The winter of 2009 brought the worst disaster caused by a natural hazard in the history of the state of Arkansas. An ice storm spanned the entire northern half of the state, leaving thousands without electricity, heat, transportation, health care, and in some cases, shelter, food, and water. In one county alone, > 13,000 power poles were destroyed. The infrastructure was severely damaged. In the University's arena, a shelter was opened by the Red Cross in partnership with the Medical Reserve Corps (MRC) to accept special needs victims and provide urgent primary care for shelter residents. The majority of patients presenting to the MRC had more than two illnesses. Examples included diabetes, renal disease requiring dialysis, hypertensive crisis, injuries from the storm, MRSA, respiratory syncytial virus, and mental illness ranging from depression to schizophrenia. Because the Red Cross did not consider ice storms as a reasonable cause for medication/medication supplies, these items were not replaced; this had health consequences of under-managed illness. Oxygen converters were preferred over oxygen tanks; however, the arena was on a generator and not all plug-ins had electricity. An ambulance company loaned the MRC a glucometer so blood glucose levels could be monitored. Those with mental illness required significant time from MRC providers. Largely, the MRC was nurse-managed with physicians or nurse practitioners available for sick call twice a day. Relationships became strained when the state placed a hold on the arena to secure it for a regional shelter. This put the university's financial stability in peril due to breech of contract with vendors scheduled to use the arena. The partnership between these three organizations does remain intact with formal memorandums of agreement now existing. They continue to work together in the community and jointly respond to regional disasters.