NATIONAL HARBOR, Md. — It is a frightening prospect to consider that the physical and emotional damage done to St. John's Regional Medical Center and its staff by the massive tornado that struck Joplin, Mo., in May 2011 likely would have been far worse had it not been for the hospital's commitment to disaster preparedness.

Without the regular and thorough emergency response training required of the hospital's staff — and, in particular, its nurses — many more lives might have been lost during the horrific twister, hospital officials said on Monday during a presentation at the American Society for Healthcare Risk Management's annual conference in National Harbor, Md.

In the immediate aftermath of the tornado, hospital staff members were able to successfully evacuate more than 180 patients out of the battered hospital — including 24 patients in emergency room care, 10 in labor care or delivery recovery and one surgical patient — despite a total lack of electricity, blocked hallways and stairwells, and severely limited communication capabilities.

“Really, we relied on the nursing staff, who had the knowledge to know what to do,” said Dennis Manley, an administrative vice president for the Mercy Hospital network, which owns the St. John's facility. Mr. Manley said nurses were forced to make several critical, and often life-saving, decisions in near-complete isolation from the hospital's central administration.

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For example, Mr. Manley said, nurses knew that patients' medical records — having been moved to an entirely electronic management system only three weeks prior to the storm — would not be accessible to the doctors receiving the evacuees, which could have led to critical lapses in urgent care. As an alternative, nurses wrote down patients' conditions and last recorded vital signs on their skin in order to provide at least some guidance regarding recommended treatments.

“A lot of independent decisions were made by nursing staff that night who knew they had to get their patients out of that building and get them to a safe area,” he said.

Hospital officials said St. John's also was reasonably well-prepared for logistical issues in the days and weeks after the tornado. Because the facility's information technology and data storage were managed by an off-site third party, the hospital's staff was able to recover patient medical records and recent purchase orders, which proved crucial to resupplying temporary triage centers and neighboring hospitals that had taken on the displaced patients.

However, despite the relative success of their disaster-planning efforts, hospital officials said during the presentation that the entire experience had highlighted certain deficiencies in their preparedness.

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One critical step in minimizing the long-term effects of the storm itself and potential liability issues stemming from unauthorized activities that Ms. Reynolds said could have been more carefully managed was the coordination of volunteer efforts after the tornado.

“You have a lot of well-meaning people show up wanting to help, but you've got to be able to manage that help,” said Marcia Reynolds, executive director of risk management at the Mercy Hospital network. “That help can quickly turn into a problem.”

Some issues that arose during the storm are being addressed in the layout of the new St. John's hospital, due to open in 2014. The new building's designated incident command posts, which had been destroyed when the tornado struck the old facility, will be located underground. The new hospital also will be outfitted with strategically placed “grab bags” of basic emergency supplies, including notepads, pens, flashlights and crowbars.

“We did a lot of things well, but there were certainly some things that we could have done better,” Ms. Reynolds said.