Injuries and Post-Traumatic Stress following Historic Tornados: Alabama, April 2011

We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011.We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls.Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10–23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04–0.40), bathrooms (OR, 0.22; 95% CI: 0.06–0.78), hallways (OR, 0.31; 95% CI: 0.11–0.90) and closets (OR, 0.25; 95% CI: 0.07–0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09–0.49), television (aOR, 0.45; 95% CI: 0.24–0.83), and sirens (aOR, 0.50; 95% CI: 0.30–0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events.Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available