Injuries and post-traumatic stress following historic tornados: Alabama, April 2011

• Published in: PloS one 2013-12, Vol.8 (12), p.e83038
• Main Authors: Niederkrotenthaler, Thomas, Parker, Erin M, Ovalle, Fernando, Noe, Rebecca S, Noe, Rebecca E, Bell, Jeneita, Xu, Likang, Morrison, Melissa A, Mertzlufft, Caitlin E, Sugerman, David E
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Alabama - epidemiology; Analysis; Basements; Bathrooms; Chi-square test; Codes; Disasters; Disease control; Disease prevention; Emergency medical services; Emergency preparedness; Fatalities; Female; Follow-Up Studies; Halls; Head injuries; Health risks; Historic tornadoes; Hospitals; Humans; Injuries; Injury analysis; Injury prevention; Interviews as Topic; Male; Mental health; Middle Aged; Patients; Post traumatic stress disorder; Posttraumatic stress disorder; Prevalence; Professional development; Public health; Risk analysis; Risk Factors; Shelters; Sirens; Storms; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Surveys; Television; Tornadoes; Trauma; Wounds and Injuries - epidemiology; Wounds and Injuries - etiology; Wounds and Injuries - prevention & control; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0083038

We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls. Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤ 15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10-23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04-0.40), bathrooms (OR, 0.22; 95% CI: 0.06-0.78), hallways (OR, 0.31; 95% CI: 0.11-0.90) and closets (OR, 0.25; 95% CI: 0.07-0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09-0.49), television (aOR, 0.45; 95% CI: 0.24-0.83), and sirens (aOR, 0.50; 95% CI: 0.30-0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events. Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available.