Around 3 o'clock on the afternoon of April 27, DCH Regional Hospital Vice President Janet Teer decided it was time to start moving patients in the Tuscaloosa, Ala., hospital away from windows and into hallways. A tornado was on the way, and the hospital had to be ready for the worst.

"All the radar had the track of the thing coming right down our throats," says Teer, who manages the hospital's emergency team.

Soon after, the storm hit, ripping the roof of the hospital's cancer center, smashing windows in the emergency department waiting room and shutting off power. The tornado, which had winds up to 190 miles an hour, obliterated a residential neighborhood 200 yards to the south; 10 minutes after the storm passed, patients started walking into the ED.

"We had people bringing in the severely wounded on any surface they could find," Teer says. "Doors, plywood, you name it."

Over the next 24 hours, the 583-bed hospital saw between 600 and 800 patients. DCH's 200-bed sister hospital in nearby Northport saw another 150 to 200 patients that night.

The story was repeated across Alabama. In the days following the storm, the state's hospitals saw 2,377 patients, and that number likely is underreported, says Danne Howard, the Alabama Hospital Association's vice president for governmental affairs and emergency planning. An estimated 1,071 were treated and released and 499 were admitted; Howard says the remaining uncounted patients show the difficulty of keeping track of tornado-related traffic.

Most of the patients came in during the first 14 hours after the storm, creating a surge that administrators had never seen before, even during the worst days of Hurricane Katrina, when evacuees flowed into Alabama hospitals from Louisiana and Mississippi. They also say the severity of the injuries was worse than they'd seen before.

"From a volume and size standpoint, it clearly was historic for us," says Mike Waldrum, CEO of UAB Hospital in Birmingham, which, as the state's only Level I trauma center, admitted at least 137 patients in the first night after the storm, 23 of whom required intensive care.

Although hospital leaders say the planning and drills that have been routine since Katrina and 9/11 helped them handle the rush of patients, there were—and still are—challenges, especially when it comes to catching up on electronic record keeping and caring for employees affected by the event.

More than once, Waldrum says, a nurse or other staff member looked down at a stretcher to find a friend or neighbor. A charge nurse called in to say she was searching for her parents; it turned out both ended up at UAB, where her father was still in critical condition weeks later.

"There's a lot of associated emotion," he says. "It's very difficult; UAB is part of the community and we're treating those patients and they're part of UAB."

Waldrum says one thing the hospital was careful to do was to hold staff in reserve, figuring the crisis could last up to 72 hours.

"The typical tendency is in an event like this everybody cares and they all want to do something so they all come in, and that can be a mistake because 24 hours later you'll need people who are fresh," Waldrum says.

Another challenge, he says, was the rush of family members who showed up in the ED looking for their lost relatives.

Across the street, Children's Hospital dealt with similar issues, especially with a slew of unidentified, severely injured children coming in from around the state. Trauma nurses used a patient-numbering system and made chart notations by hand to keep similar head trauma cases clear.

Mike Warren, CEO of Children's Health System of Alabama and Children's Hospital, says the hospital, which handled more than 60 patients that night, benefited from both the repeated drills that staff has done for years—including exercises in which children pretend to be unidentified, uncommunicative patients.

But administrators say all the drills in the world can't take the place of hiring and supporting a strong staff that's flexible enough to rise to any challenge.

"You can never plan for all the different twists and nuances in a specific disaster," says Bill Cassels, administrator at DCH in Tuscaloosa. "What allowed us to be successful was the character of the employees we have and our physicians who are completely committed to our mission. … People can be trained to do things but you can't teach that kind of character."

The Alabama Hospital Association has set up a fund to help hospital employees affected by the storm, seeded with $50,000 from the American Hospital Association. To find out more or give, go to



Plan, Plan and Plan Some More

Alabama hospital administrators offer some tips on disaster preparedness:

Plan, plan and do more planning, says Mike Waldrum, CEO of UAB Hospital. Check supplies and work through options for each possible scenario, be it a snowstorm, a tornado or a sniper on campus.

Be ready to stand up your command center, but don't do it too often or it will become less effective. For example, says Danne Howard, who runs emergency operations for the Alabama Hospital Association, tornado warnings come almost weekly in some seasons in Alabama.

Seek federal grants that may help bolster communications systems and hospital networks. Howard says Alabama's online reporting system, which is free to hospitals, was able to track beds across the state in the days after the storm.

Don't assume it won't come to you and plan your security accordingly, says Bill Cassels, administrator of DCH Regional Medical Center. For almost 50 years, tornadoes have dodged the Tuscaloosa hospital, which sits on a slight rise; this time it seemed headed straight for the building.

Prepare to be a first responder. In Tuscaloosa, the emergency management agency took a direct hit and the hospital ended up stepping in for some community needs, Cassels says. Hospitals also saw unhurt community members arrive to shelter after the storm, as well as traumatized family members who brought in injured patients.

•Even with auxiliary power, some systems may go offline temporarily or such services as CT scans and X-rays may have to be limited. Some hospitals also experienced water outages in the storm.

Plan for the long haul. Mike Warren, CEO of Children's Hospital of Alabama, says that healing the psychological wounds suffered, especially by children and families, may take longer than getting people out of intensive care and getting homes rebuilt.