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The April 8, 1998 Tornado: Assessment of the Trauma System Response and the Resulting Injuries

May, Addison K. MD; McGwin, Gerald Jr. PhD; Lancaster, Leland J. MD; Hardin, William MD; Taylor, Allison J. MPH; Holden, Shaf BS; Davis, Gregory G. MD; Rue, Loring W. III MD

Journal of Trauma and Acute Care Surgery: April 2000 - Volume 48 - Issue 4 - p 666-672
Article Titles

Background: On April 8, 1998, an F5 tornado touched down in two counties of Alabama producing a wide path of destruction. The presence of a regional trauma system in this area presents an opportunity to evaluate the effectiveness of the system in responding to the victims of this natural disaster.

Methods: Emergency room logs and the regional trauma system database were searched for all patients treated for injuries sustained from the tornado, and medical records were reviewed for demographic information, mode of transportation to hospital, injuries, treatment, and outcome. Fatalities were identified by means of the coroner’s office.

Results: A total of 224 patients were evaluated at nine area hospitals, of whom 63 (28%) required admission. There were 32 deaths: 30 persons were dead at the scene, and 2 patients subsequently died at Level I trauma centers. Among patients with nonfatal injuries, 39% were managed at Level I facilities, 46% at Level III facilities, and 15% at nontrauma facilities. Forty patients (55%) seen at Level I facilities required admission compared with 15 patients (17%) at Level III facilities and 8 patients (29%) at nontrauma facilities; Level I facilities also had the highest Injury Severity Score. Of patients requiring admission, 83% were transported by emergency medical services; these patients also had the highest Injury Severity Score.

Conclusion: The regional trauma system facilitated appropriate and efficient triage to system hospitals, routing the most severely injured patients to the Level I centers without overwhelming them with the more numerous, less severely injured patients.

From the Center for Injury Sciences at the University of Alabama at Birmingham and the Section of Trauma, Burns, and Surgical Critical Care (A.K.M., G.M., L.J.L., A.J.T., L.W.R.), and Division of Pediatric Surgery (W.H.), Department of Surgery, and Department of Pathology (G.G.D.), School of Medicine, and Department of Epidemiology (G.M., L.W.R.), School of Public Health, and Injury Control Research Center (S.H.), and University of Alabama at Birmingham, and The Children’s Hospital of Alabama (W.H.), and Jefferson County Coroner/Medical Examiner Office (G.G.D.), Birmingham, Alabama.

Address for reprints: Gerald McGwin, Jr., PhD, University of Alabama at Birmingham, Department of Surgery/Epidemiology, 700 S. 18th Street, Suite 609 EFH, Birmingham, AL 35294-0009.

Submitted for publication July 12, 1999.

Accepted for publication January 12, 2000.

Supported in part by grant R49/CCR403641–11 from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention-National Center for Injury Prevention and Control to the University of Alabama at Birmingham, Injury Control Research Center and grant DTHFH61–99-X-00039 from the U.S. Department of Transportation, Federal Highway Administration to the University of Alabama at Birmingham.

Poster presentation at the 59th Annual Meeting of the American Association for the Surgery of Trauma, September 16–18, 1999, Boston, Massachusetts.

© 2000 Lippincott Williams & Wilkins, Inc.