The April 8, 1998 tornado: Assessment of the trauma system response and the resulting injuries

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 t rauma system in this area presents an opportunity to evaluate the effective ness of the system in responding to the victims of this natural disaster. Methods: Emergency room logs and the regional trauma system database were s earched for all patients treated for injuries sustained from the tornado, a nd medical records were reviewed for demographic information, mode of trans portation to hospital, injuries, treatment, and outcome. Fatalities were id entified by means of the coroner's office. Results: A total of 224 patients were evaluated at nine area hospitals, of 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 cente rs, Among patients with nonfatal injuries, 39% were managed at Level I faci lities, 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 nontraum a facilities; Level I facilities also had the highest Injury Severity Score . Of patients requiring admission, 83% were transported by emergency medica l services; these patients also had the highest Injury Severity Score. Conclusion: The regional trauma system facilitated appropriate and efficien t 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.