"The entry doors to the emergency room started pounding and there was this roar louder than anything I had ever heard before. Then panic hit," said Katlynn Bishop, RN, of Freeman Health Systems in Joplin.

Life was rearranged within minutes. As the inky black sky dissipated, nurses became impromptu first responders. X-rays plucked from filing cabinets in Joplin rained down sixty miles away in Greene County. Blown off doors were turned into makeshift gurneys. Buildings and people were missing.

"I had little preparation for the nightmare I experienced after the tornado hit; I had not ever worked in a disaster situation before that night. Within minutes, two pick-up trucks full of injured people pulled up to the emergency room doors. We had to pry the doors opened because the power had gone out. There were no beds ready; nobody knew which way to turn," Bishop said.

The tornado that galloped through Joplin was officially the deadliest single U.S. twister in nearly six decades. The death toll is reported to be 124 and rising. An exact number of casualties remains elusive; for instance, one woman died of a heart attack May 23 immediately after learning her father had died in the tornado.

Hearts were not the only thing broken; many buildings were also damaged in the storm. Freeman Health Systems sustained only minor building damage. A mere two miles away, St. John's Regional Medical Center was all but destroyed.

Reporting for Duty

"When the storm hit, I was at home huddled in the crawlspace with my children," said Amanda Perkins, RN, also a nurse at Freeman Health Systems.

Fueled by adrenaline and instinct, Perkins instantly got in her car and made her way to the hospital. She was among the bounty of nurses that promptly reported to the hospital for duty.

"I started making my way into town but I could not drive any further than 20th Street. I got out of my car and started running toward Freeman. Along the way, I went past St. John's Hospital - it looked like the set of a movie. It was completely surreal; no words can describe the devastation," Perkins said.

After pausing to view the damaged hulk of St. John's Regional Medical Center, Perkins continued running toward Freeman until a pick-up truck offered to take her the rest of the way. When she finally reached the hospital, triage was the task of nurses and patients alike. A two-way exchange commenced: bloodied people poured into the hospital as essential medical supplies poured out to the surrounding rubble.

"I didn't even make it into the hospital before I treated an injured man lying in the bed of a pickup truck. Then I made my way into the hospital but no one knew where to go or what to do. Everyone was just shouting, 'I need this! I need that!'" said Perkins.

Web of Assisting Hospitals

Tornadoes have smashed into hospitals before Joplin. In 2001, a tornado peeled the roof off a hospital in Hoisington, Kansas, just after patients were evacuated. And in 2007, a tornado struck a hospital in Americus, Georgia. Sunday's events again proved the critical importance of emergency preparedness for hospitals.

"We accepted several pediatric patients that came to us through a variety of transport methods," said Shirley Clesson, MSN, RN. Clesson serves as clinical emergency preparedness operations manager for Children's Mercy Hospitals and Clinics in Kansas City, MO.

Children's Mercy Hospital was well-prepared to receive patients from the disaster in Joplin; three days prior, they had participated in a disaster response drill.

"We had just participated in a national earthquake preparedness drill on Thursday. The drill was eerily similar to what actually happened on Sunday with the tornado. The only difference being that we were accepting patients from a tornado disaster rather than an earthquake," said Clesson.

Along with being prepared to play an assisting role in receiving patients from a disaster area, Clesson also indicated that the hospital has a "Code Gray" similar to what was implemented in Joplin.

"On Wednesday we had our own Code Gray because of a tornado warning in the area. We make an announcement and patients are moved to a central area. If conditions warrant, patients are moved to the lower area to facilitate evacuation. Extra linens are brought out and we close the blinds and curtains to slow down any flying glass," said Clesson.

Though tornado and other emergency drills can seem pedantic, Clesson urges nurses to take them seriously.

"Nurses need to fully participate in these drills. If there is not a concerted effort at your hospital to take disaster preparedness seriously, you need to get involved. As a nurse, I know the clinical role that we can bring to the disaster preparedness conversation," Clesson said.

Pride & Pain

"I have never been more proud to be a nurse. The entire hospital came together as a family. Everybody pulled together-nurses, physicians, respiratory therapists and pharmacists were all working toward a common goal," said Perkins.

Pride is certainly an unexpected outcome of the Joplin tornado. One would expect that a sense of helplessness would pervade a community devastated by 190 MPH winds. However, even that emotion is squelched by nurses knowing that they are serving in the best way possible.

"I am coping by realizing that I can only do so much; we simply do the best that we can. We know that, as nurses, we are doing exactly what needs to be done right now," Bishop said.

The pieces are slowly being put back together; file cabinets are being reorganized and families are being reunited. Since the storm hit, nurses at Freeman have treated 916 tornado-related injuries and passed 124 patients to area hospitals outside of Joplin. Former rivals are now working together: many of St. John's insurers will be paying benefits as in-network at Freeman.

"Things are getting back to normal, as if it were possible for things to be normal ever again. The worst thing now is phone calls that continue to come in. And we are still hurting for the staff at St. John's; we used to be cross-town competitors, but now we are all just hurting for them," said Perkins.

A.Trevor Sutton is a frequent contributor to ADVANCE.