[Tone] [The U.S. Department of Health, Education, and Welfare Public Health Service presents M-1510, MCMLXVII] [Background music] [A National Medical Audiovisual Center Production] [Narrator:] This is looking south on Branch Road about 10:29 AM. You can see the funnel touching down on the outskirts of town. Here's the monster still moving northeast about 10:31, just two minutes later. That's one of our ambulances, on its way to pick up casualties. This is looking west on Fourth Street about 10:42. There are people under that funnel. [Background music] This is one of the emergency vehicles. They're following the path of destruction and trying to keep track of the funnel's direction. [Sirens] There's Simmons Chemical. Here we had most of our casualties. By 11 o'clock the list was taken. We had four fire companies here, and our rescue units. The men in white suits are civil defense rescue teams. We had every available fire company here. That's the mayor. He's making a quick survey of damage to the city. He's trying to determine whether or not to ask the governor to declare the area a disaster area so we can get more help. You see women trying to find out if their husbands are among the dead. We were lucky to have the facilities of a snorkel to get into the smoldering embers and make sure the fire was dead out. This is the explosion area, where wind knocked over a tank, and it blew up, adding that much more havoc to that caused by the funnel. Some of the casualties needed immediate care at the explosion site. You see rescue workers trying to get people out from under that debris. Despite the quick response of firefighters and rescue teams, we needed help, and we were lucky that so many plant workers kept their heads, stayed and helped with the rescue work. Here again women trying to get to the entrance. There were many killed. It was a sorrowful time for those who arrived at the scene and found that a member of their family had been a victim of the disaster. We didn't know how many more casualties would be under the debris. In another part of the plant which had sustained only wind damage, we set up a first-aid station where ambulances and other vehicles could get to the causalties, get in, and get them out to a hospital if necessary. Spectators and relatives trying to get to and find their loved ones caused a continuing traffic problem and there was no getting them out of the way. There's Dr. Ryan. He was everywhere attending to the injured. Wherever we went the ever-present problem of spectators trying to find family. We were making use of any vehicle we could get our hands on; even private automobiles. The injured, the dead, the rescuers. The frantic effort to retrieve life, to preserve it. We respond almost by instinct, with total maximum effort. There's no holding back. In an emergency like this you give everything you've got. It's the price you pay. [Background music] Memorial Hospital, the city's largest. At 11:15 this Thursday morning, the staff is attempting to provide a quality standard of care for all casualties, and their hospital is damaged, without city light or power. [Sirens] [Voice on public address system:] Mr. Barnes, please report to the emergency room, Mr. Barnes. [Sirens, shouting, more words from PA system] [Narrator:] Richard Barnes, administrator at Memorial. He has to be everywhere at once this morning as his hospital strains to meet this emergency. [Man walking with Mr. Barnes:] What about this power problem? [Richard Barnes:] They promise to turn us on in a couple of minutes. The generator is working but it's only emergency lighting. [Man walking with Barnes:] The elevators are still out? [Richard Barnes:] Right. [Doctor:] Oh hi, Dick, I had them page you. You know anything yet on how many we can expect? [Richard Barnes:] We haven't been able to reach the plant. We're getting a lot of casualties from other parts of town. [Male:] Mr. Burns, should we use the emergency ambulances to send discharged patients home? [Richard Burns:] No, I want those units kept right here until we're sure all the casualties are in. Now tell the people in the lobby to telephone home or telephone a cab, and get them out of here as fast as you can. [Male:] Yes, sir. [Doctor:] We have five injured right here in the hospital cut by glass breakage. [Richard Barnes:] With this patient load, how many beds are we going to need? [Doctor:] Well, let's see. We had three DOAs and one expired here. I'd say probably, oh, let's say at least 25 more anyway. We've got some pretty bad burn cases from the chemical plant. They must have had a pretty hard time up there. [Patient lying on gurney:] One of the tanks was damaged and it blew up. I was just going outside. [Doctor:] What was in the tank? [Narrator:] Richard Barnes can't stay to find out. With casualties arriving from all over the city, he has to keep moving to stay on top of a fast-changing situation. Where should the ambulances be sent? How many more patients will need care? Will the supplies hold out? Without communication, he can only guess. [Man on phone:] We're still having problems getting through. Oh, the police called. There are more casualties on the way. [Richard Barnes:] Where do we stand on staff? [Woman seated at table:] All available interns and residents are on duty and most of the off-duty nurses have come in. [Male on phone:] We did talk to Garden Hospital. They've got all they can handle over there too. [Richard Barnes:] This is Thursday. Let's plan to discuss this communications problem and these other difficulties at the staff meeting on Monday. [Man on phone:] Wait. I'm getting through. It's the plant. Hello? Hello, this is Memorial Hospital calling. Let me talk to--hello? This is urgent. Yes, yes, I know that, but... They hung up on us. [Richard Barnes:] Keep trying. [Mayor:] Well, it's serious enough to warrant evacuation. [Dr. Hickman:] If they don't close off the valves, I'll recommend we evacuate the whole east side of town. [Firefighter:] We should know something in five minutes. [Narrator:] This is Dr. James Hickman, the city's public health officer. He has expert knowledge of the medical implications of this disaster. He will have a crucial role in averting further casualties. At the improvised aid station, the casualties continue to arrive from the explosion site. They are cared for and given transportation to Memorial Hospital by ambulances, private automobiles, and station wagons. [Background activity, horns, and sounds] Tom Ryan is a plastic surgeon, but this morning he's very much in general practice. He must care for the injured with limited professional assistance. Relatives of the plant workers and others pitch in and help. Fortunately, Dr. Ryan's experience on the Medical Society's Disaster Committee has prepared him for some of the difficulties he's meeting. [Ambulance Driver:] Hey, doc, Memorial is not my hospital. [Dr. Tom Ryan:] These patients have got to go to Memorial. Now you know the way, don't you? [Ambulance driver:] Yes. [Dr. Tom Ryan:] Give this envelope to the admitting physician and write this down. Tell him you'll be sending Memorial at least eight more bad burns, eight, and four serious traumas. Okay? Go ahead. [Sirens, talking, PA system sounds] [Narrator:] Monday morning just after 10:00, workmen were busy replacing glass in the main lobby of Memorial Hospital. At the same time, the regular Monday meeting of the hospital staff. [Richard Barnes:] This office commends the medical family of the city. We are most pleased with the outstanding performance by the staff of Memorial Hospital in meeting this emergency. Once again, Memorial has rendered valuable service to this community. With regard to any suggestions you may have for improvement of emergency health services, Dr. Hickman has assured me he will be happy to discuss this with you. With sincere appreciation, Ralph W. Lewis, Mayor. The mayor seems to think we're pretty good, and I agree, of course. I know that we were lucky. [African-American man:] That's true. If the tornado had turned north, it would have gone right through town. [Richard Barnes:] I mean, we were lucky. Now, we're devoting this meeting to disaster readiness, to find out what you think of our performance last week. Not just this hospital, but the whole medical response. Frankly, if things had been any worse, I'm afraid we would have been in deep trouble. [Male meeting participant wearing glasses:] Now, Dick, you're going to have to clarify that. You know as well as we all know that every casualty that came in here received the best possible attention. There's no question about that. [Doctor:] The treatment was excellent. Whether the patients were handled in terms of immediate needs is another matter. We could have done better. Let me finish. We ought to establish sorting: triage from the moment the first casualty is admitted. [Man with glasses:] We didn't need sorting; we weren't dealing in mass casualties. [Richard Barnes:] Weren't we? We had no way of knowing. For a good 40 minutes, we couldn't estimate how many more casualties were going to come in. We admitted 42 in all, plus five injured here. It could have been 82, 100 or even 200. [Man with glasses:] Why didn't we know? Didn't we have communication with the disaster areas? I mean the plant, the Fourth Street school, and the downtown area for that matter. [Dr. Tom Ryan:] I'd like to answer that. As disaster committee chairman, I was at one site or the other all the time. I couldn't get through to Memorial until after the last casualties had been put aboard ambulances. [Nurse:] Dr. Ryan, was the police two-way radio made available to you? [Dr. Tom Ryan:] I found the police very cooperative. The problem was to find a squad car near our aid area that wasn't being used. [Narrator:] You started something, Mr. Barnes. You know your staff; they're still close enough to the shock and confusion of last week to be just a little scared at what might have happened. If the tornado had turned north, or if it came at night with no light, no power. [African-American man:] As recently as three months ago, I remember we decided we couldn't afford any more generating equipment. [Richard Barnes:] That's true. Today I'm sure we decide differently, and chalk it up to the high cost of survival. I'm sure there are a great many things that can be done in this hospital to ensure a better state of readiness, and evidently we've got a long way to go in coordinating the whole medical effort. But where do we begin? Where do we go from here? [Narrator:] The price of survival. Mankind has paid it over and over. For the sake of life we pay it willingly. We gather our injured and bind their wounds. We bury our dead. We rebuild. And next time we think we will know better how to cope with disaster. So destructive. So viciously unpredictable. Next time. Sometimes because we haven't planned for disaster, the price we pay is far greater than it has to be. So much bravery deserves preparedness. But in the face of disaster, ready or not, we pay the price, if we can. [Mr. Barnes:] In the chronicles of disaster, our city's experience was a minor entry, but it was enough to make us realize that special effort must be devoted to emergency services. Next time it might not be so easy to pick up the pieces. Looking at the problem citywide, the mayor and council were just as concerned as we were at the hospital. Right after the tornado we got two new bulldozers to speed clearance of debris. At the same time, a new director for civil defense came on duty. A trained full-time administrator. With energetic leadership, the Fallout Shelter Program, including the marking and stocking of supplies that we had started a couple of years back was finally pushed to completion. The city began to accumulate additional stocks of emergency food supplies against natural disasters. At first glance, the list of emergency services seemed almost too elaborate. But even for a city the size of ours, everyone was essential. And that's how we three found ourselves knee-deep in disaster planning, with a mandate from the mayor to get emergency health services organized. I was tapped along with Tom Ryan, who was chairman of the Medical Society's Disaster Committee. Jim Hickman, our public health officer, has an expert knowledge of preventive medicine and he works continuously with different city departments. We soon began to realize that no one had ever tackled this problem before. We could study existing plans but there was no ready-made formula to meet the specific needs of our community. The disaster hazards we were subject to, the facilities and resources we could marshal. Some work had been done. Each of the three hospitals in the area had a disaster plan, but none of us had ever considered gearing our plan to the other two. We had a long way to go before we could call it a community plan. So we started with simple, basic questions... so simple no one had ever asked them before. Where stretchers interchangeable between ambulances? And what about the emergency equipment on our vehicles? One point in our favor: many other people were just as concerned as we were about the problem. At first, wherever we went, surveying our vulnerability to disaster or examining medical facilities, we had good cooperation. Then as memory of the tornado began to fade, with it went some of the eagerness. People would talk to us, if it wouldn't take too much time or cost any money. In the field of medicine and health, working with other physicians and hospital people, we got a great deal accomplished quickly. We were dealing with colleagues, people we knew, in terms of specialized needs we both understood. We soon drew the local nurses association into active support. With the assistance of the Medical Society, we soon had a record of every physician residing in the area, and we set up a running inventory of the available medical supplies, including biologicals and pharmaceuticals. This included the stocks in drug and surgical supply houses. We found the state health department and the Red Cross were useful sources of information and assistance. [Instructor at head of classroom:] It's very easy to construct, and Chester, would you and Larry come up and help us demonstrate this method? The fundamentals are, again, very easy to perform but they are... [Narrator:] The students in this medical self-help course are maintenance, kitchen help, office workers, the ancillary staff of the hospital. [Instructor:] All right, Carolyn, if you would come up and help us demonstrate this. Do not be afraid that the folded blanket will fall, because the weight of the injured person will hold it firmly in place. All right. Good. Larry, if you and Chester will pick her up now and transport her to the back of the room, just like you would transport an injured person. [Narrator:] With this basic training they can function as aides in time of disaster. [Instructor:] That's very good. Carolyn, you look like you've been hit. [Narrator:] We even managed to get a Packaged Disaster Hospital located in our area. [Packaged disaster hospital representative:] Complete operating room suites by the way, in each PDH. Each hospital is packaged in some 660 cases such as this, and they are prepositioned in every state throughout the country. [Narrator:] A complete 200-bed hospital, in about 650 crates. With it came a training course for physicians, nurses and other hospital personnel. [Dr. Hickman:] Our disaster casualty potential far exceeds the normal bed capacity of... [Mr. Barnes:] In about six weeks, we had started on a number of different activities. We had accumulated a lot of data and we were beginning to gain a basic understanding of what we'd have to work with, medically-speaking, in a disaster. It was when we began to reach outside the area of medicine to draw on other community services, that it got more complicated. [Dr. Hickman:] Now listen, we've got to line up an emergency food supply for a hospital population of 600. That includes patients and staff for approximately eight days. But this does come under the city's plan for natural disasters. The mayor's office said the resources... [Narrator:] They need food, transportation, a communications network. Without this kind of support, their emergency health plan wouldn't be worth the paper it was written on. This problem of communication, to take one example. They agreed it should be a simple matter to link the three hospitals in the area with a disaster site. Then they could control the flow of casualties, manage their resources more effectively. It seemed simple until they talked it over with the police department. [Police Officer 1:] You can see how tied up the board is now. This is just everyday routine. You can imagine how busy this thing would be in an emergency like you're talking about. How would you go about rating one priority call over another medical call? [Police Officer 2:] Yes, and there's another problem, doc, how would the police officer at the scene know which doctor is authorized to make calls? [Dr. Ryan:] All right, let's take an actual emergency situation. Now the police are the first ones usually to the site. [Mr. Barnes:] We learned that the municipal police department and the county sheriff's office broadcast on different frequencies, but then we were learning a lot of things we hadn't known before. There was no problem we couldn't work out. It took more time, more digging, and it forced us to think in terms of the obstinate realities of disaster. We reviewed our plan for the mayor's transportation advisors, another of the civil defense emergency services. Members included the biggest trucking companies in the city and the chief of the county road department. [Dr. Hickman:] We must have trucks and drivers immediately post-disaster to move emergency medical supplies, sanitation equipment, personnel and perhaps even casualties. [Male:] You say here you'll need six, two and a half-ton trucks and drivers. You're going to have to cut that figure in half at least, doc. [Dr. Hickman:] We've gotten three hospitals to take care of and we're not asking for any additional ambulances. [Mr. Barnes:] That's a rock-bottom figure. [Male with mustache:] Every truck we can lay our hands on is already committed to emergency service of one kind or another. We need trucks to clear debris, evacuate survivors, bring in food supplies. [Male:] You see, doc, you're not the only people in the disaster business. [Operator:] Hello, Memorial Hospital calling. A simulated emergency drill is underway. [Richard Barnes:] We're going to need every single person we can get down here. [Assistant:] Yes, sir. [Richard Barnes:] And be sure that all the main arteries through the center of town are clear because we're going to have emergency units going through there. [Assistant:] Yes, sir. [Richard Barnes:] It's 11:04. Our test has been underway for 10 minutes. Emergency units are now moving along the main streets towards the disaster area. All other traffic has been stopped. [Man in vehicle:] Mayor, I just received word that one of our other ambulances just passed through the square and should be here at the disaster scene any minute now. [Mayor:] That's fine. Will you check back now and see whether there are any more disaster units on the way? [Man in vehicle:] Yes, sir. [Mayor:] Good. [Man in vehicle:] Zero, four base. [Narrator:] It's a full-scale disaster drill. [Sirens, then whistles] [Mr. Barnes:] For the first time, the health service plan we developed is being tested together with the other emergency services. All of that coordination we worked on so painfully is starting to pay off. We have our communication system working with the help of civil defense. This particular unit is courtesy of a local cab company. We have the police radio tied in, too, whenever we need one. [Man speaking into radio:] We got 15 hit with flying debris and some are multiple injuries, concussions, compound fractures and head injuries, 62 back. [Dr. Ryan:] This man has a sucking wound of the chest. Send him to Memorial Hospital, please. [Background sounds] [Narrator:] This test is as realistic as we can make it. Realistic to the point where we can estimate just how effective we'd be in an actual crisis and so the last litter-bearer can see for himself something of his part in the whole rescue operation. [Background sounds of traffic and voices] This time it's a test. Next time it may be for real. In one way or another, cities across the land have awakened to this need and the key role that the emergency health service must assume. Sometimes it's a drill that sets off the sirens, sometimes it's a real emergency... the ultimate test of how well your community has prepared for disaster. It's nothing new. Faced with a choice of survival or extinction, man will always choose to live. Sometimes the price he pays is greater; sometimes less. It has never been a bargain. The lesson we learned was that it doesn't matter where you begin; the important thing is to begin. It took a tornado to wake us up, but in a way we were lucky. It could have been far worse. What is the price of survival for you? For your city? For your community? How do you choose to meet it? These questions are yours to answer. [The End, M-1510, MCMLXVII] [Technical Advisors Robert O. Stewart, Hugh B. Cottrell, M.D.] [Produced for Bureau of Health Services, Division of Health Mobilization]