An exceptionally large and violent tornado outbreak occurred from April 25 to 28, 2011. The National Weather Service has estimated there were approximately 335 tornadoes in at least twenty states. The outbreak affected many regions of the United States leaving catastrophic damage behind, especially across the state of Alabama. Significantly strong storms occurred each day; however, April 27th was the most destructive tornado day of that week, and ultimately, in U.S. history. Numerous EF 4 tornadoes were recorded in Alabama, and two Alabama storms were confirmed to be EF5. The exact number of people killed and injured may never be known, however, the best estimate of deaths directly related to the tornadoes in Alabama is 250. The number injured could easily exceed 2,000. The Tuscaloosa and Birmingham areas, two of the largest metropolitan areas impacted, were hit by the same tornado. It was first thought this tornado may have been on the ground for 150 miles or more. The National Weather Service has now determined that the tornado was on the ground for about 80 miles, with a width of almost 1.5 miles at one point, and winds of around 190 mph. This storm has been rated and EF 4. To put things into perspective, this was not the worst tornado to hit Alabama that day.
The impact on the healthcare system of Alabama was significant. It is estimated that over half of the state's 120 hospitals received, treated and/or admitted patients injured from the tornados. Tuscaloosa and Birmingham alone estimate the number injured could be 1,500. In some hospitals, over a six to eight hour period, emergency rooms received up to 5 times the normal number of patients usually seen over a 24-hour period. Because of the strength of the storms, serious trauma was seen by everyone. Some hospitals had the capability to better manage these patients than others. The severity of the trauma has been compared to blast and explosive injuries, or high speed car crashes. Hospitals in rural communities impacted by the storms are much smaller facilities than those of the large metropolitan areas. The mass casualty response experience was remarkably different based on the size of the facility and the location – primarily rural versus urban. However, it is safe to say the care provided in Alabama that day was nothing short of incredible. In light of the multiple communities impacted, the varying degrees of response, the resultant catastrophic destruction and loss of life, and the thousands of injuries that occurred, The National Center for Disaster Medical Response (NCDMR), within the Center for Strategic Health Innovation (CSHI), University of South Alabama, along with The Center for Emergency Preparedness (CEP), Alabama Department of Public Health, and The Alabama Hospital Association (ALAHA) hosted a series of regional Hospital After-Action Reviews. We heard countless numbers of accounts of tremendous efforts by Alabama health care professionals. We have captured these stories and are in the process of dissecting, evaluating and incorporating them into a meaningful collection of best practices. Five regions of the state impacted by the storms were identified. Senior administrative level staff from each hospital was invited. In total, approximately 75 hospitals were represented and over 175 individuals attended. The approach utilized a detailed list of questions to be discussed by the groups of individuals and facility staff who either played a role in, or were impacted by the disaster. It was important we conducted these as soon as possible so memories were fresh, and time did not alter the recollection of the events.
The after action sessions were six to eight hours long. NCDMR facilitated the discussion, kept comments focused on the topics, and captured all of the information that was shared. Each region seemed to experienced the storms differently – medical capability, resource management, communications, emotionally, etc. The discussions were broken down into six categories: 1) Weather Awareness, 2) Disaster Plan Effectiveness, 3) Personnel Management, 4) Supply Management, 5) Healthcare Capability, and 6) Communications. Within these broad categories, we specifically believe the following are essential components of a successful response: a) Ability to evaluate and care for an increased volume of patients that challenges or exceeds normal operating capacity, b) Ability to manage patients requiring unusual or specialized medical evaluation and care, c) Usual scopes of practice may not apply, d) External events will impact internal response, e) Internal and external communication will be challenged, f) Staff challenges will create the need for flexibility during and after the event, g) Supplies and supply chain disruption will occur, h) Transportation and Fuel may be problematic, i) Security and safety is critical, j) Do we know our communities health, k) Can we communicate with public responders and disaster leadership, and l) Do we know where help comes from. Our goal is to uncover those events and activities that were productive, evaluate the reasons for the successes, and incorporate those concepts into an advanced level of preparedness training. Additionally, we believe we uncovered events and activities that were not helpful, and will develop advanced training methods to instruct facilities to avoid such counter-productive response activities. NCDMR is currently producing a report for all participants, as well as any appropriate agency and/or stakeholder in the state of Alabama.
The National Center for Disaster Medical Response, a world class medical response simulation center, provides training, planning and response support to the healthcare facilities in Alabama. The Advanced Regional Response Training Center (ARRTC) has trained over 8,000 healthcare professionals since 2004. NCDMR is developing a new slow-crisis recognition tool kit for disaster planners and also supports the Alabama Incident Management System (AIMS), a situational awareness software tool for tracking and managing healthcare resources within Alabama.