Tornado disaster in rural Georgia: triage response, injury patterns, lessons learned

Our objective was to characterize the medical response and injury patterns from a recent tornado disaster in rural southeastern Georgia. We conducted a retrospective review of 11 patients treated at a Level I trauma center after sustaining injuries due to an April 9, 1998 F3 tornado. Data were obtained from trauma registry and medical records. Of 11 victims, 8 (73%) were male. Ages ranged from 5 to 54 years. Two patients were triaged directly by military helicopter, six arrived as secondary triage from local rural hospitals (2 by air, 4 by ground), and three arrived by delayed secondary transfer. Six patients were thrown by the tornado, and five were struck by flying debris. All victims were either in exposed areas or mobile homes. Injuries by anatomic region included the chest (45%), abdomen (27%), extremity (91%), and head (45%). Nine (82%) of the patients required surgical intervention. These included three laparotomies, one thoracotomy, six orthopedic procedures, and one neurosurgical procedure. The average Injury Severity Score (ISS) was 23. Among patients who were thrown mean ISS was 31; among those struck by debris, mean ISS was 12. Hemodynamically significant pelvic fractures occurred in three patients (27%). The major complication, sepsis due to Serratia marcescens was seen in three patients, all of whom had been thrown and had clinically significant wound contamination. Both patients who died had Serratia sepsis and multiorgan system failure. The injuries and inclement weather characteristic of tornado disasters stress regional trauma triage responses, cause significant injury, and disrupt communities. Injury patterns involve multiple systems and require coordinated efforts among caretakers. Infectious complications are common and frequently involve Gram-negative bacilli and are associated with soil-contaminated wounds. Trauma severity increases if the victim is thrown rather than struck by flying debris.