critical access hospital lived up to its designation during tornado disaster

"it was the differnce between life and death for some"

In the late 1990’s and 2000 Macon County General Hospital in Lafayette, Tennessee, not unlike many other rural hospitals across the country, struggled to keep its financial head above water. Closing due to a lack of resources was a real possibility.

In July 2001, the hospital took advantage of a federal designation known as Critical Access Hospital that allowed Macon County General to collect 100% of what it cost the hospital to treat Medicare patients, improving its ability to survive.

On the evening of February 5, 2008 when an F3 tornado touched down from one end of the north central Tennessee county to the other, the 10,000 families of Macon County were glad the hospital didn’t close its doors. In the 22 hours after the tornado wreaked destruction and injury across the county, the tiny 25-bed hospital treated between 80 and 90 patients, more than three times its capacity. With all the roads in and out of the community blocked by debris and felled telephone poles, not only was Macon County General the only place in town with its lights on, it was the difference between life and death for some.

"If this hospital had not been here," said Hope Green, an employee of the local newspaper Macon County News, "People would have died."

Despite 13 fatalities throughout Macon County that night, every patient that was triaged or treated at the local hospital that night survived, with the exception of a single DOA victim.

"Our disaster plan worked to perfection," said Dennis A. Wolford, chief executive officer of Macon County General Hospital. "That night, we saw more patients in our emergency room than we usually see in an entire week. Despite the high volume and lack of space, we were able to marshal the resources to take care of every patient who presented themselves."

It was a very long night. About 10:25 p.m. that presidential primary Tuesday night in Tennessee, Wolford was at home watching storms sweep across Arkansas, Mississippi and West Tennessee on television. He turned to his wife Margaret, who works as a nurse at the hospital, and said it looked like the storm was going to the northwest and was going to miss Macon County. "No sooner had the words come out of my mouth, I heard the roar," Wolford said. Mr. and Mrs. Wolford and their ten-year-old granddaughter headed for the basement, until the tornado passed. "When it was over, I went out the front door and there was not a twig broken in my yard. Then I looked to the west and there was nothing. Where two story homes once stood, there was nothing but rubble."

It was then that Dennis called the hospital and asked the staff to swing into disaster mode. The Wolfords headed for the hospital themselves. They didn’t get far before they realized all the roads were blocked. What normally was a five-minute drive turned into an hour-long nightmare.

"When I walked into the hospital, it was a beehive of activity. But it was extremely organized," said Wolford. "About 100 of our employees had reported to work. Others in the community were there as volunteers—nurses from the nursing home, nurse practitioners, nurses from other hospitals, retired nurses and friends of the hospital."

"Our disaster plan calls for us to go on diversion when we reach about 30 patients, but we realized that was not possible. All roads leading to other hospitals were blocked or otherwise unsafe due to the damage. So we simply did what we had to do."

As the night unfolded and more and more victims presented themselves, the hospital used every inch of space it could. With only six E.R. beds, gurneys began to line the hallways. Patient rooms and waiting areas were used to counsel those in shock or looking for loved ones. A portable X-ray unit was wheeled throughout the hospital and patients were x-rayed on the spot. Children huddled under blankets near the nurses’ station. The operating room became an extension of the emergency room. And everyone received the care they needed.

Said Chief Nursing Officer and Assistant Administrator Barbara Solomon, who became the person in charge at the makeshift "central command station," the whole community came together with no one asking anything in return. "The hospital treated everyone and there was no chance to even ask people if they had insurance or process paperwork. It was charity care in the true sense of the word that night and nobody asked questions. We were caring for our friends, family and neighbors," Solomon said.

Critical Access Hospital funding has allowed Macon County General Hospital to remain viable. Without it, the circumstances would be quite different.