Tornado Emergency Plan

The following is a template for a Tornado Emergency Plan to implement in your office.

Before a tornado: Review your escape plan (in your OSHA setup materials) to learn the route. Locate and/or designate the location of the closest tornado shelter. Your escape plan should be posted in a strategic location in your practice.

When a tornado warning is issued in which there is an immediate danger:

All supervisors will instruct their personnel and any others in their work areas to move quickly to the designated shelter area.
All supervisors will check all rooms in their area before taking shelter unless there is imminent danger.
All employees will assist in moving patients in their areas to the designated shelter area (usually the basement) of the building.
Pay special attention to patients who are in need of assistance and who require the elevator to reach the shelter area. Reserve the elevator for the individuals who cannot use the stairs.
All employees must act calmly to prevent panic.
Turn off all electrical equipment.

During a tornado: Follow these safety requirements:

Stay away from open areas and windows in case of flying glass.
Do not leave the building unless told to do so. It is generally safer to be inside a building than outside.
Go to the designated shelter area if there is time.
If you are unable to reach the shelter area, take refuge under a desk or something sturdy. Avoid bookcases.
If you are unable to evacuate or cannot find a sturdy object for protection, lie on the floor with your hands covering the back of your head.

In case of evacuation:

If a tornado is imminent, all personnel will evacuate the work area. Patients will be directed to the designated shelter area (usually the basement). Turn off electrical equipment, check all rooms quickly, and assist patients to safe areas. Remain calm.

Location of the designated shelter area(s):__________________________________________________

After a tornado:

When the danger has passed, the supervisor will notify all employees and others when the all-clear signal has been given.

Updated May 21, 2025

Every year, the United States experiences approximately 1,200 tornadoes on average. These violent storms can strike with little warning and have the potential to devastate communities - including hospitals and healthcare facilities. Past disasters like the 2011 Joplin, Missouri tornado - which blew out every window of a hospital and knocked out power, resulting in multiple patient fatalities underscore why tornado disaster planning is crucial for hospitals. A comprehensive tornado emergency plan helps ensure a safe environment for patients, staff, and visitors and continuity of care even if a tornado strikes. Today, we will outline how to develop an effective tornado disaster plan for hospitals, with clear steps to prepare before a tornado, take action during a tornado, and recover after the event. We also incorporate official guidelines, expert tips, and compliance considerations to build trust and authority into your hospital's plan.

Why Hospitals Need a Tornado Disaster Plan

Hospitals are unique environments that care for some of the most vulnerable individuals. In tornado-prone regions, a hospital's emergency preparedness plan must address tornado scenarios. Key reasons to develop a robust tornado plan include:

Patient and Staff Safety: The foremost priority is protecting lives. A well-crafted plan identifies the safest areas in the hospital for shelter and procedures to quickly move patients (including those immobile or on life support) and staff out of harm's way.
Continuity of Care: Hospitals must continue critical care during a tornado and in its aftermath. This means having backup power for life-sustaining equipment, procedures for manual ventilation if needed, and strategies to maintain care for all patients even if infrastructure is damaged.
Structural and Operational Resilience: Tornadoes can damage buildings and cut off utilities. Planning helps protect the facility (e.g., securing equipment, closing fire doors, safeguarding medical records) and ensures that essential operations and communications can continue despite the storm.
Regulatory Compliance: Accrediting organizations and regulators require disaster planning. For example, Joint Commission standards mandate that hospitals have an emergency management program for all types of hazards (including tornadoes), and OSHA regulations require emergency action plans with shelter procedures for workplaces in tornado-risk areas. A solid plan not only keeps people safe but also meets these compliance obligations.
Liability and Community Trust: Demonstrating that your hospital can handle natural disasters builds trust with the community. It reassures patients and their families that the hospital is prepared to keep them safe under extreme weather conditions.

By understanding the stakes and incorporating lessons from past tornado events, hospital leaders can appreciate why investing time and resources into a tornado disaster plan is literally lifesaving. The following sections provide a step-by-step approach to developing and implementing this plan effectively.

Pre-Tornado Preparedness Measures

Tornado preparedness for hospitals involves proactive planning and regular practice. Long before tornado season, hospital administrators should take the following steps to ensure readiness:

Hazard Assessment and Plan Development: Conduct a hazard vulnerability analysis to gauge your facility's tornado risk and potential impact. Develop a written Tornado Emergency Operations Plan (often as an annex to your hospital's Emergency Operations Plan) that details specific procedures, responsibilities, and resources for a tornado scenario. Define the plan's mission and objectives - for example, to protect everyone on-site and maintain patient care during and after the storm. Ensure this plan aligns with the hospital's overall disaster policies and the community's emergency plans.
Designate Safe Shelter Areas: Identify the safest locations in the hospital where people should gather during a tornado. Ideal shelter areas are interior rooms or corridors on the lowest floor, away from windows and exterior walls. Basements or underground spaces offer the best protection, if available. If no basement exists, choose small interior rooms (restrooms, storage rooms, interior hallways) built with reinforced construction and no glass. Avoid large open areas with broad roofs (e.g. cafeterias, auditoriums or gyms) which may collapse. Clearly mark these shelter areas with signage and include their locations on evacuation maps posted throughout the hospital. Everyone - staff, patients, and visitors - should be informed of these designated tornado-safe zones.
Equip Shelter Areas with Emergency Supplies: Each designated shelter area should be stocked with basic emergency supplies in case people must remain there for an extended time. According to FEMA and OSHA guidelines, a basic disaster supplies kit for tornadoes should include items such as first aid kits, flashlights and batteries, battery-powered or hand-crank radios (preferably a NOAA Weather Radio for alerts), bottled water, non-perishable snacks, blankets, and sanitation items. Keep necessary medical supplies on hand as well - for example, extra oxygen cylinders, backup battery packs for ventilators, and other critical patient care items that might be needed if power is lost or evacuation is prolonged. Regularly check and refresh these supplies (at least annually) to ensure they are up to date and functional.
Communication and Warning Systems: Early warning is vital. Establish reliable methods to receive and disseminate tornado alerts within the hospital. This includes monitoring the National Weather Service and local emergency alerts via NOAA Weather Radio and mobile warning systems. Make sure the hospital's security or facilities team monitors when a Tornado Watch or Tornado Warning is issued for your area. A Tornado Watch means conditions are favorable for tornadoes - staff should be on alert, review procedures, and ensure supplies are ready. A Tornado Warning means a tornado has been spotted or indicated on radar immediate action to shelter is required. Have a distinct alarm or announcement system (such as overhead paging with a specific code or phrase like "Code Grey" or "Condition Gray") to notify all departments of a tornado warning. Ensure backup methods (like portable radios or runners) to reach areas if primary systems fail. Also develop plans to communicate warnings to individuals with disabilities (e.g. hearing-impaired) or those who speak other languages, so no one is left unaware of the danger.
Assignment of Roles and Responsibilities: A hospital-wide tornado response needs coordination. Assign specific duties to staff in advance and include them in the written plan. Key roles may include:
- Incident Commander: The person (often a senior administrator or charge nurse) who will activate the emergency plan, coordinate the overall response, and liaise with external emergency services.
- Department/unit leaders: Each area (ICU, ER, inpatient units, etc.) should have a supervisor responsible for moving patients and staff to safety and accounting for everyone in their area.
- Medical teams: Designate clinicians to be responsible for critical patients during the move (e.g., anesthesia or respiratory staff to manage ventilated patients).
- Safety/Facilities personnel: Assign staff to secure the building (shut fire doors, turn off non-essential equipment, isolate oxygen lines if needed) and handle utility issues (e.g., knowing how to shut off gas valves or respond to generator problems). They should also be ready to conduct damage assessment after the tornado passes.
- Communication lead: A person in charge of sending updates to staff (and possibly to patients' families or media as appropriate) so that consistent and clear information is shared. This may be a Public Information Officer role, especially if the hospital's incident command system is activated.
Provide checklists for each role so nothing critical is overlooked, and designate alternates for each role in case primary personnel are absent when disaster strikes.
Training and Drills: Planning on paper is not enough - regular training is essential so that staff know how to execute the tornado plan under pressure. Incorporate tornado response procedures into new employee orientation and annual refresher trainings. Conduct hospital-wide tornado drills (at least annually, and ideally during tornado season) to practice moving patients to shelter areas quickly and safely. Drills can be announced or unannounced; the key is to simulate the process of hearing a tornado warning and getting everyone to safety. After drills, hold debrief meetings to discuss what went well and what needs improvement. These exercises build muscle memory and confidence, helping staff remain calm and effective during a real event. They also help to continually update the plan based on any gaps or challenges observed.

By thoroughly addressing these preparedness elements, a hospital will be ready to spring into action when tornado conditions develop. The next sections describe what to do when a tornado is actually imminent and how to respond in the aftermath.

During a Tornado: Immediate Response Actions

When a Tornado Warning is issued for your area or a tornado is sighted near the hospital, every second counts. Hospital leadership should immediately activate the tornado emergency plan and all designated roles. Here are the critical immediate response actions to take during a tornado emergency:

Announce and Initiate Shelter-in-Place: Trigger the hospital's tornado alarm or announcement system to notify everyone of the emergency without delay. Clearly instruct all staff, patients, and visitors to move immediately to the designated tornado shelter areas. Use plain language if possible (e.g., "Attention: A tornado warning is in effect - move to internal shelter areas now.") to avoid confusion. If your hospital uses emergency codes (like "Code Black" or "Condition Grey"), ensure staff and patients understand what it means. Timing is crucial - aim to have everyone in shelter within minutes.
Assist Patients and Ensure No One Is Left Behind: All available employees should help move patients quickly and safely to the shelter areas, starting with those most vulnerable. Priority should be given to patients who are immobile, in wheelchairs, or connected to life-support equipment. Follow a pre-planned route (avoiding windows/elevators if possible) to the safe zones. Elevators should generally not be used once the tornado is very close or power is unstable, but in a high-rise hospital if certain patients must use an elevator (e.g. ICU patients on upper floors), try to evacuate them early before the storm hits and have backup power supplies ready. Tip: Reserve elevators for those who absolutely cannot use stairs, and monitor utilities while they're in use. Supervisors or assigned staff must check every room (patient room, restroom, closet) in their area if time permits to ensure no person is left behind. Do this quickly unless imminent danger forces you to take cover immediately.
Maintain Calm and Prevent Panic: Staff should project calm authority when moving patients. Speak in a reassuring but urgent tone, explaining that you are moving to a safe place. Often patients and visitors will mirror the demeanor of staff. Panicked movement can lead to injuries or chaos, so emphasize orderly, quick action. If you have prepared "tornado team" vests or badges for key responders, wear them so others recognize who to follow.
Protect from Flying Debris: Once in shelter areas, instruct everyone to stay away from windows, glass doors, or other objects that could shatter or become projectiles. Close doors to the shelter room or hallway. If the shelter area is a hallway, have people sit against the wall that is away from the tornado's approach (if known) or simply away from any glass. Encourage people to cover their head and neck with their arms or available materials (pillows, blankets, coats) to protect against debris. Hospitals can store hard hats or helmets in shelter areas for staff to use during tornado emergencies as added head protection.
Use Sturdy Cover if Available: In areas where patients cannot be moved (for example, an ICU where patients are connected to fixed equipment and there is no time to relocate), staff should lower beds and attempt to cover patients with thick blankets or mattresses as feasible. If you are caught in an area that isn't a designated shelter (or you cannot move the patient), get under a sturdy piece of furniture like a heavy table or desk, and stay low. Avoid areas with large ceilings or heavy equipment that could fall. As a last resort, if you're truly unable to evacuate to a safe area, have everyone lie flat on the floor and cover their head with their hands.
Shut Off Utilities and Equipment (If Time Permits): If the tornado is imminent (approaching within minutes) and you have a brief window before taking cover, consider quickly turning off or securing certain utilities. For example, turn off electrical equipment and appliances to reduce fire risk from power surges. Ensure gas valves (if any in use) are shut off. Close oxygen supply valves if the system or pipes could be damaged (hospital engineering/facilities staff should handle this if part of your plan). These actions can prevent additional hazards if the building is impacted. However, do not delay getting to shelter if the tornado is about to hit - personal safety is the top priority.
Maintain Communication if Possible: While sheltering, if you have access to handheld radios or charged cell phones, keep them with you. The hospital incident commander or emergency team should try to maintain communication between different shelter groups (for example, via walkie-talkies or a mass texting system) if the situation allows. However, everyone should remain in shelter until an official all-clear is given, even if things become quiet, as tornadoes often have a calm eye or can be one of multiple tornadoes.

While these steps are happening, the hospital's emergency leaders should also be in contact with external agencies as possible - for instance, notifying the local Emergency Operations Center or first responders that the hospital is in tornado response mode. If the tornado causes significant damage, you will need outside help quickly (for rescue, extra ambulances, etc.), so establishing communication early is important. Ride out the tornado in the safest possible location; all you can do during the storm is protect life. Once the tornado has passed, the focus shifts to rescue, treatment, and recovery.

After the Tornado: Recovery and Continuity of Care

When the tornado threat has ended (i.e. the storm has moved away and an official all-clear is given by weather authorities or your emergency coordinators), it's time to carefully transition into recovery operations. The period immediately after a tornado can be chaotic and dangerous, so a clear plan for post-tornado response is essential. Key actions include:

Ensure the Danger Has Passed: The supervisor or incident commander should confirm through reliable sources (such as the National Weather Service or local emergency management) that the tornado warning is over and no additional storms are imminent. Only then should you announce the all-clear within the hospital. Caution: If the building is seriously damaged, you may not want to move people from shelter areas until you evaluate safety of other areas.
Account for All Persons and Attend to Injuries: Conduct a careful headcount of patients, staff, and any visitors who were on-site, using your patient census and staff rosters, to ensure everyone is accounted for. Immediately attend to anyone who was injured during the sheltering process or by debris. Provide first aid or emergency medical care as needed. This may involve setting up a temporary triage area if part of the hospital is damaged (for example, moving patients to an intact area or even outside if safe). If the tornado caused mass casualties in the community, be prepared for an influx of injured people coming to the hospital; initiate your mass casualty incident plan if applicable.
Assess Building Safety and Infrastructure: Facilities and engineering teams should carefully inspect the hospital for structural damage once it's safe to do so. Check for hazards like broken glass, debris, unstable walls or ceilings, water damage from broken pipes or rain, and fire risks (e.g., from electrical shorts). Pay special attention to critical infrastructure: are backup generators running if main power is out? Are emergency lights on? Is there damage to water lines, HVAC, or medical gas systems? If certain areas are unsafe (collapsed or flooded), do not allow people to re-enter those zones. It may be necessary to relocate patients from damaged units to intact parts of the hospital or to evacuate completely if the building is not habitable. Note: Hospitals should have a contingency for partial or full evacuation in case of severe damage - this could mean transferring patients to other nearby hospitals. Begin making those arrangements early if needed, by contacting your regional healthcare coalition or nearby facilities.
Restore and Sustain Essential Services: Work swiftly to get critical systems back online. If power is out, ensure backup generators are functioning and fuel supplies are adequate for an extended period. If communications are down (phone lines, internet), consider satellite phones or radios to stay in touch with external agencies. If any life-sustaining equipment was halted, prioritize those patients for relocation to operating equipment or bring in portable devices. Housekeeping should begin cleanup of minor debris to reduce injury risk. Security should secure the facility to prevent unauthorized entry if doors or windows were blown out. Throughout this process, hospital leadership must keep staff and patients informed about what's happening, to maintain calm and order.
Coordinate with External Emergency Services: Likely, local emergency services (fire department, EMS, police, utility companies) will be responding in the area. Connect with the local Emergency Operations Center (EOC) or incident commanders to report your hospital's status and needs. For example, if you need search-and-rescue teams or help with patient evacuation, communicate that promptly. Conversely, if your hospital is intact and able to accept patients from the community, notify officials so they can direct ambulances to you. Communication with other area hospitals is also important - they might be sending patients your way or could help take some of your patients if you need to evacuate. Sharing status updates via radio or satellite link (if phones are down) is often part of community disaster plans and should be utilized.
Psychological Support and Public Information: A tornado strike on a hospital is a traumatic event for everyone involved. As things stabilize, engage your hospital's behavioral health team or bring in counselors to support staff and patient emotional needs. It's important to address psychological impacts early, as staff may have been through a frightening ordeal yet still need to continue caring for others. Also, assign your Public Information Officer (PIO) or a senior leader to handle communications with the public and media. They should provide accurate information about the hospital's status (e.g., "The hospital sustained damage but all patients have been relocated safely") and instructions for families of patients. Being transparent and timely in communications builds trust and prevents misinformation.
Document, Debrief and Improve: Once the immediate crisis has passed and everyone is safe, perform an incident debrief. Document the sequence of events, actions taken, and any problem areas encountered. Analyze how well the tornado plan worked: Did alarms function? Were people able to reach shelter in time? Did any equipment fail (like a generator not starting, as happened in Joplin)? Use this information to update and strengthen your tornado disaster plan for the future. Conducting an after-action review and compiling an improvement plan is often a requirement for compliance and is a best practice for continuous readiness. Celebrate successes - for instance, if lives were saved because of prompt actions - and address shortcomings through revised protocols or additional training.

Recovering from a tornado requires both urgency and caution. By systematically following these steps, a hospital can transition from emergency mode back to normal (or contingency) operations while keeping safety at the forefront. The ultimate goal is not only to save lives during the tornado, but also to restore full healthcare services for the community as soon as possible after the storm.

Staff Training, Drills, and Ongoing Plan Maintenance

A tornado disaster plan is only as effective as the people who implement it. Hospitals should invest in ongoing preparedness activities to ensure staff are ready to carry out the plan flawlessly:

Regular Training: All hospital personnel, from leadership to clinical staff to support staff, should be trained on the tornado emergency procedures. This includes knowing the location of shelter areas, understanding their specific role during a tornado (who they report to, what tasks they must do), and familiarizing themselves with the overall chain of command. Integrate tornado response training into routine annual safety trainings. Use multiple formats - in-person drills, online modules, and visual aids (like posters of "Tornado Procedures") - to reinforce knowledge. Don't forget to train night shift and weekend staff as well; tornadoes can strike at any time, and those on duty must be as prepared as the weekday crew.
Drills and Exercises: Schedule tornado drills at least once per year (or more frequently in high-risk regions). Announce drills in advance to allow departments to prepare, and occasionally do surprise drills to test real-time readiness. During drills, time how long it takes to get all patients and staff to shelter and identify bottlenecks (e.g., narrow hallways, slow movement of critical patients). After each drill, hold a quick debrief with participants and a formal critique with the emergency planning committee. Document what was learned and update the plan or training to address any issues. Additionally, consider tabletop exercises with leadership - discuss a hypothetical tornado scenario and walk through decisions (like "If the ICU is damaged, what is our evacuation plan?"). These discussions can reveal policy gaps or resource needs in a low-stress setting.
Orientation for New Staff and Refreshers: Make tornado safety a part of onboarding for new hires. Even a short walkthrough of where to go and what their role would be can imprint the basics. Provide easily accessible reference materials, like a one-page Tornado Response Checklist for staff that can be posted at nurses' stations or department bulletin boards. Periodically send out email reminders or include tornado safety tips in internal newsletters, especially as tornado season approaches each year.
Plan Updates and Maintenance: Emergency plans are living documents. Assign responsibility (often the Emergency Management Coordinator or Safety Officer) to review and update the tornado plan at least annually. Incorporate feedback from drills, actual incidents, or changes in hospital layout/staff. For instance, if a new wing opens or renovations change the layout, update your designated shelter areas and maps. Keep contact lists (for key personnel, external partners, etc.) up to date. Ensure copies of the plan are readily available: both digitally (on the hospital intranet or emergency management app) and in print (emergency binders) in multiple locations. A plan that sits on a shelf is useless in a crisis - keep it current, accessible, and practiced.
Leadership Support and Culture: Hospital leadership should actively support emergency preparedness efforts. This means allocating time and resources for training and drills, and encouraging a culture where safety is everyone's responsibility. Leadership can participate in drills and visibly champion the importance of being prepared. When staff see that tornado preparedness is taken seriously from the top down, they are more likely to engage fully in training and respond correctly when an emergency strikes.

By continuously educating and practicing, a hospital ensures that when the tornado sirens sound, every person knows what to do instinctively. This level of readiness can dramatically reduce injuries and save lives. It also helps the organization meet and exceed the standards set by regulators and accrediting bodies for emergency management.

Meeting Compliance Standards and Coordinating with External Agencies

In developing and refining a tornado disaster plan, hospitals should align with established standards and coordinate with community resources. These actions not only enhance effectiveness but also build credibility and trust:

Compliance with Healthcare Emergency Standards: Regulatory and accreditation requirements provide a framework for hospital emergency preparedness. The Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule (applicable to Medicare/Medicaid participating hospitals) mandates an all-hazards emergency plan, risk assessments, communication plans, and annual training/exercises - which would include tornadoes as a relevant hazard. The Joint Commission (for accredited hospitals) likewise requires a comprehensive Emergency Management program and specific emergency operations plans for likely events. Ensure your tornado plan meets these criteria: documented procedures, defined staff responsibilities, coordination with authorities, and regular drills. OSHA also requires workplaces (including hospitals) to have Emergency Action Plans when mandated, with shelter-in-place procedures for scenarios like tornadoes. Being in compliance is not just about avoiding penalties; it means your plan follows proven best practices that make it more reliable when put to the test. It can be helpful to use accreditation and regulatory checklists as you develop your plan - for example, The Joint Commission's emergency management checklist for tornadoes - to double-check that all critical elements (communication, resources, patient records backup, etc.) are addressed.
Coordination with Local Emergency Management: A hospital's plan should not exist in a vacuum. Connect with your local Office of Emergency Management (OEM) or equivalent agency to understand how the community handles tornado warnings and response. Many locales have community tornado sirens or mass notification systems - know how your hospital will receive and react to those. Inform local emergency officials about your hospital's tornado shelter capacity and any special needs (for instance, if you would require external help to evacuate intensive care patients in a worst-case scenario). Participate in regional drills or planning meetings if available, such as healthcare coalition exercises for tornado responses. This way, if a tornado hits the area, your hospital is already synced with external responders on terminology, protocols, and expectations.
Mutual Aid Agreements: Consider establishing mutual aid agreements or Memoranda of Understanding (MOUs) with nearby hospitals and facilities. In the event your hospital is struck by a tornado and must evacuate some or all patients, having a pre-arranged agreement with other hospitals can smooth the transfer process. Likewise, be prepared to accept patients from another hospital that might be affected by a disaster. These agreements typically cover sharing of resources, honoring of credentials for medical staff, and reimbursement issues during emergencies. Knowing that support is available from neighbors adds resilience to your plan.
Community Outreach and Education: As a healthcare leader, your hospital can also play a role in the broader community's tornado preparedness. Collaborate with public health departments to perhaps host community drills or education sessions (e.g., teaching local residents about tornado first aid or when to seek care). While this is ancillary to the hospital's internal plan, it builds good will and positions the hospital as a cornerstone of disaster readiness in the region. Additionally, educating outpatient clinics or long-term care affiliates of the hospital system on tornado planning can ensure continuity across the continuum of care.
Documentation and Plan Accessibility: Keep copies of your tornado disaster plan and related protocols in multiple formats. An abridged quick-reference (like an action checklist or flowchart) can be very useful during an actual event - something that can be glanced at quickly to guide decisions. Some hospitals laminate these quick guides and keep them at nurses' stations or inside stairwell doors leading to shelter areas. Also, ensure the full plan is accessible on your internal network or emergency management software, so leaders can pull it up on a tablet or smartphone if needed. During accreditation surveys or inspections, being able to show these documents and proof of drills will demonstrate compliance and diligence.
Review of Lessons Learned Externally: Unfortunately, there are real-world examples of tornadoes impacting hospitals (like the Joplin example) and many instances of tornado drills that uncover issues. Stay informed about these cases by reading after-action reports or case studies from other hospitals. For instance, California EMSA's Incident Response Guide - Tornado or FEMA case studies may offer checklists and actions that you can adapt to your facility. Learning from others' experiences can prevent reinventing the wheel and might reveal blind spots in your own plan.

By embedding your tornado planning in the larger context of compliance and community coordination, you not only improve the hospital's readiness but also contribute to a more resilient healthcare system overall. Surveyors and officials will take note of a well-integrated plan - and more importantly, your staff and patients will be safer for it.

Frequently Asked Questions (FAQ) about Hospital Tornado Plans

Q: What is the safest place in a hospital during a tornado?
A: The safest location is typically a designated interior shelter area on the lowest possible floor, away from windows and outside walls. Basements or underground corridors are ideal. If those aren't available, choose small interior rooms (like restrooms or storage rooms) or interior hallways that are not adjacent to external glass. Avoid large open spaces with wide roofs (e.g., cafeterias or lobbies) which are more prone to roof collapse. These designated safe zones should be clearly marked in advance as part of the hospital's tornado emergency plan.

Q: Should a hospital ever evacuate during a tornado?
A: During an actual tornado warning, evacuation to the outside is not recommended because the risk from flying debris is extremely high. The general guidance is to shelter-in-place inside the facility in the safest interior location. However, a hospital may need to relocate internally - meaning moving people from upper floors or unsafe areas of the building to lower, protected areas (this internal movement is sometimes referred to as "horizontal" or "vertical" evacuation to shelter). Only after the tornado passes and if the building is severely damaged would an external evacuation of the hospital be considered. In that case, patients might be moved to other facilities as part of the disaster recovery. The decision to evacuate the hospital entirely after a tornado would depend on damage assessments and is typically made by hospital leadership in coordination with emergency services.

Q: How do hospitals keep patients on life support safe if power is lost?
A: Hospitals are required to have emergency backup power generators for critical equipment. These generators should automatically activate if main power is lost, powering life support machines like ventilators and monitors. To prepare for tornado-related outages, hospitals must regularly test their generators under load. Additionally, for patients on ventilators, many modern ventilator units have internal battery backups that last for a limited time - staff should ensure those batteries are charged and know how long they last. The hospital's respiratory therapy department may have manual resuscitation bags at the ready to ventilate patients by hand if needed. In the Joplin tornado, some backup generators failed, so it's crucial to have contingency plans: e.g., quickly relocating patients to areas with power, or even to other hospitals, if your power systems fail. Having extra portable oxygen tanks and battery-powered suction machines in your emergency kits can also help sustain patients until power is restored or they are transferred.

Q: What are some key items in a hospital's tornado emergency kit?
A: In addition to the standard items in any emergency kit (first aid supplies, flashlights, batteries, battery-operated radio, water, non-perishable food, etc.), a hospital's tornado kit might include: backup communication tools (handheld two-way radios, spare batteries), patient care supplies (extra bandages, IV fluids, medications for emergency conditions), personal protective equipment (gloves, helmets or hard hats, safety goggles for debris cleanup), and comfort items for patients (blankets, diapers, etc.). It's also wise to include building-specific items like keys to secure areas, tool kits to shut off utilities, and printed lists of emergency contact numbers. These kits should be stored in or near designated shelter areas for quick access.

Q: How often should we review or update the tornado plan?
A: Review your tornado disaster plan at least once a year. Update it whenever there are significant changes in the hospital's layout, patient population (e.g., opening a new unit), or staff roles. Also, after any drill or real tornado event, revisit the plan to incorporate lessons learned. Continuous improvement is part of best practices and compliance; regulators like CMS and Joint Commission expect hospitals to keep plans current and effective through regular reviews, training, and exercises. Keep documentation of these updates and trainings - not only for compliance, but to ensure each iteration of the plan is more effective than the last.

By addressing these common questions, hospitals can better clarify their tornado preparedness strategies and ensure everyone from frontline nurses to facility managers understands the plan. Preparation and knowledge save lives when nature throws its worst at us.

Our Tornado Disaster Plan

Tornadoes may be unpredictable and intense, but with a thorough and well-practiced tornado disaster plan, hospitals can dramatically reduce risks and protect both people and critical operations. The key is to plan ahead: identify your safe zones, train your staff, and coordinate with partners long before the storm clouds gather. When a tornado warning strikes, an organized and confident response - moving patients to safety, shielding them from harm, and maintaining essential care - will make all the difference. After the storm, effective recovery and flexibility ensure that your hospital can continue its lifesaving mission, even under challenging conditions.

Being prepared is the best defense. Use the tips and guidelines above to strengthen your hospital's tornado emergency plan today. By doing so, you're not only complying with safety regulations - you're safeguarding your patients, staff, and community when it matters most. Stay safe, stay prepared, and ensure that when the winds howl, your hospital stands ready to weather the storm.