When the warning bells sounded inside the behavioral health center at a Sioux Falls, S.D., hospital shortly before midnight, the clock turned into a stopwatch for staff members working the night shift.
"We had 10 minutes to wake up 102 residents, get them to the center of the building," said David Flicek, the president and CEO of Avera McKennan Hospital and University Health Center in South Dakota's largest city. "And all are safe and sound."
Although a significant tornado had not struck Sioux Falls for years, the Avera Health System hospitals have kept up regular preparedness training. The work paid off when an EF-2 tornado pummeled the hospital campus overnight.
The twister with wind speeds of up to 130 mph also roared over the system's heart hospital after a man was brought in with a heart attack. Doctors and nurses continued operating on the man — and saved his life — as the storm blew past, according to the CEO of Avera Heart Hospital, Nick Gibbs.
"We talk at our hospital about doing drills. I've got to tell you, our staff was courageous," said Flicek.
The National Weather Service has determined that three EF-2 tornadoes struck the city, lead meteorologist Todd Heitkamp said Wednesday.
Dozens of buildings were damaged or destroyed, trees torn up and power lines downed. But no one has been reported killed or even seriously injured. Flicek said seven people suffered minor injuries from falling debris at the hospital campus and another was hurt outside.
Noting that Sioux Falls hasn't experienced a tornado since October 1996, Heitkamp said even the weather service staff ducked for cover as the storm rolled in.
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On top of it all, there was a snafu with the city's outdoor siren warning system. Most of the sirens sounded in southeastern Sioux Falls, where the most serious damage occurred, but they were not activated in the rest of the city. Mayor Paul TenHaken cited a "miscommunication" among staff and vowed it would never happen again.
"I'm owning it. It's my team. It's my administration," he said.
At least 37 buildings collapsed or were damaged. Among them was an Advanced Auto Parts store where a wall collapsed. Kohl's and Best Buy lost part of their roofs and Pizza Ranch suffered heavy damage.
The Red Cross opened a shelter at the Sioux Empire Fairgrounds' armory for people displaced by the storm. The city of about 190,000 people lies about 240 miles southwest of Minneapolis.
Xcel Energy says as many as 25,000 customers were without power at one point because of the damage, but that more than two-thirds of those had electricity Wednesday morning.
The storm system appears to have spared the rest of the state. The South Dakota Department of Public Safety received reports of flooding in Hutchinson and Brule counties, but no assistance was requested.
The same storm system that caused the damage in Sioux Falls dropped heavy rain on parts of north-central and northeast Nebraska.
The National Weather Service said up to 3 inches of rain had fallen on Thurston County, and a flash flood warning was issued there, as well as for Pierce, Cedar, Knox, Antelope and Wayne counties.
The weather service warned of possible severe thunderstorms Wednesday across the Plains and Upper Midwest, stretching from western Nebraska, Minnesota and Iowa to Wisconsin. The likeliest threat was in western Nebraska, and the weather service warned of possible flash flooding in the north-central part of the state.
Lincoln saw some intermittent showers Wednesday morning, and there is a 50% chance for more rain Wednesday night and Thursday morning. The high Wednesday was forecast to top 90 degrees for the second day in a row.