TWISTERS TERRORIZE Sunshine State

In the predawn hours of last February 2, while most residents of Central Florida slept, a lethal swath of tornadoes swept through the area, leaving death, destruction and damage in its wake. Lake, Sumter and Volusia counties received the brunt of what was the second-deadliest tornado event in Florida's history. According to the National Weather Service, the tornadoes were as strong as 3s on the Enhanced Fujita scale, with wind speeds of up to 155-165 mph.

     A tornado warning was issued at 3:06 a.m. for northern Lake and Sumter counties, which included the communities of Paisley, Lake Griffin, Lady Lake, The Villages, Emeralda and Lisbon. The NWS reported that the first tornado touched down near Wildwood in Sumter County at 3:08 a.m., then crossed into Lake County, lifting east of Lady Lake at 3:25. Post-storm surveys indicated a track length of 16.5 miles. Eight fatalities and dozens of injuries were associated with this tornado.

     The second tornado touched down in rural eastern Lake County at 3:37 and devastated the Lake Mack area before crossing into Volusia County. This tornado also reached EF-3. It had a track length of 26 miles and caused 13 fatalities and, once again, dozens of injuries. All of those killed in both communities lived in manufactured housing.

The Early Response
     Lake-Sumter EMS, as the provider of emergency medical services to the region, responded immediately to multiple impact sites in both Lake and Sumter counties. At the time the tornadoes touched down, the agency had 22 ambulances in service--16 in Lake County and six in Sumter. Lake-Sumter EMS also utilizes quick-response vehicles staffed with single paramedics and full ALS equipment. These are primarily deployed in the rural areas of Lake and Sumter counties to provide rapid first response ALS services. Seven QRVs were in service and responded to the impacted areas.

     To keep pace with the anticipated call volume, eight additional ambulances were put into service, with four deployed to each county. Five additional QRVs joined the first responder fleet.

     At the time the tornadoes struck, Lake-Sumter EMS was at normal staffing. Over the next few hours, operational staffing increased nearly 40%. The 29 paramedics and 22 EMTs on duty when the tornadoes hit were soon joined by 13 additional paramedics and eight more EMTs, many of whom called in to the communications center for assignments in the early hours of the disaster.

     As a result of the tornadoes, Lake-Sumter EMS experienced a spike in 9-1-1 calls for several hours following the storms' initial impact. The Lake-Sumter EMS Communications Center not only handles all calls for EMS, but also dispatches for 11 fire departments. The system realized an increase in call volume of more than 40%. Increases in unit staffing closely mirrored those in call volumes.

     In the first two hours of the incident, Lake-Sumter EMS responded to 100 EMS calls. A total of 144 patients were transported in the first 24 incident hours. From 3 a.m. to noon, EMS crews transported 70 patients, 58 of them with storm-related injuries and conditions. The service usually averages 102 transports every 24 hours.

     These patients suffered primarily traumatic injuries, including traumatic brain injuries, long bone fractures, blunt/multisystem trauma and serious lacerations. There were also several stress-related cardiac emergencies and hundreds of patients requiring basic first aid. Given the time of day and intensity of the damage in the impacted communities, that hundreds were not killed or critically injured is nothing short of miraculous.

     The high volume of transports and loss of life during that crucial time frame provide only a small reflection of the extremely difficult conditions in which Lake-Sumter EMS first responders operated. While saving lives and responding to emergencies is all in a day's work for these providers, the tornadoes created situations far outside the conditions of normal operations. Downed power lines, uprooted trees and metal and debris from damaged homes and vehicles were common obstacles during the early hours of response.

     Paramedic Josie Barrett, who was one of the first responders in the heavily damaged Lake Mack area, described the intense situation she encountered as "dark, rainy and bloody." She was operating a QRV soon after the tornado struck, and as she dodged debris, an elderly couple emerged from the wreckage of trees looking for help. Barrett characterized them, and many of the victims she encountered in the early hours after the storm, as "zombies" walking around in a daze. Other crew members had similar experiences and worked through the challenges of providing aid while maneuvering around leaking propane tanks, frightened pets, fallen limbs and other physical obstacles. Crews often found themselves assisting residents who would walk up to them on the site of a call requesting help for their families, neighbors and friends.

     Crew members also assisted with the difficult task of rescue and recovery and were, in some cases, called upon to remove the bodies of the deceased and comfort the loved ones of those who perished. In Lake County, Lake County Fire Rescue had the primary role of search and recovery, assisted by several municipal fire departments and resources from Orange and Seminole counties. In Sumter County, the task was performed by The Villages Fire Rescue Department, with assistance from Marion County Fire-Rescue. There were many stories of individual acts of heroism during the first hours of the response that are testaments to the quality of emergency personnel serving these Central Florida communities.

     EMS, fire and law enforcement faced the challenge of establishing and managing multiple simultaneous commands in infrastructure-damaged environments. Lake-Sumter EMS lost a critical communications tower in the Lake Mack area. Electricity and phone lines were also down, and cell phones were overloaded to the point of failure. As the morning progressed, unified commands were established with fire and law enforcement at The Villages, Lady Lake and Lake Mack. The Lake-Sumter EMS Operations Center was established, and Lake-Sumter EMS representatives staffed health and medical positions at both the Lake and Sumter emergency operations centers.

Disaster Planning
     Lake-Sumter EMS, in conjunction with the local and state emergency management planning process, utilizes an all-hazards approach to disaster planning. Disaster plans include many potential multi-casualty, high-patient-volume incidents such as hurricanes, train derailments with hazardous materials, wildfires, transportation incidents and, of course, tornadoes.

     Disaster planning and both tabletop and full-scale MCI exercises are conducted annually at the local and regional levels through local emergency planning councils. The Lake-Sumter EMS multi-casualty incident plan is an annex to both counties' comprehensive emergency management plan. In addition, Lake-Sumter EMS was a partner in the development of both the state and regional catastrophic health incident response plans.

Mutual Aid
     Local response would not have been as effective had it not been for a range of mutual aid provided by neighboring counties. Ambulances from Marion County's Emergency Medical Services Alliance (EMSA) responded to calls in The Villages and Lady Lake from a large staging area in The Villages; Orange County Fire Rescue staffed stations in southern Lake County; and an urban search and rescue team from Marion County searched demolished homes and facilities in The Villages. Mutual aid resources were utilized both to respond to impacted areas and to support normal operations. The Lake-Sumter EMS Communications Center received many calls from dispatch centers around the state offering assistance. The unified command system was utilized and worked extremely well.

The Recovery
     The recovery process began almost immediately after the tornadoes passed. Florida Governor Charlie Crist quickly issued proclamations declaring the affected counties disaster areas. President George W. Bush followed with a disaster declaration speeding federal assistance.

     In cooperation with the Lake and Sumter county emergency management agencies, FEMA established multiple disaster recovery centers (DRCs) close to the impacted communities. The DRCs provided much-needed information on local, state and federal assistance available to victims. The American Red Cross opened mass-care shelters and deployed mobile emergency response vehicles. The Salvation Army and other faith-based groups established feeding stations.

     The counties were blessed with an outpouring of volunteers from both local communities and across the country. Nearly 700 volunteers descended on the region; many were from AmeriCorps, the American Red Cross and faith-based groups. These volunteers provided food, comfort, cleanup and other humanitarian assistance to those impacted by the tornadoes.

     Estimates indicated that Lake County's communities suffered more than $26.3 million in damage, which included 185 destroyed structures and 385 that received damage. More than 200,000 cubic yards of debris, from metal to mattresses, were generated by the storms in Lake County.

     Lake--Sumter EMS continued to support the community in the recovery phase by staffing the Lake County EOC in support of the Lake County Health Department. The service provided roving paramedic coverage to the remote and heavily impacted Lake Mack area for weeks, and delivered food, equipment and family first aid kits provided by the American Red Cross to storm victims and those assisting with cleanup efforts. In addition, the agency's staff established a wellness check program at the volunteer base camp, which had a daily census of 125 volunteers.

     In the ensuing weeks, EMS also continued to respond to storm-related incidents. Post-storm injuries included falls from roofs/ladders, hydration issues, chainsaw wounds and even several carbon monoxide poisonings from the improper use of gasoline-powered generators.

Table 1: Successes

• Teamwork--Cooperation between both local and mutual aid EMS, fire and law enforcement response agencies was frequently mentioned.
• Unified command--The unified command process was cited frequently as a reason for successful incident management. Lake-Sumter EMS and its partner fire and law enforcement agencies participate regularly in joint tabletop and full-scale exercises.
• Problem solving--In the early hours of the incident, with communications almost nil, officers, firefighters and medics solved problems in the field with little supervision or communication.
• Supervisor communications--EMS supervisors and crews all commented on the quality and accuracy of shared information.
• Response--Response was timely and appropriate.
• Independent critical decision making--EMS personnel made accurate and timely critical decisions. This was particularly evident early in the event, with the loss of communications infrastructure.
• Communication with hospitals--Hospitals were contacted early to activate their disaster plans, and were frequently updated.
• Payroll--Payrolls were accurate.

Table 2: Opportunities for Improvement

• Notification of off-duty personnel--While all field crew are assigned pagers, the feasibility of a staff call-down system and a policy for notifying critical staff should be investigated.
• Redundant communications systems--Communication difficulties immediately after the storm were partially precipitated by the destruction of a key radio tower. Lake-Sumter EMS has now purchased portable towers which can be quickly deployed in emergency situations. The service has also enrolled in the Government Emergency Telephone System (GETS) to receive priority cellular service.
• Training in complex incident response--All agencies in Lake and Sumter counties, including Lake-Sumter EMS, have been trained in ICS, and it is recommended that additional training in complex incident response occur to build on current ICS skills.
• Lines of authority and communications in special operations--A few situations occurred early in the event where it was unclear who was in command, where commands were, and what the line of authority was. With three separate command posts, severe weather still a problem and the loss of a primary communications tower, some personnel received conflicting orders. This issue resolved as the event progressed, commanders had better intelligence and workarounds were established to replace lost communications infrastructure.
• Coding of payroll--Some confusion was experienced regarding a predetermined disaster payroll code and when to actually begin using it. Also, separating tornado victims from routine non-storm-related patients after the event was challenging.

The Aftermath and After-Action Review
     Lake-Sumter EMS staff completed an after-action report, which was based on a collaborative survey made available to all employees for comment. The survey was offered in a form that allowed a confidential response. It was designed to solicit feedback in a variety of areas, from different locations, to help better understand the agency's performance and improve upon it. Responses were received from paramedics, EMTs, supervisors and dispatchers, as well as administrative and support personnel.

     Survey items included:

• Respondent demographics (where they normally work, what they do);
• Notification (how, when they learned of the tornadoes);
• Report information (where they were advised to report, what they were briefed on);
• Assignment (where they were assigned, what they did);
• Operations (related issues);
• Logistics (related issues);
• Administration/finance (related issues);
• Planning (related issues);
• Opportunities for improvement
• Successes; and
• General comments and observations.

     A review of the employee after-action report survey highlighted successes and opportunities for improvement (see Table 1 and Table 2). The next steps in the after-action process will be to:

• Establish working groups to review and validate the report recommendations;
• Determine action items for review;
• Establish priorities for training, protocol/SOP changes and capital improvements;
• Assure budgetary commitment from public officials;
• Develop/modify plans; and
• Train and exercise (and critique).

     While this article focuses on the tornado response and recovery from Lake-Sumter EMS' perspective, it should be emphasized that local fire, EMS and law enforcement agencies have a close relationship and the collective, collaborative response by all entities to this disaster was remarkable. Each public safety agency performed its role effectively under difficult conditions, and a high level of cooperation was demonstrated among the community of first responders and recovery organizations. At the time of this writing, Lake-Sumter EMS continues to gather after-action report information, recognizing that all data has not been fully analyzed and vetted.

James A. (Jim) Judge II, CEM, EMT-P, BPA, is executive director of Lake-Sumter EMS, Inc. A 35-year veteran of EMS, the fire service and emergency management, he has received numerous state and national awards for administrative and operational excellence in public safety, including the National Association of EMTs' EMS Administrator of the Year Award in 1994 and induction into the Florida EMS Hall of Fame in 2004.

Lloyd Parker, EMT-P, BS, is assistant chief for emergency preparedness and response with Lake-Sumter EMS and a team commander for the FL-6 Disaster Medical Assistance Team. He has over 30 years of emergency services experience and has worked in command positions for hurricanes Andrew, Charley, Frances, Jeanne, Katrina, Rita and Wilma.

Jim Judge will discuss his agency's response to the tornadoes at EMS EXPO, October 11-13, in Orlando, FL. For more information, visit www.emsexpo2007.com.