The Joplin tornado and St. John’s Regional Medical Center.

There’s “vulnerable,” and then there’s vulnerable.

Ever wonder what it might be like to be hit by a tornado? At first blush, it might seem that the vigorous tornado season of 2011 has combined with 21^st-century IT to leave a lot less to our imagination.

News accounts, YouTube  videos, and much more are available on the web, and connect the rest of us, even when half a world away, to the world of tornado survivors. We’re on top of the statistics. We know that the scale of the loss and suffering has been remarkable, and the tornado season is by no means over. Hundreds have died so far this year. Thousands have been injured or rendered homeless. The death toll from yesterday’s Joplin tornado by itself exceeded 100 people. Property damage and business disruption total billions of dollars. Then there’s this tornado season’s duration. For weeks on end we’ve experienced new losses daily. And still more tornadoes are in prospect as I write this.

The reality, however, cannot be captured by this secondhand recounting, or by the sheer numbers, no matter how staggering. The fact is that those hit by the earliest tornadoes of the season are still struggling to put their lives back together, and will be for months, if not longer. Coming to terms with the loss of loved ones. Getting news from doctors week by week that recovery from their injuries will prove more extended than anticipated. Muscles aching and bodies cut from scrabbling around in wreckage searching for possessions and keepsakes. Living in temporary quarters in regions where more permanent housing is suddenly at a premium. Trying to find new work, to replace the job that was lost. Bucking up the kids. Encouraging the neighbors. The shopkeepers. The customers. The friends from church or synagogue. Coping with post-traumatic stress.

Minor damage? Slight injuries? That’s damage and injury to someone else, the distant stranger we don’t know. No such thing as minor or slight when it’s our turn. More and more Americans are joining the ranks of those harmed and recovering each and every day.

But the Joplin tornado reminds us that our larger community has special pockets of even greater vulnerability. The poor. The aged. The young. Under-represented groups. People in airports.

The ill.

You’ve seen the damage to Joplin’s St. John’s Regional Medical Center. Now, picture yourself there, in harm’s way as the tornado approaches. For most of your life, you’ve been ambulatory. You’ve been alert. You’ve enjoyed great situational awareness. See the storm coming? Get to the basement. Or climb in the bathtub. No big deal.

But for whatever medical reason, your defenses are down. No tornado shelter for you, and no way to reach one even if it existed. You’re immobilized. Perhaps semi-conscious. Maybe, just maybe, hospital staff will have time to get you to an interior hallway. Those hospital elevators? They’re dependent on the structural integrity of the components on the hospital roof. Will they survive the winds? Or will staff be using the stairs to move you?

Now picture yourself undergoing surgery. Maybe it’s scheduled; maybe it’s emergency surgery. At what point during the tornado’s approach does the hospital staff decide to stand down? They’ve got emergency generators. If the building integrity is maintained, they should be okay. But that 10-20 minutes advance notice of the tornado, which seemed adequate when you were at home, doesn’t seem so good now, does it?

Now picture yourself a doctor or nurse at that same hospital. What are your options? What are your hospital’s emergency plans? Those patients in ICU…are they at greater risk staying put, on all those life-support systems? Or is the danger so great that they need to be moved? What are the prospects for litigation associated with inaction? With action? At what point does the hospital become non-viable? What are the options for transferring patients elsewhere? [Remember, in the effort to keep hospital costs down, we’ve eliminated what used to be called “surge capacity” – the extra beds in hospitals area-wide available for an emergency like a tornado, or a plane crash, or other sudden calamity.] You’re the hospital administrator. What should you do?

Get the picture? Health care facilities are vulnerable in special ways to hazards. And no two hazards pose exactly the same threat. In Katrina, the hazard was flooding in the short term – and loss of emergency generating power over the next several days. Earthquakes pose another threat entirely. Forest fires? A different case as well. [Think respiratory problems.]

Turns out that federal agencies, hospital administrators, insurers, and even meteorologists have been wrestling with these issues a while. [See, for example, a recent AMS report, Rising above the Weather.] It also turns out, that no matter what care has been put into planning, it’s never seemed to be quite enough. That’ll likely be the case at St. Johns.

We can and should do more. And the responsibility doesn’t end with those health care providers and a few emergency managers. It’s the job of the entire community. In part, that’s because health care is everyone’s responsibility. In part it’s because every community holds other major exposures to hazards. Like those airports. Schools. Police and fire stations. [Firemen in Joplin had to pull themselves out of their destroyed stations in order to respond to the community tragedy.]

Building community resilience to disasters? The National Academies National Research Council has recently put out a report on this subject. Not a complete guide, but a good starting point. Get a few copies, get together with others in your community, and start building your town’s resilience to threats like these.