When an EF-5 multiple vortex tornado struck Joplin, Missouri, on May 22, 2011, 158 people were killed and 1,100 people were injured, making it the deadliest tornado to strike the United States since 1947. No one can plan for disaster, but they can plan to mitigate the effects by building proactively—especially health-care facilities, which are called upon most in the wake of a catastrophe. The role of these facilities will be a central theme at this year’s Healthcare Facilities Symposium & Expo in Chicago in October because hospitals must plan for how to keep their buildings, and their systems, intact during a tornado like the one in Joplin or a massive storm like Hurricane Sandy in New York.

Of the $2.8 billion worth of property damaged by the Joplin tornado, which was a mile wide and had winds estimated between 225 and 250 miles per hour, one of the buildings hit was St. John’s Mercy Regional Medical Center. Although the structure remained standing, it sustained major damage. Nearly all windows and doors were broken, the roofing had peeled off, interior walls had collapsed, and the contents of sanitary pipes had been sucked out and blown throughout the building. Outside, downed power lines around the perimeter posed an electrical hazard, and debris, including vehicles, made it difficult to enter the building.

After an EF-5 tornado destroyed St. John’s Mercy Medical Center in Joplin, MO, this modular hospital was built as a temporary facility.

After an EF-5 tornado destroyed St. John’s Mercy Medical Center in Joplin, MO, this modular hospital was built as a temporary facility.

By early Monday morning, the hospital had been cleared of patients and visitors, and a command center had been set up to begin recovery efforts. Key to those efforts was McCarthy Building Companies, one of the nation’s leading health-care builders, which had been working with the Mercy system for 25 years. “We were engaged the day the tornado hit to help Mercy respond to the disaster,” says Mike Stapf, McCarthy’s preconstruction director, who will be speaking about the disaster recovery efforts at the Healthcare Facilities Expo.

McCarthy worked alongside the National Guard and volunteers to help set up a temporary 60-bed field hospital of tents, which were later upgraded to insulated panels from Johnson Portable Buildings, so that Mercy could re-establish medical services as soon as possible. That facility served patients until spring 2012 when a more secure but still temporary solution—a 150,000-square-foot, 110-bed prefab system provided by California-based Walden Structures—was trucked to the site and assembled with the help of McCarthy. “Every employee knew within a few days that their jobs were secure and Mercy was committed to helping rebuild stronger and better than ever,” says John Farnen, executive director of planning and design at Mercy.

Now, Mercy has selected McCarthy to serve as construction manager for a new 880,000-square-foot hospital in Joplin. The new hospital has a construction budget of $345 million and will initially have 211 inpatient beds but will expand to 261. According to Stapf, the tornado made the hospital acutely aware of things previous disaster planning had not considered. “We hit the ground running so hard and so fast, everyone was rushing to do what we normally do—design, procure, and build—in half the time,” Stapf says. “I remember a meeting in the summer of 2011 when someone asked, ‘What are we doing so this doesn’t happen again?’ We had to slow down and think about it before we went too far down the path.”

The design and building team, along with the hospital, made a list of the things it should do. “At first it was an exhaustive list, so we ranked them in three categories: what’s going to save lives, what’s going to save lives and save the building, and what’s going to save lives, save the building, and keep the building operating 100 percent,” Stapf says. “That helped us focus, and all of the ‘number ones’ we instituted on the job.”

Those ‘number ones’ included hardening the skin and roof of the building, putting in tornado-proof glass, putting safe zones inside the building, having critical systems (such as NICU bassinets, exit signs, and lighting) on additional uninterrupted power supply systems, and ensuring emergency supplies are stored in accessible locations. “Mercy has adopted those practices in other buildings we’re building for them,” Stapf says, “and we’ve shared those best practices with others, especially in Tornado Alley.”

Learn More

Healthcare Facilities Symposium & Expo
October 1-3, 2013, ChicagoPanel highlight
The City and the Storm: New Paradigms in Health Care Planning
-Tuesday, October 1
-2:15 p.m.

Panel highlight
Accelerated and Collaborative Planning, Design and Construction (PD&C) in Rebuilding Mercy Joplin
-Wednesday, October 2
-8:00 a.m.

Panel highlight
Using Reverse Innovation to Improve Health in Developing & Developed Worlds
-Wednesday, October 2
-8:00 a.m.

Roughly a year and a half later, on the East Coast, New York-Presbyterian Hospital faced its own unique challenges in the wake of Superstorm Sandy, a category three tropical cyclone. The storm’s surge, which hit New York City on October 29, 2012, flooded streets, tunnels, and subway lines and cut power throughout the city. Conditions worsened quickly, and many hospitals, such as New York University Langone Medical Center, were forced to evacuate.

New York-Presbyterian Hospital was one of the hospitals that picked up much of the slack. “Even with the flooding and blackout conditions in the city, we were prepared and mitigated the impact with adequate manpower and equipment,” says Thomas Breglia, corporate director of engineering for New York-Presbyterian Hospital. Breglia will be speaking at the Healthcare Facilities Expo along with Kenneth Chien, a senior project manager for Jones Lang LaSalle, which New York-Presbyterian hired to help with assessing the hospital’s infrastructure and its ability to hold up in the event of future disasters.

Each of New York-Presbyterian Hospital’s five campuses are required to create a hazard vulnerability analysis (HVA), and its infrastructure team has taken the HVA to another level. “We asked ourselves, ‘If we had another event like a hurricane or flood, what are we doing about mitigating the risk before the hazard disrupts our equipment or service?’” Breglia says. To that end, the infrastructure team set up a hazardous mitigation assessment program. “We took the hazards listed on the HVA, then went back to facility and clinical operations colleagues and asked them what they considered the most important events and what systems they would be most concerned about,” he says. “What began as a total of 31 events and 12 systems was prioritized to 12 events and eight systems.”

Now, New York-Presbyterian Hospital’s infrastructure team is acting on that information with the help of Jones Lang LaSalle. “We want to have preventive measures in place to keep the heart and arteries of hospital systems operational,” Chien says. The hospital is making sure the rooftop equipment is stabilized and anchored properly. Chien adds that the team is looking into putting temporary generators or chillers on the street that would feed into the buildings.

“After Sandy, everyone wanted to talk about what will happen when another Sandy occurs in New York,” Chien says. “But we’re really looking at all types of hazards. This program is a proactive approach to hardening the facilities rather than being reactive after the fact.”