Natural Hazards, Disasters, and Demographic Change: The Case of Severe Tornadoes in the United States, 1980-2010.

Natural hazards and disasters distress populations and inflict damage on the built environment, but existing studies yielded mixed results regarding their lasting demographic implications. I leverage variation across three decades of block group exposure to an exogenous and acute natural hazard-severe tornadoes-to focus conceptually on social vulnerability and to empirically assess local net demographic change. Using matching techniques and a difference-in-difference estimator, I find that severe tornadoes result in no net change in local population size but lead to compositional changes, whereby affected neighborhoods become more White and socioeconomically advantaged. Moderation models show that the effects are exacerbated for wealthier communities and that a federal disaster declaration does not mitigate the effects. I interpret the empirical findings as evidence of a displacement process by which economically disadvantaged residents are forcibly mobile, and economically advantaged and White locals rebuild rather than relocate. To make sense of demographic change after natural hazards, I advance an unequal replacement of social vulnerability framework that considers hazard attributes, geographic scale, and impacted local context. I conclude that the natural environment is consequential for the sociospatial organization of communities and that a disaster declaration has little impact on mitigating this driver of neighborhood inequality.

Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado.

BACKGROUND: On May 22, 2011, an F5 tornado ripped through the city of Joplin, Mo, resulting in over 150 fatalities and over 750 injuries. Pediatric trauma centers in the region needed to be prepared to receive patients. Little data exist on the types of patients who are received at pediatric trauma centers after disasters such as tornados. OBJECTIVE: The purpose of this study is to describe the patients received at the nearest level 1 pediatric trauma center after the tornado. METHODS: Cases were identified through the trauma registry. Data regarding patient demographics, past medical history, characteristics of injury, treatment received, and outcomes were obtained retrospectively from medical records. RESULTS: A total of 10 patients were received at the pediatric trauma center. Traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, but only 1 patient required surgery within the first 24 hours of arrival. Eight patients were intubated and were in the pediatric intensive care unit. The average length of stay in the hospital was 19.4 days with a range of 14 hours to 94 days. CONCLUSIONS: Immediately after a significant tornado in the referral region, pediatric trauma centers need to prepare to receive patients. Head injuries will likely be common, and pediatric trauma centers will likely receive multiple intubated patients. Knowledge of injuries received and resources needed can better prepare these trauma centers for future devastating tornadoes.

Prevalence and predictors of PTSD and depression among adolescent victims of the Spring 2011 tornado outbreak.

BACKGROUND: Relatively few studies have examined prevalence and predictors of posttraumatic stress disorder (PTSD) or major depressive episode (MDE) in disaster-affected adolescents. Fewer still have administered diagnostic measures or studied samples exposed to tornadoes, a common type of disaster. Further, methodologic problems limit the generalizability of previous findings. This study addressed prevalence estimates and risk factors for PTSD and MDE among adolescents exposed to the Spring 2011 tornado outbreak in Alabama and Joplin, Missouri. METHODS: A large (N = 2000), population-based sample of adolescents and caregivers, recruited randomly from tornado-affected communities, participated in structured telephone interviews. PTSD and MDE prevalence were estimated for the overall sample, by gender, and by age. Hierarchical logistic regression was used to identify risk factors for PTSD and MDE. RESULTS: Overall, 6.7% of adolescents met diagnostic criteria for PTSD and 7.5% of adolescents met diagnostic criteria for MDE since the tornado. Girls were significantly more likely than boys to meet diagnostic criteria for MDE, and older adolescents were more likely than younger adolescents to report MDE since the tornado. Female gender, prior trauma exposure, and an injured family member were associated with greater risk for PTSD and MDE. Specific incident characteristics (loss of services, concern about others' safety) were associated with greater PTSD risk; prior disaster exposure was associated with lower MDE risk. CONCLUSIONS: However, most adolescents were resilient following tornado exposure, roughly 1 in 15 developed PTSD, 1 in 13 developed MDE, and many more endorsed subclinical mental health problems. Information regarding specific risk factors can guide early screening, prevention, and intervention efforts in disaster-affected communities.

Injury Patterns and Medical Evacuation of Patients in Chifeng Tornado in China, August 11, 2017.

OBJECTIVES: To study injury patterns and medical rescue operations related to tornadoes that occur in rural areas, this study investigated the data pertaining to the 2017 Chifeng tornado (China). METHODS: Medical records of 52 tornado-related patients were investigated. Data were collected from 3 local hospitals that received all the tornado victims. RESULTS: A total of 148 injuries were diagnosed. Tornado-related injuries were mainly caused by collapsed houses (51.9%) and direct physical trauma caused by the tornado (38.5%). Most injuries occurred outdoors (63.5%). The head (20.3%) and thorax (14.8%) were most 2 frequent anatomical injury sites. Soft-tissue injuries (43.9%) and contusions and lacerations (37.3%) were the 2 most common injury types. On evaluating the Abbreviated Injury Scale scores, a score of 1 was the most common (66.2%), and a score of 6 was not recorded. CONCLUSIONS: A trailing phenomenon in the distribution of time to admission among the victims of a particular tornado in China was observed. The delivery is timely compared with nondisaster situation. There was a statistically significant difference of injury causes between outdoor and indoor patients. Helmets should be used by potential tornado victims. Basement units capable of functioning as shelters should be built in villages.

Injury Patterns and Outcomes of Victims After the 2016 Jiangsu Tornado in China: A Retrospective Analysis of Injuries Treated at a Teaching Hospital.

OBJECTIVE: The aim of this study is to characterize the injury profiles and outcomes of victims of a tornado in Jiangsu Province, China. METHODS: This study retrospectively investigated the clinical records of 144 patients treated at a teaching hospital due to a tornado. Each patient's demographic data, diagnosis, injury types, causes of injury, infection status, and outcomes were all reviewed. RESULTS: Of the 144 patients, 64 (44.4%) were male, and 80 (55.6%) were female. The patients' ages ranged from 2 months to 94 years; 91 (63.19%) were admitted within the first 12 h after the disaster. The most frequently injured sites were the body surfaces (24.48%), followed by the limbs and pelvis (21.79%) and chest (20.3%). Soft-tissue injuries and fractures were the most frequent injuries. Traumatic brain injuries were the main causes of death. Tornado-related injuries were primarily caused by flying/falling bricks, wood, and glass. Twenty-three (15.9%) patients suffered from infections, which consisted mainly of skin/soft tissue infections and pneumonia. CONCLUSIONS: Destructive tornadoes often cause heavy casualties with little warning. Medical aid agencies must be prepared to accommodate the massive numbers of injured patients after a catastrophe. Proper triage and prompt treatment of injured victims may decrease mortality. (Disaster Med Public Health Preparedness. 2019;xx:xxx-xxx).

Tornado Disaster Casualties Admitted to a County Hospital in the Jiangsu Province of China.

OBJECTIVE: We analyzed characteristics of tornado-related injuries and medical impact on a county-level hospital in China in June 23, 2016. The objective of this study was to describe and analyze local government rescue responses following the tornado. METHODS: County hospital medical records of 288 tornado-related injury patients were collected. Descriptive analyses to study injury characteristics and associated risk factors were performed. RESULTS: Of the studied population, 84% of the wounded were older than 45 years. Only 30 (10.4%) people were sent to the hospital for treatment within 3 hours following the disaster. Heavy objects or collapsing houses accounted for 191 (66.3%) of the documented injuries. The proportion of people with resulting brain injuries was 46.2% of the entire injured population, and the incidence of lower extremity injuries was 27.8%. A total of 89.6% of the wounded had skin and soft tissue injuries. Multiple injuries were found in 129 (44.8%) people and 156 had a single injury (54.2%), and 3 cases with acute stress disorder were admitted to the hospital. CONCLUSIONS: Preparation plans, including tornado warnings, prevention, and rescue, are a basic requirement for the mitigation of tornado-related injuries. Protection awareness of tornado disasters is also critical to ensure injury prevention.

Implications of Prenatal Exposure to the Spring 2011 Alabama and Missouri Tornadoes on Birth Outcomes.

OBJECTIVE: Despite emerging evidence of the detrimental effects of natural disasters on maternal and child health, little is known about exposure to tornadoes during the prenatal period and its impact on birth outcomes. We examined the relationship between prenatal exposure to the spring 2011 tornado outbreak in Alabama and Joplin (Missouri) and adverse birth outcomes. METHODS: We conducted a retrospective, cross-sectional cohort study using the 2010-2012 linked infant births and deaths data set from the National Center for Health Statistics for tornado-affected counties in Alabama (n=126,453) and Missouri (Joplin, n=6,897). Chi-square and logistic regression analyses were performed to estimate associations between prenatal exposure to tornadoes and birth outcomes. RESULTS: Prenatal exposure to the tornado incidents did not influence birth weight outcomes. Women exposed to Alabama tornadoes were less likely to have a preterm birth compared to unexposed mothers (OR: 0.93, 95% CI: 0.91, 0.96). Preterm births among Joplin-tornado exposed mothers were slightly higher (13%) compared with unexposed mothers (11.2%). Exposed mothers from Joplin were also more likely to have a cesarean section compared to their counterparts (OR: 1.14, 95% CI: 1.02, 1.26). CONCLUSIONS: We found no association between tornado exposure and adverse birth weight and infant mortality rates. Our findings suggest that prenatal exposure can amplify the odds for a cesarean section. (Disaster Med Public Health Preparedness. 2019;13:279-286).

Longitudinal cross-lagged relationships between posttraumatic stress disorder and depression in adolescents following the Yancheng tornado in China.

OBJECTIVE: The aim of this study was to examine the comorbidity and longitudinal cross-lagged relationships between posttraumatic stress disorder (PTSD) and depression among Chinese adolescents after their experience of the Yancheng tornado. METHOD: A total of 154 adolescents from 2 local middle schools in Yancheng city participated in this longitudinal study. Participants completed the Child PTSD Symptom Scale and the Center Epidemiological Studies of Depression at 6 months (T1), 9 months (T2), and 12 months (T3) after the tornado, respectively. RESULTS: Results include the following: (a) the prevalence of PTSD was 55.84% at T1, 50.00% at T2, and 47.40% at T3; the prevalence of depression was 56.49% at T1, 65.58% at T2, and 66.01% at T3; (b) the comorbidity between PTSD and depression was high, 46.75% at T1, 42.86% at T2, 43.51% at T3; (c) PTSD at T1 significantly predicted depression at T2 (ß = 0.42, p < .001), and PTSD at T2 significantly predicted depression at T3 (ß = 0.64, p < .001); however, depression cannot significantly predict PTSD at different cross-time points. CONCLUSIONS: The results suggest that there is comorbidity between PTSD and depression and that PTSD positively influence the development of depression in adolescents during the early period of the tornado, whereas depression did not predict PTSD. The implications of the results for the psychological services provided to children and youth are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Defining, Describing, and Categorizing Public Health Infrastructure Priorities for Tropical Cyclone, Flood, Storm, Tornado, and Tsunami-Related Disasters.

OBJECTIVES: The study aim was to undertake a qualitative research literature review to analyze available databases to define, describe, and categorize public health infrastructure (PHI) priorities for tropical cyclone, flood, storm, tornado, and tsunami-related disasters. METHODS: Five electronic publication databases were searched to define, describe, or categorize PHI and discuss tropical cyclone, flood, storm, tornado, and tsunami-related disasters and their impact on PHI. The data were analyzed through aggregation of individual articles to create an overall data description. The data were grouped into PHI themes, which were then prioritized on the basis of degree of interdependency. RESULTS: Sixty-seven relevant articles were identified. PHI was categorized into 13 themes with a total of 158 descriptors. The highest priority PHI identified was workforce. This was followed by water, sanitation, equipment, communication, physical structure, power, governance, prevention, supplies, service, transport, and surveillance. CONCLUSIONS: This review identified workforce as the most important of the 13 thematic areas related to PHI and disasters. If its functionality fails, workforce has the greatest impact on the performance of health services. If addressed post-disaster, the remaining forms of PHI will then be progressively addressed. These findings are a step toward providing an evidence base to inform PHI priorities in the disaster setting. (Disaster Med Public Health Preparedness. 2016;10:598-610).

Kinetic Energy of Tornadoes in the United States.

Tornadoes can cause catastrophic destruction. Here total kinetic energy (TKE) as a metric of destruction is computed from the fraction of the tornado path experiencing various damage levels and a characteristic wind speed for each level. The fraction of the path is obtained from a model developed for the Nuclear Regulatory Commission that combines theory with empirical data. TKE is validated as a useful metric by comparing it to other indexes and loss indicators. Half of all tornadoes have TKE exceeding 62.1 GJ and a quarter have TKE exceeding 383.2 GJ. One percent of the tornadoes have TKE exceeding 31.9 TJ. April has more energy than May with fewer tornadoes; March has more energy than June with half as many tornadoes. September has the least energy but November and December have the fewest tornadoes. Alabama ranks number one in terms of tornado energy with 2.48 PJ over the period 2007-2013. TKE can be used to help better understand the changing nature of tornado activity.

Impact of tornadoes on hospital admissions for acute cardiovascular events.

BACKGROUND: There is a paucity of data describing cardiovascular events after tornado outbreaks. We proposed to study the effects of tornadoes on the incidence of cardiovascular events at a tertiary care institution. POPULATION AND METHODS: Hospital admission records from a single center situated in a tornado-prone area three months before and after a 2013 tornado outbreak were abstracted. To control for seasonal variation, we also abstracted data from the same period of the prior year (control). Hospital admissions for cardiovascular events (CVEs) including acute myocardial infarction, stroke and venous thromboembolism (VTE) were summated by zip codes, and compared by time period. RESULTS: There were 22,607 admissions analyzed, of which 6,705 (30%), 7,980 (35%), and 7,922 (35%) were during the pre-tornado, post-tornado, and control time frames, respectively. There were 344 CVE in the controls, 317 CVE in pre-tornado and 364 CVEs in post tornado periods. There was no difference in the prevalence of CVE during the post-tornado season compared with the control (PPR=1.05 95% CI: 0.91 to 1.21, p=0.50) or the pre-tornado season (PPR=0.96, 95% CI: 0.83 to 1.21, p=0.63). CONCLUSION: In conclusion, tornado outbreaks did not increase the prevalence of cardiovascular events. In contrast to the effect of hurricanes, implementation of a healthcare policy change directed toward the early treatment and prevention of cardiovascular events after tornadoes does not seem warranted.

Increased variability of tornado occurrence in the United States.

Whether or not climate change has had an impact on the occurrence of tornadoes in the United States has become a question of high public and scientific interest, but changes in how tornadoes are reported have made it difficult to answer it convincingly. We show that, excluding the weakest tornadoes, the mean annual number of tornadoes has remained relatively constant, but their variability of occurrence has increased since the 1970s. This is due to a decrease in the number of days per year with tornadoes combined with an increase in days with many tornadoes, leading to greater variability on annual and monthly time scales and changes in the timing of the start of the tornado season.

Impact of dual-polarization radar technology and Twitter on the Hattiesburg, Mississippi tornado.

OBJECTIVE: Dual-Polarization Radar and Twitter were analyzed to determine the impact on injuries sustained by the Hattiesburg EF-4 tornado. METHOD: Tracking data provided from the Dual-Pol radar systems in National Weather Service Jackson were reviewed. Twitter data from four local Twitter handles were obtained. The change in tweets and followers for the day of the storm were compared to historical averages. A Student t-test was utilized in determining statistical significance (p<0.05). Medical records from two local emergency departments were reviewed for patients treated up to 24 hours after the tornado. An Injury Severity Score (ISS) was calculated for trauma records related to the tornado. RESULTS: Radar detection of the tornado gave approximately 30 minutes of advanced warning time. Statistical significance in follower growth was seen in all four Twitter handles. Out of 50 patients, the average ISS was 3.9 with a range of 1 to 29. There were zero fatalities. CONCLUSIONS: An ISS average of 3.9 was significantly less than two previous tornadoes of similar strength that occurred prior to increased usage of Dual-pol radar and Twitter as a means for communicating severe weather information. Early detection from Dual-pol radar improved warning time. Tweets informed citizens to seek appropriate shelter. (Disaster Med Public Health Preparedness. 2013;7:585-592).