient records in a protected site. Because its patient records were stored at another location, St. John’s Regional Medical Center in Joplin, Missouri, was able to access the complete medical record for every patient evacuated the night of the storm.
“Our hospitals have the Epic electronic medical record (EMR) system, and Joplin went live on May 1, just three weeks before the storm,” said Edwina Cook, MS, MT, SM(ASCP) Director of Laboratory Services of St. John’s Mercy Hospital in nearby Springfield, Missouri. “Within minutes of the tornado hitting Joplin, our command center here in Springfield became operational.
Health System’s EMR
“Because we are all one Mercy system, the Epic EMR is being rolled out to all Mercy facilities,” Cook added. “Mercy has 30-plus hospitals and more than 200 physician offices across four states. Eventually all these hospitals will be connected to the Epic system.
“At this time, our hospital and clinics here in Springfield and its surrounding region are all on this common EMR system,” she stated. “There are Mercy hospitals in the St. Louis area, Arkansas, Kansas, and others that are also already on our EMR system.
“Therefore, for a patient in one facility, it is possible for physicians and those who need to know in other facilities within the Mercy system to access that patient’s records from other facilities,” observed Cook. “This connectivity comes through a computer facility in St. Charles, Missouri, that is rated to withstand earthquakes and major tornados.
“Because of this integration of the EMR system, our command center here in Springfield could pull the patient roster from the Joplin hospital in a matter of minutes,” she explained. “It was immediately known that there were 183 patients in that facility.
Viewing the Patient’s EMR
“As patients of St. John’s Regional Medical Center in Joplin were transferred to other Mercy hospitals, we could view those patients’ electronic medical records with a few keystrokes,” continued Cook. “For patients sent to facilities outside the Mercy family, the command center in Springfield printed the medical records and faxed them to those facilities.
“Following the tornado, patients from St. John’s Regional Medical Center were sent to Freeman Hospital in Joplin, and hospitals in Springfield, Arkansas, Oklahoma, and Kansas,” she noted. “For each of these patients, fast access to their EMR was invaluable.
“This was important,” stated Cook. “Wherever those patients went—whether it was to Tulsa, Fayetteville, Freeman Hospital, or here in Springfield—physicians had each patient’s medical reports and could treat them appropriately.
“This demonstrates the value of having an EMR system at one hospital, and keeping back-up records in another hospital,” Cook explained.