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When I was in grade school there was a huge storm that hit northern Wisconsin. We were up north with my grandparents at the time when the storm hit and lost all power for 3 days. We were not able to drive anywhere either because a large tree had fallen across the only road in and out of my grandparent's property and the electric company could not get in. Luckily, my grandparents were prepared and had plenty of food and drinking water stocked up. The neighbors came to help remove the tree and eventually all was well. Things could have been a lot worse but I remember realizing how even in our current times, when we are used to having all the resources we need at our finger tips, a natural disaster can quickly isolate you from all those resources and leave you feeling helpless. Being prepared and working together as a community were fundamental to overcoming this challenges but I wonder what we can do to make sure people are prepared and that communities have the resources they need to respond appropriately and efficiently.

Brenna - I think you bring up a really good point that is often overlooked in recovering from disasters - the psychologic effects of fear, loss and stress. Often times when I think of disaster relief I think of rescue and clean up as the immediate need and reconstruction as the long-term need. But we really need to provide resources for people to address the effects on mental health.

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I am grateful to not have been involved in disaster so I don't have much to share in term of stories. I only had personal memories of hearing about forest fires in California or flood when I lived in Vietnam. However, a question I have is when natural disaster destroys people's home, what kind of shelters are available? Additionally, as someone who works in health care, I'm interested to know how do hospitals deal with natural disasters that are specific to their region? What tools or infrastructures that hospitals can use to prevent disasters or combat them when they occurs?

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When I was in undergrad in St. Louis  we would have a few tornado warnings a year. I remember early one morning of sophomore year I woke up to the tornado alarm outside going off indicating that a tornado had spotted near campus. My roommates and I knocked on each other's doors until we were all awake and then ran downstairs to the basement of the dorm with the rest of the students. We were down there for about an hour and thankfully the tornado never touched down near the school. It was scary to think that our home could be destroyed. Additionally even though there was a tornado warning signal there was never an all clear signal given by the school. This caused a dilemma because it was a little tough to make the decision that the weather was safe enough to go back upstairs to our rooms.

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Thankfully, I've only ever been peripherally involved in disasters of any kind. I've worked as a research coordinator in Addiction Medicine for the past year and a half. One of our studies involves screening patients who have experienced traumatic injuries and looking for factors that are associated with higher potential for individuals to misuse their opioids. This may seem tangental, but I promise it will all come together. Because of the nature of this study, we were screening patients on the trauma and orthopedic units at UW hospital. This study was happening last fall when the Middleton shooting occurred. I remembered being in our office and creating a schedule of what patients I would see for the day. All of a sudden, the trauma protocol was called over the loud speaker and many of the trauma unit staff members that I was working with were preparing for patients to start coming in. Given the complexity of the situation and how much effort we knew each new patient was going to take, we decided to not screen patients that day or the following day. My roommate at the time worked in the transplant department and mentioned that all non-emergent surgeries and procedures were postponed until further notice because they weren't sure if and how many operating rooms would be needed. Despite not being directly involved with the protocol or patients admitted because of this incident, I still was able to see first hand how these types of unnatural disasters impact their community, victims and their families, and the healthcare staff.

One particular question that it left me with was how protocols for mass shootings have changed over the past several years as these have become more prevalent within our society? What similarities and differences exist among hospital response plans to mass shootings?

India - I'm glad that both you and your family were safe. It's amazing how much impact the damage of disasters can have on families and their belongings. I couldn't imagine being displaced from your home for a month but thankfully - from what you said - it seems like everyone was safe.

Helen - That's shocking to me that the building would not have proper fire escapes or exit routes. However, this really isn't something that I've thought about before and probably wouldn't have thought about until the situation would happen. Looking back, thankfully those people outside yelled loud enough to wake you up and I'm glad that you were able to get out of the building unharmed.

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I haven’t been directly involved in any disasters or emergencies like the ones we are learning about (thankfully), but I took part in treating the consequences of the couple weeks of brutal cold we had in Madison this past winter. During my Burn Surgery rotation in March, we had multiple patients with severe frostbite requiring amputations. Two of the patients suffered frostbite after losing consciousness outdoors while intoxicated, and two other elderly patients had exposures as a consequence of their dementia. Many of them had most of their fingers amputated and some of their toes. It was devastating to see so many people suffering from preventable injuries. The winters in Wisconsin and other northern states can easily reach disaster-level cold. I spent a lot of time pondering how these specific cases could have been prevented, and struggled to reach a conclusion considering that impaired mental status and being alone were essentially the cause of all of them. In general, I worry for the homeless people in Madison and other cold cities each winter, because I see them sleeping outside in the bitter cold. I do wonder if police or volunteers from some other organizations ever check on them or offer transportation to a shelter during those nights.

Mel - I did not realize the power went out in the VA that day. I was in the NICU at the main hospital when it happened, and the teams were preparing for potential loss of power. It is really interesting to see or hear about how hospitals manage loss of power when we are so reliant on our technology.

Allison - I’m so sorry to hear you went through that experience. I can’t imagine what it would be like to lose a home. It is disappointing to hear how long it took the fire department to arrive - you’d think they would have a better process in place, such as one person bringing the truck and all of the other volunteer firefighters meeting at the burning house. I’m sure there are logistical challenges to that idea.

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I remember being a little girl in elementary school when there was a huge tornado that touched down in Madison, WI. It was about 5 or 6 in the evening and it was raining pretty bad. My mom had just finished cooking dinner and made everyones plates before she went downstairs to sit down and relax. My sister and I had been eating fir maybe 10 minutes when my parents yelled upstairs for us to go inside and let the dogs in. While were were outside letting the dogs in my sister and I started playing in the backyard in the rain. I remember the ominous feeling that came across both of our faces when all the trees stopped moving and everything went still. We quickly made it back into the garage with the dogs and as soon as we closed the door to the backyard the entire house started to shake and the lights went out. A tornado had hit our house and knocked down a tree in our backyard. The tree fell over, knocked out the power lines and had fallen through our roof. I don't remember much of what happened in the aftermath with emergency response. I do remember having to stay at my aunts house for a month while our roof was being repaired. I remember all of our food in the freezer downstairs thawing and going bad because the power was out for so long. I was really young at the time but i remember wondering what resources were there to help families in emergencies like this when they are displaced out of their home. I remember asking who was going to help us refill our freezer downstairs with the food we had stocked up.

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We used to live across the street from a park when I was little and when we'd get heavy rain fall in the summer, the park would flood. I loved when this happened because me and all the neighbor kids would run outside and go swimming in the park and play on all of the swing sets and jungle gyms that were now submerged. It was honestly so fun! There was one storm however, that caused such severe flooding that the water  spilled into the streets and flooded the basements of nearby houses (ours included). My mom worked as a nurse at a nearby hospital and they also had flooding that required patients to be transferred to higher floors. As a 9 year old kid, I didn't fully appreciate the financial burden that this had on individual homeowners but I imagine it was significant, as it required weeks of professional cleanup. As I've gotten older and had more experiences in the healthcare system, I've wondered what sorts of emergency action plans are in place for severe weather events that endanger hospitals, employees and patients and what kinds of preparation goes into developing these so that when they need to be put into action, people know what to do.

Mel - The event you described reminds me of an experience I had recently while working at the ED in Burlington, WI. I was on an overnight shift when the power went out due to a severe thunderstorm. It was the first time I've experienced that in a hospital setting, but it was pretty eerie feeling! Luckily, the generators kicked on within a couple minutes and everything turned out fine but I couldn't help but wonder what would happen if you didn't have a backup energy supply.

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A personal experience I had with an emergency was during a winter storm in Maryland in the 2016. There had been warnings of us getting more snow than typical later in the evening. As I drove home from work, it began snowing.

Unfortunately, the streets had not been salted, which is a practice typical of Maryland whenever a big snow storm is anticipated. This made roads very slippery. To make matters worse, the traffic light at a major intersection near my home was not working. Due to the weather and faulty traffic light, I witnessed multiple people almost hit each other and they tried to navigate who had right of way, while being unable to quickly react.

At that moment I wondered, how the government allocated resources, such as the salt that for whatever reason was not used that evening. I was also surprised there wasn't a police officer directing traffic, or someone working to fix the traffic light. I wondered what the protocol was for ensuring rapid response in situations like this.

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A personal experience I had with an emergency or disaster was when my family had a house fire when I was younger. It was a hot summer night and my family was all in the living room when we heard what sounded like fireworks coming from outside. It turns out that an electrical fire started in the garage and the popping was coming from the wiring within the walls. 911 was called right away, but I remember my mom blanking with the address to our home where we lived for over 10 years while on the phone with the operator due to the unexpectedness of the situation. It was not long before we found ourselves outside of the house in our neighbors’ driveway watching as the entire house became engulfed in flames. It seemed like hours before the fire department was on the scene to respond. This experience helps me to relate to the families from Joplin who lost their homes and personal possessions in an instant. One question/dilemma that it left me with was how long it took the fire department (over 20 minutes) to respond due to living in the country where the fire crew consists of all volunteer firefighters who have to individually drive into the fire station to meet beforehand versus larger cities where fire departments are always staffed. It made me aware of not only the importance of services/resources available based on where you live, but also of the logistics that go into responding to an emergency.

Kim-I also wonder how warning systems work in alerting the public of dangerous weather including flooding and ensuring that as many people as possible receive these messages. From your story it sounds like not everyone was expecting/aware of how dangerous the flooding could potentially be.

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When I was in 2nd grade I was flying back from visiting my parents in Jordan when out plane landed in Canada instead of the USA. That was the day of 9/11 and the American airspace was closed and so we had been diverted to a small town in Canada near Nova Scotia.

I remember a lot of it really well and I won't go into detail. But my family was essentially housed and fed by the Red Cross for like 2 weeks (I can't remember how long it had been). I am not exactly sure what happened at the school that everyone was initially sent to since we were housed by some volunteers, but you could tell that everything was quickly but efficiently put together. I know the red cross did a lot, but the community clearly had stepped up to make the response to this situation the best that it could be. I think it was a great example of how being prepared made a big difference and how public health is not in the hands of a few. Everyone was safe and sound despite the potential dangers of having several thousand people displaced.

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This summer, I was rotating at the VA on the cardiology team when a power plant on the other side of Madison caught fire. That plant supplied half of the power to the VA, which had many consequences. We had to cancel all "non-emergent" tests and procedures out of fear that the power would completely shut off in the middle of a test/procedure. This meant that many people were unable to have heart caths that day. Luckily UW still had full power and we could send any emergent cases there, but the VA had to start generators to prevent the VA from draining UW's power. And the lights at the VA kept flickering, which was really unnerving. This experience made me wonder how hospitals, nursing homes, etc with many vulnerable patients handle emergencies and disasters. The video about Joplin was frightening- for some reason, I'd always assumed hospitals were somehow indestructible. How do you evacuate all those patients? Where do they go? What about patients requiring machines when there is no power? I hope to learn how to be prepared for those situations so I can keep patients safe.

Ms. Siegenthaler- I'm impressed that you were able to jump into action like that when a tornado hit. I hope to learn what to do in those situations, too!

Danika- I like your idea of additional support for people for the time it takes to sort out logistical things after a disaster. I wonder if there are any currently existing programs/protection for this?

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When I was in college, it was a Friday night and I was staying late in a lab I worked at. When I finished, I headed home to my apartment and was so tired I decided to take a nap. I remember waking up at exactly 8:48 PM really annoyed because people were screaming, but I thought it was really just people walking around outside and being loud since it was a Friday night and I lived on Telegraph Ave which is similar to State St at UW Madison. I tried to go back to sleep, but couldn't because of the continuous shouting outside when I heard someone shout, "Sequoia apartment is on fire!" I immediately got up and decided to open the door to my apartment to see what was going on. When I opened the door, everything was pitch black and smoke filled my apartment. There was a fire definitely burning on the east side of the building where the elevators were. I couldn't leave through the front door, and only a small window was able to open a tiny bit above the kitchen sink my apartment. I had to kick the window and jump onto a fire escape. The fire escape was broken, but I was lucky that there were some kind fraternity guys who were walking by and saw what was happening. I actually had to jump off the fire escape and they caught me which allowed me to get out of a burning building.

I always assumed there were things in place for fires that needed to be up to code in buildings such as fire alarms which did not go off in my apartment, a working fire escape, and elevators that were inspected (the fire started with wiring issues there and spread to the building as the elevator moved up and down). I wondered how often these things had to be checked and how long apartments had to bring these things up to code if they were not. The American Red Cross got involved and gave us each $200 to buy warm clothes and food and offered shelter for immediate issues, but I wondered what other things were in place to help people get their lives back in order. I was a student at the time so the university helped a lot, but many residents were not and had to go through a lot more to get a new place to stay permanently, replace a lot of personal belongings, etc while balancing their obligations and not getting excused like I did as a student.

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When I was little and living in Oshkosh, WI, a significant straight-line wind tore through the city when severe storms moved through the area. I remember sleeping in our basement overnight, wondering whether our home would still exist in the morning. We woke to an intact home, but were surrounded by trees that had fallen down, all in the same direction. Our house had lost power, and we would be without it for another 4 days. I recall storing Gogurts in a cooler and going to our neighbor's house for eggs that she cooked on the side burner of her grill. How would we keep our food cold? Would the power ever come back on? After that point, I developed a pathologic fear of storms. My stomach lurched whenever I saw darkened storm clouds and allocated our cherished belongings to the basement with every whiff of a tornado watch. That fear has thankfully resolved, but I still have an occasional dream involving the inability to escape a tornado.

I was too young to truly appreciate the gravity of what happened or how adversely people may have been affected by these storms. In the video outlining the tornado in Joplin, MO, I was astonished by how the hospital was affected and that they were actually triaging patients on the lawn. One question I have is how do local emergency departments and first responders prepare for and triage the large volume of patients coming to the hospital in the setting of power outages, trees across roads, and limited resources?

- Brenna

Kim: I am stunned by what you experienced with the flooding in Madison. I've heard people tell similar stories about flooded parking garages and I am SO sorry for the loss of your belongings. I also sympathize for you when you mentioned feeling like there wasn't anything you could do to help the people getting stuck. I think that all the time when I see people in the ditch during the winter, etc.

Vince: That is a heart-wrenching story about your neighbor. I'm curious to know why she died secondary to being homebound -- or if it was something unrelated? Is it possible for homes to have carbon monoxide build-up if their vents are clogged by snow or something?

Danika: I cannot imagine being stranded during SPC! I am so happy your apartment wasn't affected. It reminds me of the stories of Joplin where people were talking about not knowing how to feel given that people died or had their homes demolished, while their own homes and loved ones were okay. And I appreciate your comment about wondering how we can support people better when faced with such tragedy -- I am curious about this as well!

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Hi everyone! I would also like to share my experience with the flooding that occurred in Madison/Middleton last summer. I had just moved to a new apartment building and I remember watching the storm from the window of my 4th story apartment. I couldn't believe how fast the street filled with water and my husband I watched car after car got stuck in several feet of water. I asked him "should we go out there and help them?" He responded by asking me what we would even do, and how we would even reach them... I was at a loss of words. I was about to call 911 to report what I was seeing when rescue vehicles started to arrive. The next morning we woke up to find that our entire parking garage had essentially filled to the ceiling with water and all of the cars and storage units on the lower level were fully submerged and therefore totaled. The water must have came in so fast that the metal elevator door had been blown out of the elevator shaft. After the water was pumped out, I spent the entire day hauling all of our destroyed belongings from our storage unit to the dumpster. However, I later came to find out that many people had it much worse and one citizen had even died after being swept away by the current of the flooding... I just wonder what more I could have done to help those struggling outside my building and how the cars coming down University could have been better warned about the quickly rising waters they would encounter.
- Kim

Danika - I can totally relate to your question of how we can better support people after losing so much. I especially struggled with those feelings after finding out how much more other families in my building alone lost during that flood.

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The disaster I would like to share is of a particularly heavy blizzard that enveloped Milwaukee in the late 1999-2000 winter. It was incredibly impressive in the amount of snow it produced, even for Wisconsinites. I remember school, work, and many public services being cancelled for several days as they attempted to clear the roads. Mail and garbage services were stopped, and of course all I fixated on was having snow days. It really stands out to me in that a neighbor of mine died during that blizzard. She was home-bound and required several people to check on her, and most likely her passing was related to people being unable to reach her. It really stood out how we take for granted things such as being able to travel easily.

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Hi Team-

I am going to talk about my experience with the flooding in Middleton just over a year ago now. I moved to Middleton two summers ago to get out of the immediate Madison area. I was lucky enough that my apartment building did not flood directly, but the surrounding roads to my apartment were completely under water. So, I was trapped there for almost two days until the water receded enough so that I could drive out. All that I could think was how incredibly inconvenient it was for me to have to miss a day of rotations (on SPC of course). However, I couldn't imagine how much worse it must have been for those people who had damaged homes, apartments, or other belongings. What it made me think about is how the damage of these disasters is really two-fold; the physical damage as well as the incredible amount of time people have to give to make insurance claims, find new housing, replace old belongings, etc, and it made me wonder if there is better ways to support people for the time they lose in addition to everything else.

-Danika

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Hey everyone, Debbie here -- thanks for your interest in this course!  I am going to comment on the first (and only) time I ever witnessed a real live tornado ....on the ground. The image of it is forever engrained in my mind.  It was night time and raining so so hard.  I was at a bachelorette party (IKR?) and we were at a bar (IKR#2 !!!!) and the tornado whistle blew.  Because I was Health Officer at the time, my preparedness instincts (and nursing) kicked in. Myself and the volunteer (off duty) fireman on scene quickly began moving everyone into a concrete semi-shelter building that was a bit of a distance from the bar.  When I was outside, directing people to move quickly,  I saw it! I will never forget how huge the tornado was.  It was also very, very, VERY black. I remember thinking, OMG, there it is... there it ACTUALLY is! Thankfully it was to the east of me, so I was confident it was moving away from us. It was a moment of being truly in awe of Mother Nature. Even though it was scary, it had a fierce beauty to it.