At 1:30 in the afternoon, the building collapsed in a thunderous catastrophe with shoppers, businessmen and workers trapped inside. A fire started among the rubble, hampering efforts to rescue the trapped and wounded. The Sioux City Fire Department fought the blaze for nearly thirty-six hours. The Journal reported, "Searchlights played over the burning debris while the rescuers, some wearing gas masks because of a persistently strong odor of ammonia, began chopping through the piles of brick and mortar to free the living and remove the dead."

The administration of Mayor Wallace M. Short received much criticism in the aftermath of the Ruff Disaster. Short, along with two of his commissioners, W.R. Hamilton and Henry Michelstetter, had lowered the qualifications for the office of City Building Inspector. They wanted to appoint their campaign manager, E.J. O'Connor to the post. The Sioux City Civil Engineers Club was against lowering those standards, stating that it would be "dangerous and objectionable." While the controversy swirled, O'Connor held the post of Assistant Building Inspector. The plans for remodeling the Hedges Block crossed his desk, but O'Connor was evidently not knowledgeable enough to recognize the dangers in the project.



However, in investigating the thirty-nine deaths, the coroner's jury primarily blamed the owners of the Hedges Block for underestimating the deteriorated condition of the building. They also blamed the city building inspection department for not adequately overseeing the project.

In yet another controversy, Commissioner of Public Safety, W.R. Hamilton (a supporter of E.J. O'Conner) was heavily criticized for providing whiskey to rescue workers. Sheriff W.H. Jones stopped this action, but Hamilton was later removed from office, a consequence of his acts at the disaster scene.