On May 22, 2011 a tornado tore through the small town of Joplin, Missouri, killing 161 people and triggering the largest insurance payout in state history. Damages neared $3 billion. One of the more than 900 buildings destroyed or badly damaged was St. John’s Mercy Regional Medical Center. The EF5 tornado ripped apart St. John’s roof and ravaged its structural systems, rendering it useless during the disaster’s aftermath. Its owner and operator, the Catholic healthcare conglomerate Mercy, wasted no time in their response.

“I was home having dinner with my family when I got the phone call,” said Norman Morgan, HKS principal in charge of the project. “We said, ‘we’ll do whatever we can to be there.’”

HKS has a long working relationship with Mercy, whose Joplin facility was one of only two hospitals in the city serving the population of 50,000. But Morgan said the Joplin job was unlike any they had taken on before. Mercy gave the design team two tasks: provide shelter for an immediate response, and help the town recover long-term by erecting a new hospital as soon as possible.

“You had to get something that was at least temporary, and then you also had to be thinking three years out, five years out for a replacement,” said Ryan Felton, project director for McCarthy Building Companies, who noted the construction firm “had boots on the ground within 24 hours after the tornado.”

Working out of a vacant warehouse nearby, they had a 160,000-square-foot modular hospital up and running less than one year later. Using a combination of federal emergency relief money, the old hospital’s insurance claim, and the healthcare company’s own capital dollars, Mercy enlisted HKS to draft a disaster-resilient replacement facility totaling 890,000 square feet that could be designed and built in less than four years.

“That commitment and that promise really set the stage,” said Felton. They opened the new hospital in March. “It was pretty emotional to hear everyone’s speeches,” said Felton. “We’re standing here three years later and there’s a facility behind them ready to open doors.”

Mercy’s reconstruction became a kind of real-life case study for disaster resilient design. The design team reviewed all kinds of standards for high winds, borrowing from the International Code Council’s committee on storm shelters, Federal Emergency Management Agency standards, and the building code from hurricane-prone Miami-Dade County.

During the tornado, 200-mile-per-hour winds ripped up the hospital’s ballasted roof, turning building materials into projectiles that shattered windows. The only hospital unit with intact glass after the storm was outfitted with high-impact laminated glass, which became standard throughout the building in the new design. Intensive care units and other parts of the hospital sheltering immobile patients got extra reinforcement in the form of premium windows designed for wind gusts up to 250 miles per hour. The old hospital’s precast exteriors also survived, so the new building features sturdy, precast facade and structural components—systems that helped accelerate construction.

Though new, the recently reopened Mercy hospital retains some local legacy. They were able to salvage some materials from the wreckage, reusing stone, travertine tile, and wooden crosses from the old hospital’s chapel. During the tornado, debris destroyed the building’s mechanical systems, throwing the air handling units into nearby generators and knocking out the power. In the new building, HKS enclosed Mercy’s mechanical equipment in the penthouse instead of on the roof, and imbedded the backup generators into a hillside 450 feet from the main site. Safe zones on each floor, stocked with emergency supplies like shovels and flashlights, are available for patients and staff caught in a future, worst-case scenario catastrophe.

“It’s hard to say you’re going to resist every tornado,” said HKS’ Morgan, adding that no design can truly be tornado-proof. “But we’re doing everything we can so we don’t have the disaster we had in 2011.” Felton said the disaster-resilient elements of Mercy’s design only increased its price tag by a marginal 3 percent.

“I think we’ll see much more of it as we’re looking at other hospitals around the country, people are asking us about these features,” said Morgan. “It was very touching to see that Mercy made the commitment to bring this hospital back. It has really helped bring life back to Joplin. Three years ago you wouldn’t have thought this community would have withstood this. For an architect to be a part of that, fulfilling that, it’s at the top of my list of my career.”