In this article, I review how the Oklahoma Blood Institute (OBI) responded to 2 disasters: the bombing of the Alfred P. Murrah Federal Building on April 19, 1995, and the tornadoes that hit Oklahoma City and the surrounding area on May 3, 1999. We learned some important lessons about handling large numbers of donors, transporting blood supplies, planning for future disasters, and helping the public heal. I hope that many of these insights will be useful for the medical community as a whole.
OBI has 7 blood centers in the state of Oklahoma: in Oklahoma City, Lawton, Enid, Ada, Ardmore, Tulsa, and Ponca City. OBI supplies blood to about two thirds of the transfusing hospitals in the state (71 institutions). The main center is in Oklahoma City, and each subcenter is 85 to 100 miles away from the main center. The subcenters act independently, except for laboratory testing, component production, and information services, which are centralized in Oklahoma City.
Blood, of course, is very important in a disaster. Not only does it allow blood transfusions, which either save lives or improve the quality of life, but it serves as an insurance policy of sorts. Surgeons will not perform operations unless blood is available. Based on that, the blood serves a purpose even if it is never used. When a disaster occurs, no one can estimate how much blood will be needed. Therefore, it is critical to have adequate supplies of blood products on the shelves of the hospitals served and of the blood center itself.
THE BOMBING
The bombing that occurred at 9:03 AM on April 19, 1995, was incredibly powerful—affecting not only the Alfred P. Murrah Building but many other buildings in downtown Oklahoma City as well. The bomb, detonated in a truck parked in front of the federal building, blew the building apart (Figure 1). Destruction was everywhere. The blast effect was felt more than 50 miles away.
Figure 1.
The Alfred P. Murrah Building after the bomb on April 19, 1995. Photo: Oklahoma City Fire Department.
Overall, 168 people—149 adults and 19 children—died in this disaster; if you include the 3 unborn children, the total is 171. Many people were killed outright, and many others were injured. Some people were pulled out of the debris as late as 2 or 3 days after the bombing. There were many blast injuries, burns, and penetrating wounds. Glass had penetrated many of the victims' critical vessels and organs, and much blood was required. Over the next few weeks, blood was required as victims underwent orthopaedic and plastic surgery.
Our blood center, which is half a mile from the bombing, shook violently. At the time of the bombing, we knew something terrible had happened, but we didn't know what it was. At the moment the bomb went off, nobody knew that this was an act of terrorism. Within moments we learned of an explosion and, recognizing that the victims would need blood, we began moving blood to the major hospitals in Oklahoma City before any of the victims had been pulled from the blast site. As it turned out, all of the emergency blood needs were met by blood that had been donated before the tragedy and was available on our shelves. Blood reserves on the shelf at OBI were the bottom line that day.
Blood donations in response to the bombing
Within an hour of the bombing, people began lining up to donate blood—all in all, 7000 donors turned out in 72 hours. I had estimated that we could draw a maximum of 1500 or 1600 units of blood a day. In that first day after the bombing, OBI staff drew about 2800 units of whole blood. People lined up outside the building and waited for hours. Part of handling the disaster for us was finding a way to accommodate all of these donors; we were not equipped to handle that many people. We immediately developed some strategies for triaging the large number of donors. We separated donors who were already in our system from first-time donors, and within the established-donor group we separated those with group O blood, so that the most needed blood would be available for the victims.
The people who came in to donate were stunned and dazed (Figure 2). They could not believe such an act of terrorism could happen in Oklahoma City. Unfortunately, early on, a non-American was wrongly accused of the bombing; no one wanted to believe that an American would or could do this.
Figure 2.
Some donors who came out after the bombing. They tended to be stunned and dazed. Photo: Oklahoma Blood Institute.
In addition to the blood drawn at our center downtown, blood was drawn at Tinker Air Force Base by their staff using a special provision under the Food and Drug Administration that relaxes the rules somewhat in a disaster situation (Figure 3). Otherwise, OBI was the only facility in the entire Oklahoma City area that could take donations; none of the Oklahoma City hospitals draw blood.
Figure 3.
Blood being drawn at Tinker Air Force Base in response to the bombing. Photo: Oklahoma Blood Institute.
The third day after the bombing, we put up a sign in front of our center that said, “Thank you, Oklahoma, for giving blood.” We also put ads in newspapers across the state, thanking people in Oklahoma for coming out and donating. The business community in Oklahoma City recognized the importance of blood donation during the bombing; on the day of the bombing, Lucent Technologies presented OBI with a check for $10,000 to defray our extra expenses, and restaurants such as Wendy's and McDonald's provided free food for our donors. Everybody wanted to help.
Far from being profitable for OBI, the increased number of donations was very, very costly. In addition, such a large number of donations was not needed to meet the needs of the bombing victims. However, we were committed to serving our donors, since the process of donating helped them to heal. Cindy Grantham, one of our blood donors and volunteers, stated, “I hope your center fully appreciates the role it played in healing the state. Whether or not the amount and types of blood were needed, donating was the only outlet for many people. Thanks again.”
Our staff worked day and night without complaining, and their efforts were recognized by the hospitals. St. Anthony Hospital in Oklahoma City, for example, wrote, “Words cannot express the fantastic job you did during the disaster last week. You kept us supplied with blood and components better than we ever could have imagined. It's reassuring to know that when the needs are so great, we can count on you to do a superlative job.” Both the statement by Cindy Grantham and the note from St. Anthony Hospital were motivational to our staff.
As it turned out, one third of the adults who died in the blast were blood donors in our system. OBI created a memorial to these blood donors: a granite bench engraved with the names of the donors sits in the front courtyard of the blood center (Figure 4). Some of the individuals who died had donated blood just a few days before the bombing.
Figure 4.
The granite bench memorial to the blood donors among the bombing victims. The bench sits in the front of the courtyard at the Oklahoma Blood Institute, which is half a mile away from the site of the bombing. Photo: Oklahoma Blood Institute.
We've been asked about what we did with all of that blood. Since we couldn't let it outdate, we exported it out of our system. Interestingly, other areas also had a lot of blood because people everywhere in the country donated in response to the bombing as a way to give of themselves. There was actually too much blood in the country at that point. That tells us that the donors are out there. A lot of our first-time donors disappeared after the bombing and did not donate again (although some donated after the tornadoes). Since our regular donors could not donate for 56 days, we experienced a slump after the bombing. We had to plan for a potential shortage in the system a month and a half after the surge in donations at the time of the bombing.
THE TORNADOES
The tornadoes that hit Oklahoma City and the surrounding area in the early evening and night of May 3, 1999, had the fastest winds ever recorded on the planet: 318 miles per hour. The number of people who died from this disaster, 44, was far less than with the bombing, partly because people knew it was coming. Some people had experienced tornadoes before and knew what to expect. Local television stations played an incredible role in preparing Oklahoma City residents for the disaster and clearly deserved credit in reducing the loss of life.
The destruction was unbelievable. It looked as if a mile-wide rotary mower had gone through a section of the city and ground up everything. The trees were completely stripped of their limbs and their bark. Cars were totaled and homes destroyed. For the first time, a disaster directly involved OBI: 11 of OBI's 250 Oklahoma City employees were affected, and 9 had their homes completely demolished (Figure 5).
Figure 5.
An OBI employee's home that was destroyed after the tornado hit on May 3, 1999. Photo: Oklahoma Blood Institute.
Despite the fact that some staff members were dealing with personal disasters, the staff as a whole were extremely generous. Without being called in, they arrived at OBI to help. They knew they could make a difference and that they would be needed.
Transporting blood from subcenters to the main center in Oklahoma City and from the main center to the hospitals was easy at the time of the bombing but difficult during the tornadoes. With the tornadoes, the roads were blocked and debris was scattered everywhere. The police prohibited vehicles from going to certain areas, and we had to ensure that they understood the importance of letting our vehicles through.
As an example, we had sent 50 units of O-positive blood to Midwest City Hospital, which is about 10 miles from OBI, when hospital staff called and said, “We're down to the last 2 units. Where is the blood?” We had sent it 20 minutes before, but the driver was caught in traffic and debris and couldn't move. Be cause we had the supply, we called the Oklahoma City Police. In less than 2 minutes, a police car was at OBI to pick up blood, and the police arrived at the hospital within 10 minutes. A good relationship with the state highway patrol and local police force is critical when help is needed to deliver blood in these difficult situations.
Blood donation in response to the tornadoes
For this disaster, 3000 people came out to give blood in a 3-day period—still a very large number. However, the attitudes of the donors were different. Rather than being struck with disbelief (as with the bombing), they knew this disaster was coming. They gave of themselves, yet they were not as willing to wait to donate as they were with the bombing. The “slump effect” was not as great after the tornadoes as after the bombing.
A COMPARISON BETWEEN THE 2 DISASTERS
The Table highlights some points of comparison between the 2 disasters from the perspective of OBI. The one word that most differentiated the disasters was fear. Terrorist attacks evoke a different type of fear than natural disasters. People were worried about the possibility of other bombs; they were worried about what was going on in our country and how the bombing could happen.
Table.
The bombing and the tornadoes from the perspective of the Oklahoma Blood Institute
| Factor | Bombing | Tornadoes |
| 1. Location | One site; the event occurred during the day. | Multiple sites; the event occurred mostly at night. |
| 2. Cause | Terrorism. | Natural disaster. |
| 3. Reactions of the general public | They were stunned, shocked, dazed, and scared; they had marked disbelief and later had extreme anger. They had received no warning and had no expectations. | They were stunned, and some were dazed. Because they were warned, they had greater acceptance, understanding, and expectations. |
| 4. Blood donors | 7000 in 3 days. Donors were tolerant of waiting; they needed to donate to “heal”. | 3000 in 3 days. Donors were intolerant of waiting. They donated to help others, not heal themselves. |
| 5. Situation at the Oklahoma Blood Institute | Staffing was not a problem, but staff were overtaxed. Costs increased significantly. | Staffing was not a problem, but staff were overtaxed. The roads were blocked with debris and hazards. |
| No components were available. There was a “slump” effect on regular blood donations. | Costs increased somewhat. No components were available. | |
| 6. Victims | 168 dead. The injured were bleeding to death. Victims blast injuries required >300 units of red blood cells in 3 days. | 44 dead. Bleeding was not as much of a problem; victims used <100 units of red blood cells in 3 days. |
PREPARING FOR DISASTERS
There are 4 essentials for crisis planning at a blood center: 1) a crisis plan, 2) infrastructure, 3) backup/redundancy, and 4) blood on the shelf. Although proactive planning is important, people tend to work in a reactive mode when the disaster strikes. We learned a lot of things on the spot, such as how to handle large numbers of donors and how to triage them. Our plan is not to practice crisis medicine. In order to avoid practicing crisis medicine, we operate as though there will be a crisis tomorrow. Our infrastructure included additional subcenters, and they had blood on their shelves, which provided backup and redundancy. Ultimately, our crisis plan is to have blood on the shelf. Regardless of how good the crisis plan or the infrastructure is, if blood isn't available at the moment the disaster occurs, the whole system will fail.
Looking back at our blood supply on April 19, 1995, the center in Oklahoma City had 491 group O units and 1258 units of all types of blood, in addition to about 10,000 different non–red cell blood products. We had another 150 O-positive and 65 O-negative units of red blood cell units at our subcenters, which we moved right away to Oklahoma City. We asked hospitals to curtail elective surgery at that point, which they were willing to do. On April 19, we shipped 600 units of red cells, yet only 300 were actually used for the victims.
CONCLUSION
The Oklahoma City bombing was highly emotional, with everyone wanting to help in some way to heal the terrible tragedy. The tornadoes were not as emotional because of less loss of life and the cause being a natural event. However, the physical destruction was much greater with the tornado than with the bombing and clearly influenced many more lives. The anger over the tornado has subsided. The anger from the bombing, I'm convinced, will never subside.
OBI was able to respond extremely well in both disasters because of the amount of blood on the shelf (the bottom line) and because of the infrastructure in place to handle large numbers of donors and rapidly distribute blood to the hospitals receiving patients.