Tornadoes and Trauma: Injury Risks and How to Prevent Them

Consider the following scenarios:  1) You are sitting at home on a bright, clear sunny day, or  2) You are driving down the road, or  3) You are shopping in one of those big box stores, or  4) You are at work and it is quitting time, and you are contemplating the journey home.  Gradually, it begins to rain, and you being pelted by quarter-sized and then golf-ball sized hail.  Gray skies suddenly become darker until they become a sickly green-black hue. Now, the sound of sirens. The power flickers out, and then…the sound of a rapidly approaching freight train. The only thing now left to do is to seek shelter – optimally in a sturdy structure – and hope and pray for the best.

Large, violent tornadoes can cause catastrophi...
A fierce tornado  (Image Credit: Wikipedia)

The reality of the recent May 20 Moore, Oklahoma, tornado just one week ago is all too fresh.  A 2002 paper published by the American Meteorological Society entitled, “Tornado-Related Deaths and Injuries in Oklahoma Due to the 3 May 1999 Tornadoes,” examines what really happens to the human body during tornadoes.  An F5 tornado in May 1999 followed a similar path to that of the May 20, 2013, storm. (1) Here are a few facts the researchers discovered:

Reasons for Tornado Injuries and Deaths

Primary reasons cited in the paper for injuries and death during tornadoes included being hit by flying debris; being picked up and carried away by the tornado; being pelted by projectile, missile-like items such as flying wood and other objects; structural collapse (walls, ceiling, roof); falling or flying rubble (bricks, concrete); shattered glass; and automobile accidents while fleeing a tornado or when the car and its occupants are picked up and hurled by a twister. (1)

Destruction in the May 20, 2013, Moore, Oklahoma, tornado (Image Credit: National Weather Service)

Top Ten Tornado Injury Risks

10. Inhalation Injuries
Gas (including carbon monoxide and other noxious gases), smoke, dust, sand, dirt, and other airborne particles can be a problem when inhaled during or after a tornado. Asbestos inhalation from building insulation materials poses a risk for cancer and chronic lung diseases.  Airborne particles of lead paint can potentially cause health problems in the aftermath of a major storm. (1-3)

9. Internal Organ Injuries
Several types of internal organ injuries result from tornado-associated trauma. These include severe chest trauma, collapsed lung(s), ruptured spleen, liver contusion(s), and a ruptured bladder.

8. Eye Injuries
Various types of eye injuries, including foreign bodies in the eye, corneal abrasions (scratches) and lacerations (cuts) can occur.

7. Sprains
The most common are back, neck, and upper and lower extremity sprains. These are usually caused by attempting to hold a storm cellar door shut during a storm or during clean-up efforts after the storm while trying to move heavy debris. Ankle sprains are commonly caused by unsteadiness or falls while hurrying to seek shelter or after the storm while attempting to walk on shifting debris. It is important to seek shelter quickly but carefully and to use the utmost caution when walking about in the aftermath of a storm.

6. Severe Chest Trauma
Crushing injuries from collapsed structures and/or rubble can cause severe chest trauma. Severe chest trauma can also result from being battered with heavy flying debris. Although severe crushing chest injuries are not always avoidable, seeking sturdy shelter is the best possible protection.

5. Foreign Body Injuries
Foreign body injuries can result from exposure to practically anything that is airborne during a tornado. Impalement with pieces of wood, shards of glass, straw, nails, or other objects is common.  Most of these injuries occur to the upper extremities (shoulders, arms, hands), likely while attempting to shield the head, neck, and face from flying debris.  Fatal injuries can occur when impaled flying objects penetrate the head, neck, chest, or abdomen.

4. Brain Injuries
Occasionally one hears stories of people grabbing baseball helmets, motorcycle helmets, or bicycle helmets before seeking shelter. Concussions are the most common types of mild injuries. More severe injuries ranged from skull fractures, brain contusions, and brain hemorrhages. Although the Centers for Disease Control and Prevention (CDC) does not offer a recommendation regarding the use of helmets during tornadoes, but there is no question that they may offer additional protection from head injury during a tornado. (1, 4, 5)

3. Fractures/dislocations
Fractures and dislocations from flying debris, structural collapses, and crush injuries occur commonly.

2. Soft tissue Injuries
Impalement injuries were discussed earlier, but again, these are of the utmost concern.  Lacerations (cuts) are quite common.

1. Multiple Injuries
Often, injuries observed as the result of a tornado can include some or all of those above. Data included in charts in the paper cited this fact. Those who do not survive tornadoes often have multiple injuries.  Other risks include infection from dirt, mud, and debris.  Awful degloving injuries in which the skin separates or is peeled away from underlying tissues have been described, as well. (1, 6)

Tornado Safety and Shelter

An F5 tornado from Moore, Oklahoma tornado on ...
Remains of a vehicle wrapped around a telephone pole.  Here is one good reason NOT to seek shelter from a tornado in your car.  (Image Credit: Wikipedia)

An underground FEMA-approved tornado shelter or above-ground safe room are two excellent options for staying safe during a tornado.(7) The next best options are an interior windowless room, closet, or bathroom in the lowest level of the house.  Vacating a mobile home is crucial, as these structures do not offer adequate protection and may become airborne during a tornado.  Big box stores are a no-no, as well, because these often collapse once the roof is lifted away.  Seeking shelter by lying flat in a ditch is best if traveling in a car at the time a tornado approaches.  Learn more about seeking adequate shelter from tornadoes at CDC “Emergency Preparedness and Response.” (8)  The FEMA website also offers helpful tips about tornado preparedness.

Questions for the blog community: Have you been affected by the recent spring tornadoes?  How did you prepare? What will you do differently to stay safe in the future if another tornado occurs where you live?

Updated May 28, 2013.  Revised on May 28, 2013,  to replace previous 1999 Moore tornado “Destruction” photo with May 20, 2013, Moore tornado “Destruction” photo.

1. Brown, Sheryll; Archer, Pam; Kruger, Elizabeth; and Mallonee, Sue. “Tornado-Related Deaths and Injuries in Oklahoma due to the 3 May 1999 Tornadoes.” American Meteorological Society. June 2002.
2. “Tornado Debris and Asbestos Concerns.” Environmental Protection Agency. July 14, 2011. Website. Retrieved May 25, 2013.
3. “EPA Urges Caution on Tornado Renovation Activities Involving Lead Paint.” Environmental Protection Agency. 06/21/2011. Website. Retrieved May 25, 2013.
4. Dickson, Caitlin. “Oklahoma Tornado Football Team Survivors Wore Helmets. So Should You.” The Daily Beast. May 22, 2013. Website. Retrieved May 28, 2013.
5. “Emergency Preparedness and Response: Tornadoes.” Centers for Disease Control and Prevention. Updates May 17, 2012. Retrieved May 28, 2013.
6. Iqbal, Nasreen. “OU Medical Center Staff Describes Tornado Victims’ Injuries.” NewsOK. May 21, 2013. Website.  Retrieved May 28, 2013.
7. “Safe Rooms.” FEMA Website.  Updated November 15, 2012.  Retrieved May 28, 2013.
8. “Emergency Preparedness and Response: During a Tornado”  Centers for Disease Control and Prevention.  Updated December 23, 2003.  Website.  Retrieved May 28, 2013.

Wikipedia images are licensed under a Creative Commons Attribution 3.0 Unreported License.

Categories: MSP3

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

1 reply

  1. Wow! For someone who is not familiar in living in areas where tornadoes are prevalent, after reading your article, it provided me with a new sense of empathy for those who do live in such areas.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Health Blog

WSJ's blog on health and the business of health.

Health Care Experts

Where Medicine, Biomedical Science, and Policy Meet.....

The Hill

Where Medicine, Biomedical Science, and Policy Meet.....

Bill of Health

The blog of the Petrie-Flom Center at Harvard Law School

Health Insurance Blog -

Where Medicine, Biomedical Science, and Policy Meet.....

NIH Director's Blog

Where Medicine, Biomedical Science, and Policy Meet..... blogs

Where Medicine, Biomedical Science, and Policy Meet.....

The Greatest Literary Works

Where Medicine, Biomedical Science, and Policy Meet.....

Health : NPR

Where Medicine, Biomedical Science, and Policy Meet.....

Politics, Policy, Political News Top Stories

Where Medicine, Biomedical Science, and Policy Meet.....

Science Careers Blog

Where Medicine, Biomedical Science, and Policy Meet.....

NYT > Well

Where Medicine, Biomedical Science, and Policy Meet.....

Where Medicine, Biomedical Science, and Policy Meet.....

MSP3 - The Policy Cafe

Where Medicine, Biomedical Science, and Policy Meet.....

%d bloggers like this: