JOPLIN, Mo. — The tornado was coming.

Staff at the Greenbriar nursing home in Joplin began rushing residents into a central hallway. That’s where Peggy Wilson, 83, found herself on May 22, holding hands with her neighbors for comfort as the horrifying roar of the wind overtook the building.

“We heard the sound, and we said, ‘Uh oh,’ and about that time — plunk, plunk, plunk — the ceiling, whatever it was made of, fell on us,” she said. “When it hit, it took everything down — pipes, plaster, wood, the ceiling construction, everything. And there wasn’t much of a way to avoid it, either.”

Debris fell on her head, shoulder and legs, but she avoided serious injury.

“It was awful, though,” she said. “Just the sound of it, and there you sit. What could you do? You certainly couldn’t run away from it.”

Wilson is a survivor of the EF-5 tornado that struck Joplin on May 22, killing 159 people. A Globe analysis of where people were when they were killed or fatally injured found that at least 16 were killed at the Greenbriar, 2502 S. Moffet Ave. The nursing home had the single highest number of fatalities of any location in Joplin, surpassing other hard-hit locations such as St. John’s Regional Medical Center and the Home Depot.

Janice Zalen, senior director of special programs with the American Health Care Association, based in Washington, D.C., said a team from the association’s disaster committee could travel to Joplin soon to study where improvements in safety could be made. She said her group has not done much work with tornado planning and preparedness. The group has worked largely with hurricane disasters, particularly after Hurricane Katrina.

“We will be in there to (see) what went right, what went wrong and to help others,” she said. “We have to learn from these experiences. You never learn immediately. You have to let some time go by.”

The tragedy is likely to spark discussions among other nursing homes and in the health care industry about what could be improved before the next storm hits.

‘Annihilated’

Zach Simonds, 26, had arrived at the Greenbriar, where he worked as a janitor, less than an hour before the storm struck.

The air was hot and windy, he said. When it started hailing and the sirens had sounded at least two different times, Simonds noticed the storm on the western horizon.

He said the staff were “doing whatever they could do” to get residents to the central hallway. Although he was not allowed to work directly with residents, he tagged along with a few nurses. Then he saw what was happening outside the building.

“When I saw a car go past the window and debris flying outside the window, that’s when I started screaming at everyone,” he said.

Simonds ducked into a small closet with about four other people, where he dived underneath a table for protection. He said the tornado blew open the doors of the nursing home and imploded the windows before lifting off sections of the roof, taking a few people with it, and scattering what was left.

“It just annihilated the whole building,” he said.

Rodney Oglesby, 57, a Greenbriar resident for about a year, was at an auction in north Joplin when the tornado hit. He returned to the nursing home moments after the storm had passed to find everything gone.

“It was all rubble,” he said. “There wasn’t nothing standing.”

Keith Robinson

About 80 residents and 20 staff members were inside the nursing home the night of the tornado, according to Greenbriar administrator Bobbie Misner.

She praised the staff for their dedication to their patients after the storm. She said some staff members stayed with residents in the ruins of the nursing home, while others traveled to different triage centers with injured patients.

One heroic staff member, Keith Robinson, 50, was found in the rubble with two elderly residents in his arms, she said. All three had died of their injuries.

“Caring for his residents — that was his life,” she said of Robinson.

Emergency procedures for severe weather involved moving residents into inner hallways and closing all doors to the residents’ rooms to avoid flying glass, said Bill Mitchell, who represents a consulting oversight company for the operator of both the Greenbriar and the Meadows Care Center on West 32nd Street.

“That’s exactly what happened at Meadows, and that’s why there were no serious injuries (at that location),” he said. “At the Greenbriar, the procedure would have been the same.”

But even the best emergency plan could not have held up against a direct hit from the ferocious storm, he said.

“When that tornado hit that building, it immediately imploded it, and therefore no matter where those individuals were, they were subject to the destruction that the wind brought about,” he said.

Storm severity

Skilled nursing centers are required under federal regulations to have “detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather and missing residents.” They must also train employees in those procedures, review them periodically and carry out unannounced staff drills, under the regulations.

In addition, state regulations require that skilled nursing units consult with local fire departments each year about their written plans.

Multiple efforts to reach state regulators through Jacqueline Lapine, spokesperson for the Department of Health and Senior Services, or to determine whether the state plans to study the Greenbriar situation, as it had investigated a fatal fire at the Anderson Guest House five years ago, were unsuccessful.

Jon Dolan, executive director of the Missouri Health Care Association, said his group will “carefully consider” any potential efforts by state regulators to evaluate safety measures for nursing homes. The group, he noted, had previously supported a 2007 law mandating sprinkler systems in nursing homes following the 2006 Anderson Guest House fire that killed 11 people.

But he also said that “no amount of regulation” of nursing homes can compete with the devastation left by an EF-5 tornado.

“A category 5 (tornado) will take out just about anything,” he said. “These people die because of the severity of the storm, and there are no regulations that are going to save them.”

Fate of residents

Dale Arsenault, 52, had been living at the Greenbriar for about two years. He had just finished eating dinner that Sunday when the tornado alarms sounded, said his mother, Sandy Lautenschlager, of Rogue River, Ore.

She said her son and other residents were shepherded into the hallways, but they were no match for the deadly storm.

Arsenault was found later that night amid the debris with a severed leg. He managed to tell doctors his name and the names of his mother and sister, but he never fully regained consciousness, Lautenschlager said.

Surgeons at Freeman Hospital West eventually amputated his leg above the knee because they couldn’t get all of the debris out, she said. He was transferred to the University of Missouri Hospital in Columbia, where doctors removed his crushed right arm above the elbow, she said.

Then came mucormycosis, which has infected about a dozen tornado victims and killed at least five. The fungal infection attacked Arsenault’s body; surgeons removed his muscles and soft tissues piece by piece until he was finally taken off life support and died.

Another resident, Amonda Eastwood, 49, was outdoors as the tornado approached, said her mother, Sondra Crabtree, of Miami, Okla. She was with at least one other resident in the gazebo when debris began flying toward them, her mother said.

A quadriplegic who was paralyzed from the neck down, Eastwood had just enough mobility in one arm to operate her wheelchair, but she could not reach the door of the nursing home in time, Crabtree said.

Her neck, originally broken in an accident in 1997, was broken a second time by the force of the tornado’s winds. She died instantly, her mother said.

Greenbriar resident Nancy Douthitt, the oldest victim of the tornado, was pulled from the rubble by an employee of the nursing home, said her son, Bob Douthitt, of Tulsa, Okla.

The 94-year-old, described as soft-spoken and easygoing, died of injuries caused by flying debris. Douthitt identified her body by providing the numbers that matched those printed on the Pacemaker in her left shoulder.

“I don’t know how anybody survived, just looking at the damage at the nursing home,” said Douthitt, who arrived in Joplin the morning after the tornado. “It was totally flattened with cars on top of it.”

Studying Joplin

The primary concern with severe weather at a nursing home is getting residents, many of whom have cognitive or mobility issues, to safety, said Brenda Phillips, a researcher with the Center for the Study of Disasters and Extreme Events and a faculty member in the Fire and Emergency Management program at Oklahoma State University.

“It is distance traveled that is really the issue,” she said.

That’s why emergency preparedness is key, particularly in nursing homes, where the resident and employee turnover rate can be high. The ideal, she said, is working through different scenarios with each patient to ensure that everyone knows what to do when disaster strikes.

Tim Lovell, with Tulsa Partners, which focuses on building disaster-resistant communities, said the tornado has provided a “teachable moment” to launch a dialogue with engineers, architects and others about what can be done to improve safety.

“The Joplin experience is going to offer an opportunity to visit the level of risk we have in our community with long-term care and other facilities,” he said.

The devastation of the Greenbriar is also causing other local nursing homes to re-evaluate their own disaster plans.

The severe weather plan at Spring River Christian Village, which was undamaged in the storm, calls for the movement of residents into the hallways in the case of a severe thunderstorm or tornado warning, said Rick Keller, executive director. An evacuation plan also requires that residents on the second and third floors move to the first-floor hallways, he said.

“The corridors are generally picked because there are no windows,” he said. “Because of the numbers of people and the speed at which you have to get it accomplished, you can’t put them in a smaller enclosed area that may be better.”

Keller said he and other leaders at Spring River anticipate reviewing their emergency plans, particularly studying how the building uses its corridors.

‘Refuge of choice’

“That’s one of the things just starting to surface now, looking at those policies and procedures,” Keller said. “Corridors, whether we like it or not, have been the refuge of choice, and it’s for convenience’s sake. It’s the best place we have, given the time frame we have to work with (in a tornado).”

When asked whether there has been any discussion of adding storm shelters or safe rooms, Keller said: “I think those are subjects that are just starting to surface.”

Joplin city officials have expressed interest in strengthening building codes but have stopped short of requiring that buildings have storm shelters or safe rooms, often defined as concrete or steel-reinforced bunkers than can be built above or below the ground. Those involved in studying natural disasters say that safe rooms are worth looking into to increase one’s chances of survival.

Ernst Kiesling, executive director of the National Storm Shelter Association, said he does not favor requiring storm shelters in buildings except “possibly for the most vulnerable populations, such as (in) nursing homes and mobile home parks where people are really not in a position to help themselves.”

Shelters could be particularly beneficial to nursing home residents, who can be less mobile and rely on others for safety, he said.

“I think we owe it to people like that to offer them protection,” he said.

When asked whether a shelter could have made a difference in reducing the number of fatalities at the Greenbriar, Kiesling said: “Oh, indeed. I think a properly designed and built safe room that meets the standards would provide a very, very high degree of occupant protection and would have saved those people.”

Gay Jones, regional disability integration specialist with the Federal Emergency Management Agency, also encouraged the use of concrete safe rooms in nursing homes, as well as the use of solid emergency preparedness and evacuation plans.

“A nursing home has its own regulations, but they might be really, really smart to build in a safe room,” she said.

Future plans

Don Bedell, who represents the Greenbriar’s owners, said the nursing home will be rebuilt. When asked whether plans might include new safety features, such as a safe room or storm shelter, he indicated that it was too soon to know.

“We have not had the time to begin to delve into those types of issues because we’re giving every consideration that can possibly be given to the people that have been displaced and the trauma that people have had to face as a result of this accident,” he said.

As for Wilson, the 83-year-old survivor, she hopes for now to stay out of the path of any more tornadoes.

“One time’s enough,” she said. “One time was plenty.”







Metro Editor Andy Ostmeyer and Scott Blanchard, on special assignment to the Globe, contributed to this report.