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Tuesday, May 21, 2013

The Oklahoma City Tornado Medical Aftermath: What to Expect

The tornadoes that struck the Oklahoma City area on 5/20/13 will be recorded as one of the worst disasters in U.S. history. The damage is almost indescribable. Thousands of homes and cars were destroyed.  Buildings were also destroyed, including at least one elementary school.

Many other schools were damaged along with at least one hospital. The situation remains fluid as of this writing, with 24 people killed, 9 of whom were children. In addition to those who died, there will be many survivors who are left to deal with serious medical injuries.

FEATURED BOOK: Disaster Response and Recovery

Here is what we can expect based on similar tornado disasters in the past.

Implementation of hospital disaster plans: All hospitals have disaster management plans, with leaders identified in various departments who will coordinate emergency care and response activities. These drills are practiced throughout the year so that the proper medical management guidelines are followed, proper rapid decisions are made, secondary teams of medical staff are well-rested, and other patients who are not tornado victims still receive medical care when disaster.  In addition, stockpiled supplies and equipment will be used to serve the needs of disaster victims.  Patients at damaged hospitals will need to be transferred to more secure locations.

Neurological injuries in adults and children: Many of the injuries will involve damage to the brain, spinal cord, or nerves outside the brain and spinal cord, with the latter generally presenting in a delayed manner. These injuries typically occur due to falling or flying debris (e.g., concrete slabs, wood products, glass) but can also occur from being trapped in vehicles that are picked up and thrown and/or pelted with debris.  The most common injuries will involve the head and bones. Traumatic brain injuries will likely be the leading cause of death.

Examples of specific injuries will likely include skull fractures, scalp lacerations, crushing bone injuries, brain bleeds (some of which can compress the brain tissue), leakage of fluid that cushions the brain and spine, loss of oxygen to the brain, fractures of the bone surrounding the spinal cord, narrowing of the spinal canal, degloving injuries (removal of extensive areas of skin from the underlying tissue, severing the blood supply), nerve damage, wounds contaminated with soil and debris (e.g., wood, gravel), blunt trauma to the chest or abdomen, sprains, strains, and ligament damage. A ligament is a tough band of tissue that attaches to joint bones. Injuries will also occur during the search and recovery and cleanup phase.  Injuries outside the brain and spinal cord may initially be overlooked due to medical staff tending to more life threatening matters.

Emergency surgeries and treatment: Neurosurgeons will be critical to treating patients in the first 12 to 24 hours after the tornado strikes.  Some patients may need to be resuscitated, stabilized, and transferred to other hospitals. Blood transfusions may also be needed. Surgeries will likely include placing drainage tubes in the brain to decrease swelling (edema) and blood accumulation, placing pressure monitors  in the brain, removal of excessive brain  bleeding, placement of a tube in the windpipe to assist breathing, placement of chest tubes to assist breathing due to lung damage, repairing fractures and lacerations, stopping fluid leakage, surgery to decompress the spinal cord, fusion of bones surrounding the spinal cord, placement of pins and rods to stabilize the spinal cord, and placement of skin grafts. Many patients will be placed in intensive care units.

Serious to deadly fungal infections: As noted earlier, wound contamination is a serious problem in tornado related injuries. Within a few days, some patients may suffer fungal infections that can invade the soft tissue and can be deadly even after surgical and medication treatment.  The fungus can come from soil, as was the case in Joplin, Missouri, in which five people died from Apophysomyces trapeziformis, a toxic fungal infection found in soil, decaying vegetation, and water containing living or formerly living materials (e.g., leaves).

Ongoing care: In addition to many patients needing ongoing physical rehabilitation, the emotional impact of living through a tornado and its aftermath (e.g., personal property destruction) cannot be overstated. Many of the patients will be significantly traumatized emotionally and will need access to psychological counseling to address depression, anxiety, and/or anger.

References

Centers for Disease Control and Prevention (CDC). (2013) Tornado-related fatalities--five states, southeastern United States, April 25-28, 2011. MMWR Morb Mortal Wkly Rep. 61(28):529-33.

Chern JJ, Miller JH, Tubbs RS, Whisenhunt TR, Johnston JM, Wellons JC 3rd, Rozzelle CJ, Blount JP, Oakes WJ. (2011). Massive pediatric neurosurgical injuries and lessons learned following a tornado disaster in Alabama. J Neurosurg Pediatr. 8(6):588-92.

Comstock RD, Mallonee S. (2005). Get off the bus: sound strategy for injury prevention during a tornado? Prehosp Disaster Med. 20(3):189-92.

Kanter RK. (2012). The 2011 Tuscaloosa tornado: integration of pediatric disaster services into regional systems of care. J Pediatr. 161(3):526-530.

May BM, Hogan DE, Feighner KR.(2002). Impact of a tornado on a community hospital. J Am Osteopath Assoc. 102(4):225-8.

Weinhold B. (2013). Rare fungal illness follows tornado. Environ Health Perspect.121(4):A116.

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