KDEM

Mitigation Case Studies 


Clara Barton Hospital 
Shelter 

Hoisington, Kansas

May 2004


FEMA 426



Severe damage to the hospitals clinic building.



Hospital Critical Facility Shelter

 


On April 21, 2001, an F4 tornado struck Hoisington, Kansas (population 2,975), severely damaging 230 
homes and businesses and leaving one person dead. The Clara Barton Hospital sustained extensive 
damage, estimated at nearly 1.5 million dollars. The destruction and potential loss of life from that event 
was an alarming wake-up call for the region. 

Following the tornado, Lloyd Arnold, of the Kansas Division of Emergency Management (KDEM), and Hospital 
Administrator Jim Turnbull discussed ways to ensure the safety of the patients and staff in the event of another 
tornado. They decided to build a shelter at the hospital  the first hospital shelter in the state to meet the design, 
performance, and construction criteria presented in Design and Construction Guidance for Community Shelters, 
FEMA publication 361. 

RED CROSS

KDEM

Severe damage to metal stud walls of 
the hospitals clinic building.


Rear view of damaged clinic building 
(left) and main hospital building 
(right).

KDEM

Between 1950 and 2003, the National Climatic Data Center reported 
51 tornadoes for Barton County resulting in 2 deaths and 39 injuries.



At 7:49 p.m. on 
April 21st, ham 
radio operator 
Carl Andersen, the Barton 
County Emergency 
Coordinator for emergency 
radio communication at 
the Emergency Operations 
Center (EOC) in Great Bend, 
Kansas, sent out a warning 
that storms were reported 
in the neighboring counties 
to the west. At that point, 
the warning was only for hail. However by 9:15 p.m., it had changed to a tornado warning because of funnel 
cloud sightings in the Hoisington area. At 9:30 p.m., another radio operator, Larry Bruce, reported back to the 
EOC that a storm had just passed through Hoisington, approximately 10 miles north of Great Bend. Little did 
anyone suspect at the time that the reported storm had produced an F4 tornado. These amateur radio exchanges 
are described by Robert Haneke, Kansas District 5 Emergency coordinator, WGOQ, in Anatomy of a Tornado 
Response: Hoisington, Kansas (http://www.arrl.org/news/stories/2001/04/26/3/). 

With severe weather approaching, Clara Bartons Administrator Jim Turnbull gave the staff instructions to move 
the patients to safer areas within the hospital. No sooner had the patients been relocated to a central hallway with 
no windows and the visitors moved into the basement, than the tornado hit the hospital, ripping the roof off its 
clinic and smashing nearly every window in the main building. 
Approximately 30 people were in the hospital at the time of the 
tornado, including 3 patients, a newborn baby, staff, and visitors. 
The sirens in town did not sound that night because the poles 
they were mounted on snapped during the first few moments of 
the storm. 

After the danger from severe weather had passed, the patients 
were moved from the hallway to a triage area set up at the back 
of the hospital where four windows remained intact. The hospital 
had reserve power from an emergency generator, which kept 
lights and electricity on within some areas of the main hospital 
building. Because of the damaged condition of the hospital, the 
local Disaster Field Office and the Red Cross worked together to 
set up an emergency field hospital at the Municipal Building in 
Hoisington. After the tornado had passed, patients were moved 
to the field hospital.


What to do in the event of 
a tornado when a shelter is 
not available:

If you are in a building without a shelter 
or designated shelter area:

 
Go at once to the basement or the 
lowest level of the building. Go to 
an inner hallway or a smaller inner 
room, without windows, such as a 
hallway, bathroom, or closet.

 
Avoid places with long-span roofs 
such as auditoriums and cafeterias.

Visit FEMAs website for more 
information  www.fema.gov/mit/
saferoom



Clara Barton 
Administrators Take Action

This tornado incident provided 
the hospital staff with enough 
reason to act, and act quickly. A 
decision was made to reconstruct 
the clinic, not merely the way it was 
constructed previously, but in a way 
that would enable the hospital and 
community to provide an improved 
shelter in terms of both design and 
construction.

Funding the Shelter

Funds for the shelter were obtained 
through the FEMA Public 
Assistance Program. Following a 
Federally Declared Disaster, this 
program provides supplemental 
Federal disaster grant assistance 
for the repair, replacement, or 
restoration of disaster-damaged, 
publicly owned facilities and 
the facilities of certain Private 
Non-Profit (PNP) organizations. 
Eligible PNP facilities must be 
open to the public and perform 
essential services of a governmental 
nature. Public assistance funds will 
cover at least 75 percent of the cost 
of the project.

FEMA modified the Public 
Assistance Program in August 
1998 to provide more flexibility 
in funding mitigation measures 
under Section 406 of the Robert 
T. Stafford Disaster Relief and 
Emergency Assistance Act. 



Critical Facilities Must Operate During and 
Following a Disaster

It is necessary for hospitals and other critical facilities, such as fire 
stations, police stations, and EOCs, to remain operational during an 
event and maintain service afterwards. The local hospital is typically 
the first place to which the injured are taken after a disaster occurs. 
If the hospital cannot function because of damage to the building, 
then those seeking immediate medical attention must be rerouted to 
a functioning hospital. In rural areas such as Barton County, towns 
are spread out and the next hospital could be many miles away.

Construction Techniques Can Help Minimize 
Damage to a Building

While it is not always economically feasible for entire buildings to 
be constructed as shelters that meet FEMA 361 criteria, certain 
construction techniques such as strengthening connections between 
structural elements and systems and specifying the use of stronger 
and more wind- and impact-resistant materials on the building 
envelope will increase buildings resistance to wind and debris impact 
damage. When the Clara Barton Hospitals clinic building was 
reconstructed, the connections between the roof and walls were 
strengthened and a brick veneer was added to increase the exterior 
walls resistance to the impact of windborne debris.

The main hospital building survived the F4 tornado with broken windows 
and power loss. A new emergency generator, large enough to 
provide power for the entire building, was installed after the event because 
the existing generator served only some areas of the hospital. 
The protection and maintenance of these emergency generators is a 
critical issue. Emergency generators must be protected to the same 
level as the shelter occupants. The new generator for the hospital 
is located outside the building, mounted on a concrete slab that is 
adjacent to an exterior wall and provided with a lockable steel shell. 
To ensure its reliability during an emergency, the generator is tested 
every Monday by the hospitals maintenance staff.

KDEM

Front view of damaged hospital building.



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Shelter Layout

The new shelter is located between the main hospital 
building and the clinic building to facilitate easy 
access from both areas. The shelter is connected 
to the two buildings with interior doors that meet 
the criteria presented in FEMA 361, Design and 
Construction Guidance for Community Shelters. The 
shelter has one exterior door (meets the FEMA 
361 criteria) and no windows. The shelter has 1,026 
square feet of finished area and is designed to 
accommodate 14 patients  assuming 6 are seated, 
6 are in wheelchairs, and 2 are bedridden  and 30 
standing staff members, with space for an additional 
67 evacuees. The maximum number of occupants 
the shelter is designed to hold is 111. The shelter 
layout includes one large open area, two restrooms, a 
mechanical room, and a storage room. Typically, the 
open area is used for meetings and training classes.

KDEM


This photograph, taken before 
construction of the shelter, shows the area 
between the hospital building (left) and 
clinic building (right) where the shelter 
is now located

KDEM

Shelter, as seen from the front, between hospital building (left) and 
clinic building (right).


To design a successful shelter, the architect or engineer should 
be familiar with the high loads caused by extreme wind, the guidance 
provided by FEMA 361, Design and Construction Guidance 
for Community Shelters, and the special inspections and quality 
control required.

FEMA 361, contains tornado and hurricane statistics, wind speed 
and wind hazard data, a shelter benefit-cost model on CD-ROM, 
evaluation checklists for potential shelter areas in existing buildings, 
and other information that will help the reader assess risks 
in a specific area, determine the need for a shelter, and decide 
where and how a shelter should be built. FEMA 361 also contains 
information about meeting the requirements of the Americans with 
Disabilities Act in shelter design.



Shelter Construction

The extreme forces of a tornado 
require that a shelter envelope 
be designed to resist high wind 
pressures and the impact of 
windborne debris. To calculate 
the wind and debris loads for 
the new shelter, architect Linnea 
Winter and structural engineer 
Jim Jantz, of MKEC Engineering 
Consultants, Inc., Wichita, Kansas, 
consulted FEMA 361.

The walls, roof, and doors to the 
shelter were designed, at a minimum, 
to resist 250 mph (3-second gust) 
wind speeds and the impact of 
windborne debris (15-pound wood 
2 x 4) traveling at 100 mph. 

Although the shelter adjoins the 
hospital and clinic (see plan view 
on next page), it is designed as a 
stand-alone structure; therefore, 
it does not rely on the walls of 
the hospital building or clinic 
building to resist the extreme wind 
loads. This design helps ensure 
the safety of the occupants in case 
the hospital or clinic buildings are 
damaged extensively or destroyed.

The wall system is Insulating 
Concrete Form (ICF) 
construction. This type of 
construction comprises 12-inch 
poured-in-place concrete, with 
polystyrene forms left in place, 
reinforced with #5 bars spaced at 8 
inches on center (see cross-section 
of wall and roof on next page).

Shelter Capacity and Size

FEMA 361 includes requirements for shelter size based on the number 
and type of expected shelter occupants. For the Clara Barton Hospital 
shelter, the required size would be as follows:

Total of 14 patients (average)

6 seated patients at 6 square feet each = 
36 square feet

6 patients in wheelchairs at 10 square feet each = 
60 square feet

2 bedridden patients at 30 square feet each = 
60 square feet

Total of 30 staff (average)

30 standing adults at 5 square feet each = 
150 square feet

Total of 70 additional evacuees (average)

70 standing adults at 5 square feet each = 
350 square feet

Total area required to meet FEMA 361 criteria = 
656 square feet

The shelter also includes restroom space for two toilets.*

Restrooms = 
128 square feet

* FEMA 361 recommends that a minimum of two toilets be provided 
in the shelter but does not require or recommend a minimum area for 
the toilets.

The shelter also includes the following: 

One storage room = 
64 square feet

One mechanical room = 
64 square feet

Circulation area as required by design = 
80 square feet

Total area required by design of hospital shelter = 
992 square feet

Actual finished shelter area is 14 feet x 73.3 feet = 
1,026.2 square feet

As these figures indicate, the Clara Barton Hospital shelter meets the 
size requirements of FEMA 361 while including space for additional 
functions. 



The roof structural system consists 
of pre-cast, pre-stressed, 8-inch-
deep hollow-core concrete panels 
covered by a 4-inch reinforced 
concrete slab (#4 bars spaced at 12 
inches on center in both directions, 
longitudinally and laterally). The 
concrete panels are designed for a 
gross wind uplift pressure of 206 
pounds per square foot.


Plan View

KDEM

All perimeter walls were constructed with insulating concrete 
forms and reinforced with #
5 
bars spaced 
8 
inches on center to 
resist 250 mph wind speeds.

Plan view

KDEM

Interior of shelter, showing insulating concrete 
form perimeter walls.

Cross-section of shelter wall 
and roof adjacent to Clara 
Barton Clinic building.



The architect and the structural engineer 
ensured that the connections between the shelter 
foundation and walls and between the walls and 
roof were adequate to resist the design loads 
specified by FEMA 361.

The Clara Barton Hospital shelter uses a gravity 
or passive air ventilation system with ducts that 
open to an outside air supply. A benefit to a 
passive air system is that no electricity is required 
to operate the system. The hospital shelter has 
both vertical (roof fresh air intakes  see cross-
section on next page) and horizontal (wall fresh 
air intakes) ventilation openings. Although 
horizontal ventilation openings may be easier 
to design and construct, vertical ventilation 
openings have a smaller probability of being 
penetrated by a missile. All ventilation openings 
must be protected and must meet the missile 
impact requirement presented in FEMA 361. 
The air intakes of the Clara Barton shelter are 
protected by a grid of #3 reinforcing bars spaced 
at no more that 3.5 inches on center. This steel 
grid should prevent windborne missiles from 
damaging the ventilation system.


KDEM

KDEM

Construction of the reinforced ICF exterior wall at the rear of the 
shelter (top). Interior walls of shelter with gypsum board finish 
(bottom).

Ventilation

Fresh air venting is required in the construction of all shelters. The shelter ventilation system must be 
capable of providing the minimum number of air changes required by the governing building or mechanical 
code for the shelters occupancy classification under normal use. For example, if the shelter will typically 
be used as a meeting room, the ventilation would be designed for the occupancy classification of the meeting 
room, not the shelter capacity. Although the ventilation system may be overwhelmed in a rare event 
when the area is used as a shelter, air exchange will still take place. However, the designer should confirm 
with the local building official that the ventilation system may be designed for the normal-use occupancy. 
In the event the community where the shelter is to be located has not adopted a model building and/or 
mechanical code, the requirements from the most recent edition of the International Building Code (IBC) 
are recommended. The IBC is published by the International Code Council (www.iccsafe.org).



A Design Challenge: Doors

Doors posed a particular problem in the design of 
this shelter. The architect needed to find double doors 
that met the criteria specified by FEMA 361. In 
addition, the hospital had a special need for double 
doors without a center mullion (center vertical 
support) that would allow rolling beds and medical 
equipment to be moved into the shelter area. 

 After checking with area suppliers to determine the 
storm protection door system most often used in the 
region, the architect selected doors manufactured by 
Steelcraft. At the time, Texas Tech University was 
testing Steelcrafts Paladin double-door model 
for compliance with FEMA 361. After Texas Tech 
completed the testing and verified that the Paladin 
double doors did meet FEMA 361 criteria, the doors 
were shipped to the hospital and installed. 

FEMA 361 requires that all doors and windows be 
able to resist the impact of a 15-pound wood 2 x 4 (referred to as a missile) traveling horizontally at 100 mph. 


CAUTION
If a powered 
ventilation 
system 
is used, it 
should be 
connected 
to a backup generator to ensure 
that ventilation will occur during a 
power outage. The generator and 
its related components (e.g., fuel 
supply, transfer switch) must be 
protected to the same degree as 
the occupants of the shelter. Therefore, 
sources of backup power 
located outside the shelter must 
be housed within an enclosure that 
meets FEMA 361 criteria.

Cross-section of roof fresh air intake.


KDEM

The double door without mullion allows hospital staff to move patients in 
rolling beds into the shelter.



Doors and windows should be tested with the 
exact installation methods to be used on the actual 
site. Some doors that can resist missile impacts on 
their own have failed as a system when the framing 
attachment to the walls has come loose under 
missile impact and the entire door and frame have 
been pushed out of the wall. Therefore, the door 
frames have to be attached properly to the building 
for the entire system to work. The same concept 
applies to door hardware. Often the door may resist 
debris impacts, but the hardware snaps or bends, 
leaving the door free to swing open. 

Testing of Door Assemblies

Texas Tech University rates complete door 
assemblies  door, 6-point locking hardware 
(single-action activation), and steel frame  based 
on FEMA 361 criteria. These tested assemblies 
include both single and double doors. Door 
assemblies (door, frame, and hardware) that have successfully passed the pressure test (1.75 pounds per square 
inch) and three impact tests (15-pound wood 2x4 traveling at 100 mph) are summarized in the following table.

List of Commercially Available Doors/Hardware Tested at Texas Tech University (TTU)* 
and Found To Comply With FEMA 361 Requirements

Name of Manufacturer

Type of Door/Hardware Tested

Websites

Ceco Door Products

Double-door assembly with removable mullion

www.cecodoor.com

Curries

Single- and double-door assemblies with removable 
mullion

www.curries.com

Steelcraft

Door pairs with mullion

Door pairs without mullion

Door pairs with emergency exit hardware

Door pairs with classroom function hardware

www.steelcraft.com

Securitech

Classroom function hardware, panic bar operator

www.securitech.com

PositiveLock, Inc.

Emergency exit hardware

www.positivelock.com





*Wind Science and Engineering Research Center


clara 
barton 
hospital

View of the FEMA 
361-compliant double door with 
3-point latching 
hardware from inside shelter.



More door assemblies that meet the FEMA 361 
criteria may now be available as a result of testing 
performed since the above list was compiled. When 
reviewing the information on the TTU website, look 
only for door assemblies that have passed the FEMA 
361 test. Note that the door requirements discussed 
in FEMA publication 320, Taking Shelter From the 
Storm: Building a Safe Room Inside Your House, are not 
the same as those presented in FEMA 361.

Multiple Uses Make Shelter Popular 
With Community

The shelter has been very well 
received by the town. It is used for 
city meetings, Lions Club meetings, 
and other town gatherings. It has also 
been used by the townspeople during 
tornado warnings. Lloyd Arnold

According to Jim Blackwell, the 
hospital financial administrator, the 
shelter is open to the general public. 
There are signs in both the hospital 
and the clinic buildings that direct 
visitors and staff to the shelter in the 
case of a tornado warning. A number 
of community residents have retreated 
to the shelter for protection during 
tornado watches and warnings. 

Hospital Administrator Chris Stipe 
has spread the word to the community 
that the shelter is available for use for 
meetings by the town government, 
schools, clubs, and other non-profit 
groups. The hospital uses the shelter 
for educational seminars, displays, 
and staff meetings. Because the shelter space is used by a number of groups, it is an ideal location for providing 
information, educating the public on safety issues related to tornadoes, and promoting shelter and safe room 
construction throughout the community.


clara 
barton 
hospital

KDEM

Signs identifying the room as a shelter are posted inside the hospital (top).

Minimal furniture in the room is light and mobile for easy removal in order to clear the space 
for patients in an emergency (bottom).



Summary

The Town of Hoisington has shown 
remarkable recovery since the violent F4 
tornado in 2001. Photos of the town in 
the aftermath show incredible devastation, 
while now, a few years later, a visitor might 
notice only that the trees along the streets are 
relatively young. The famous Kansas Can Do 
attitude is well represented by the recovery of 
this little town. This attitude has resulted in 
securing a safe place for the patients and staff 
of Clara Barton Hospital and additional peace 
of mind for the community.

Useful Resources for Designing Shelters

Department of Homeland Security/FEMA

Section 406 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act 
http://www.fema.gov/about/stafact.shtm

FEMA 361, Design and Construction Guidance for Community Shelters, Washington, DC
http://www.fema.gov/libraryviewRecord.do?id=1657

FEMA 320, Taking Shelter From the Storm: Building a Safe Rome Inside Your House, Washington, DC
http://www.fema.gov/library/viewRecord.do?id=1536

American Society of Civil Engineers

Minimum Design Loads for Buildings and Other Structures, ASCE 7-02, 2002, American Society of Civil 
Engineers, ISBN: 0-7844-0624-3
http://www.pubs.asce.org/ASCE7.html?99913

Related Websites

FEMA Safe Rooms  http://www.fema.gov/plan/prevent/saferoom/index.shtm

Texas Tech University Wind Science and Engineering Research Center  http://www.wind.ttu.edu/

National Storm Shelter Association  http://www.nssa.cc/


KDEM

A view of the completed hospital complex.