Epidemiologic Notes and Reports Tornado Disaster -- North Carolina, South Carolina, March 28, 1984

On the evening of March 28, 1984, a series of tornadoes touched down in northeastern South Carolina and cut a swath almost exclusively through rural areas and small towns in a northeasterly direction through eastern North Carolina (Figure 1). In a 5-hour period, these storms caused more than 1,000 casualties (killed and seriously and slightly injured), along with extensive property damage of more than $100,000,000. The severity of the tornadoes varied from one to four on the Fujita scale (maximum five) and generated winds of at least 260 miles per hour.

Emergency room (ER) charts and medical records from several of the temporary first aid posts were reviewed in both North Carolina and South Carolina, and death certificates for persons with fatal injuries were analyzed. In addition, all hospitals that treated 15 or more casualties were visited and evaluated for: (1) ER treatment of these casualties; (2) "disaster drill" response of each hospital; and (3) problems that each hospital encountered in coping with the disaster.

A case was defined as an individual in either North Carolina or South Carolina who, on March 28, 1984, was injured in a tornado storm and required medical treatment. A total of 955 individuals were injured by the tornado storms and sought medical assistance. Of these, 640 (67%) had minor injuries (i.e., were treated and released); 256 (27%) were hospitalized; and 59 (6%) were killed. The age and sex distribution (56% were female) of those injured (excluding fatal injuries) for the counties in which the tornadoes struck reflected the age distribution of residents in these counties. Residents of the affected North Carolina counties who are 55 years of age or older comprise 18% of the population. Of those in North Carolina with nonfatal injuries and recorded ages, 106 (16%) of 660 were in this age group; of the fatalities, 19 (43%) of 44 were in this group (p 0.0001). As expected, contusions and lacerations, as well as other minor injuries (caused usually by blunt trauma), predominated (Table 1). Injuries to vital organs were uncommon.

The ER records recorded the location of each person at the time of injury for 346 (39%) of the 896 nonfatal injuries. The death certificates recorded this in 55 (93%) of 59 fatalities. Where location was recorded, 19 (46%) of 41 of the North Carolina fatalities and 176 (51%) of 348 of the injured persons in North Carolina and South Carolina were in trailers or mobile homes at the time of injury. Of the counties that sustained tornado damage, an estimated 11% of residents live in trailers or mobile homes.

All 20 hospitals in North Carolina that treated tornado-associated injuries had implemented their respective disaster plans and recall systems well before the first persons arrived; thus, rarely was an ER overloaded. The disaster plan had relatively few problems, but important among them were: poor radio communication between the hospital ER and the centralized, nonhospital disaster-control staff at the disaster sites; reluctance to treat the tornado storm as a mass casualty disaster; infrequent use of casualty "tags" in contrast to that hospital's ER medical record; only partial implementation of triage; inadequate recording of essential information on the health records of most patients (e.g., vital signs not recorded in 44% of cases); and a relative deficiency of clerical, administrative, and other support staff (e.g., kitchen workers, social services staff, transport employees, chaplains). Reported by administrative staffs of the following hospitals and clinic: Duplin General Hospital, Kenansville, Wayne County Memorial Hospital, Goldsboro, Cape Fear Valley Hospital, Fayetteville, Wilson Memorial Hospital, Wilson, Lenoir Memorial Hospital, Kinston, Southeastern General Hospital, Lumberton, Pitt County Memorial Hospital, Greenville, Bertie County Memorial Hospital, Windsor, Scotland Memorial Hospital, Laurinburg, Beaufort County Hospital, Washington, Bladen County Hospital, Elizabethtown, Chowan Hospital, Edenton, Columbus County Hospital, Whiteville, Roanoke-Chowan Hospital, Ahoskie, Moore Memorial Hospital, Pinehurst, Nash General Hospital, Rocky Mount, Albemarle Hospital, Elizabeth City, Robersonville Community Hospital, Robersonville, Sampson County Memorial Hospital, Clinton, Family Medicine Clinic, Mount Olive, D Cognilio, Pitt County Memorial Hospital, EJ Allison, MD, JE Williamson, MD, Dept of Emergency Medicine, School of Medicine, East Carolina University, Greenville, CG Smith, MD, B Watson, M Swift, D Button, MSPH, J Williams, MPH, L Wright, MPH, Epidemiology Section, JM Bowling, MA, State Center for Health Statistics, JN MacCormack, MD, State Epidemiologist, North Carolina Div of Health Svcs; Administrative staffs of the following hospitals: Loris Community Hospital, Loris, Anderson Memorial Hospital, Anderson, Hillcrest Hospital, Simpsonville, Marlboro Park Hospital, Bennettsville, Fairfield County Memorial Hospital, Winnsboro, Elliott White Springs Memorial Hospital, Lancaster, Kershaw County Hospital, Camden, Richland Memorial Hospital, Baptist Medical Center, Columbia, Laurens District Hospital, Laurens, Chesterfield General Hospital, Cheraw, Newberry County Memorial Hospital, Newberry, RL Parker, DVM, State Epidemiologist, South Carolina Dept of Health and Environmental Control; Div of Field Svcs, Office of the Director, Epidemiology Program Office, Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Tornado-related trauma has been responsible for more than 9,000 deaths in the past 50 years (1). Recommended safety measures (updated with information from a recent epidemiologic study (1)) are as follows:

1. Persons in buildings should seek shelter indoors--on the lowest floor, preferably in a basement. Central rooms, including closets and stairwells, are safer than rooms along the outside of the house, and areas near windows should be avoided.

2. Drivers should not attempt to drive away from a tornado. Instead, they should seek shelter indoors immediately on hearing a tornado warning.

3. If drivers in open country cannot find indoor shelter, they should drive away from the tornado path at right angles. If there is not time to escape, persons outdoors should lie flat in the nearest ditch or ravine.

4. Even properly anchored mobile homes are unsafe when wind speeds exceed 50 miles per hour. In tornado-prone states, mobile-home parks should have alternative tornado shelters. Tornado-related mortality rates have decreased continuously over

the past 50 years (1). Possible factors in this decrease are: more effective early warning systems, better public education and preparedness, and improved emergency medical services during disasters. Further epidemiologic studies are needed to evaluate to what extent these factors contribute to the continued decline in deaths and injuries from tornadoes.

Reference

1. Glass RI, Craven RB, Bregman DJ, et al. Injuries from the Wichita Falls tornado: implication for prevention. Science 1980;207:734-8.

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