- Email: [email protected]
Morbidity of Hurricane Frederic
ORIGINAL CONTRIBUTION , disaster management; disaster planning; hurricanes
Morbidity of Hurricane Frederic On September 12, •979, Hurricane Frederic struck the Gulf Coasts of Mississippi and Alabama. A retrospective review of emergency department logs for a three-week period surrounding the storm was conducted to determine the amount and type of back up needed for an emergency department to cope with the results of such a disaster. There was a significant increase in the number of patients presenting to the emergency department for at least two weeks after the storm, with the greatest demand being for professionals skilled in outpatient trauma management. The nature of hurricanes is discussed, as are specific items to be considered in disaster planning'for areas subjected to these storms. [Longmire AW, Ten Eyck RP: Morbidity of Hurricane Frederic. Ann Emerg Med May 1984;13:334-338.]
INTRODUCTION Hurricanes strike our Gulf and Atlantic coasts frequently. On an average, four hurricanes form each year.1 The mortality in this century is estimated at 45,000, including 13,000 in the United States. 2 Hurricanes develop from storms in the Atlantic from June to November. The dynamics of these storms are described in detail by Eliot.3 In essence, the easterly trade winds are heated at the surface of the warm ocean waters. As the heated air rises, the pressure at the surface drops and the earth's rotation creates a spiral pattern forming a counterclockwise rotation in the Northern Hemisphere (Figure 1). If the cycle perpetuates itself to sustained winds of 39 mph, a tropical storm is formed and it is given a name. When sustained winds of 74 mph are achieved, the storm is upgraded to a hurricane. Although these killer storms are primarily a threat to coastal areas, they have caused significant damage inland, as evidenced by the Wilkes-Barre, Pennsylvania, floods from Hurricane Agnes in 1972. Hurricanes are classified by a disaster potential scale, the Saffir/Simpson Scale, according to their wind velocity and tidal surge. 1 A Saffir/Simpson Scale I hurricane has winds of 74 to 95 mph and a storm surge of tides four to five feet above normal. A Saffir/Simpson Scale V hurricane has sustained winds greater than 155 mph and a tidal surge greater than 18 feet above normal (Table 1}. This study was prompted by problems that we noted in dealing with the aftermath of Hurricane Frederic. There are few available guidelines for the operation of an emergency department and an emergency medical services (EMS) system under these conditions. We believe that a study of the number of patients and the nature of their complaints following a hurricane of a specific intensity should be helpful for an emergency department in planning medical support. A review of the literature fails to reveal any systematic attempt to quantitate injuries or illnesses following a hurricane. Previous publications have been concerned with anecdotal descriptions, 4-6 problems with communications and logistics, 7-1o death counts, n, 12 or emotional response,ts An increase in gastroenteritis, dysentery, rheumatic fever, and pneumonia were alluded to after Hurricane David in Dominica, 4 but the number of patients and their times of presentation after the hurricane were not documented to anticipate emergency department requirements for future storms.
13:5May 1984
Annals of Emergency Medicine
Atkinson W Longmire, MD, LTC, USAF* Pascagoula, Mississippi Raymond P Ten Eyck, MD, MAJ, USAF1Biloxi, Mississippi From the Department of Emergency Medicine, Singing River Hospital, Pascagoula, Mississippi, and the 3343rd Army Reserve Hospital, Mobile, Alabama;* and the Department of Emergency Medicine, Keesler AFB Medical Center, Biloxi, Mississippi.t Received for publication August 18, 1983. Accepted for publication November 8, 1983. The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Air Force, the Department of the Army, or the Department of Defense. Address for reprints: Atkinson W Longmire, MD, Emergency Department, Singing River Hospital, Pascagoula, Mississippi 39567.
334/49
HURRICANE FREDERIC Longmire & Ten Eyck
Fig. 1. The structure of a hurricane.
MATERIALS A N D M E T H O D S The Singing River Hospital Emergency Department is the only emergency facility serving approximately 100,000 people14 on the eastern edge of the Mississippi Gulf Coast and the extreme western edge of the Alabama Gulf Coast. On September 12, 1979, this area was hit directly by Hurricane Frederic, a Saffir/Simpson Scale III hurricane. Class 1II denotes sustained winds of 111 to 130 mph and a storm tidal surge of nine to 12 feet. A retrospective analysis of emergency department logs was performed for a period of nine weeks. The intervals analyzed were the week prior to Hurricane Frederic and the two weeks post Frederic (1,185 patients). The corresponding three-week periods were analyzed for both 1978 and 1980 (772 and 671 patients, respectively) (Table 2). T h e chief c o m p l a i n t s considered were those that were believed to have a possible change in incidence due to the storm or that were shown to increase in previous reports. The results were evaluated for statistical significance using chi square analysis. Expected frequency was calculated by averaging the total n u m b e r for the nine weeks for each e n t i ~ The average was considered the best estimate of the expected frequency if the null hypothesis of cells coming from the same population were true. A 1 x 9 chi square was used to d e t e r m i n e whether the scores showed significant variation. When significance was found, the two cells representing the post-Frederic weeks in 1979 were excluded and a 1 x 7 chi square was performed on the remaining cells. Lack of significance in the 1 x 7 chi square indicated t h a t the two weeks post Frederic represented the significant difference. RESULTS There was a dramatic increase in the number of patients seen each day beginning directly after the hurricane and lasting approximately two weeks, with a gradual return toward normal census afterward. The average during this period was approximately 160 per day, compared with the normal average of 120 per day. Similar increases were not seen in 1978 and 1980. The data fell into three groups. 50/335
m
=_-
-~
_.
• ~___~~----
I I
~ - - ~
__=-
I I
-
- r--~
L
I
J
I
I
l
r
I I
I
-~,.'~
I
I
EYE rCALM) 5 - 25 MPH
I
I
t..,,~,---DL-STRUCTIVE W/NDS 500-500M/LE DIA.'
--
I
I I
Group 1 consisted of those entities showing a significant difference in the 1 x 9 analysis and no significance in the 1 x 7 analysis (Table 3). This group r e p r e s e n t e d t h o s e p r o b l e m s thought to have a significantly increased incidence due to Hurricane Frederic, and included lacerations, puncture wounds, chain saw injuries, burns, gasoline aspiration, gastrointestinal complaints, stings, and spouse abuse. Group 2 was composed of entities with significant chi square scores in both the 1 x 9 and 1 x 7 analysis (Table 4). This group had too m u c h random variance to conclude that the post-Frederic weeks showed a statistically significant difference. This Annals of Emergency Medicine
TABLE 1. Saffir/Simpson hurricane scale
Class
Winds (mph)
Tidal Surge (ft)
I II III IV V
74-95 96-110 111-130 131-155 > 155
4-5 6-8 9-12 13-18 > 18
group included obstetrical problems, fractures, eye injuries, and psychiatric complaints. Group 3 consisted of those entities 13:5 May 1984
TABLE 2. Number of patients seen per week with complaints showing
significant variance
Complaint
Weeks in 1978" 1 2 3
Weeks in 1979" 1 2 3
Weeks in 1980" 1 2 3
Stings
4
3
6
9
15
11
2
2
4
Gasoline aspiration
0
0
0
0
3
0
0
0
0
Gastrointestinal complaints
10
12
7
7
20
19
4
10
7
Lacerations
68
88
77
78
167
133
71
66
76
0
0
0
1
8
6
0
0
0
Chain saw injuries
/
Puncture wounds
11
7
4
10
36
15
5
11
9
5
7
6
11
16
10
7
3
3
0
3
1
0
0
0
Burns
Spouse 0 assaults 0 0 "1 = week preceding September 12. 2 = first week after September 12. 3 = second week after September 12.
TABLE 3. Areas showing significant variance post Frederic
Category of Complaint
x2
P Level
Degrees of Freedom
Stings
1 x 9 1 x 7
26.38 8.60
.001 NS*
8 6
Gasoline aspiration
1 x 9 1 x 7
27.00 0.00
.001 NS*
8 6
Gastrointestinal complaints
1 x 9 1 x 7
23.02 5.29
.01 NS*
8 6
Lacerations
1 x 9 1 x 7
105.29 4.43
.001 NS*
8 6
Puncture wounds
1 x 9 1 x 7
29.83 5.03
.001 NS*
8 6
Chain saw injuries
1 x 9 1 x 7
47.53 0.10
.001 NS*
8 6
Burns
1 x 9 1 x 7
18.43 7.60
.02 NS*
8 6
Spouse abuse *Not significant.
1 x 9 1 x 7
18.52 0.00
.02 NS*
8 6
in which the I x 9 chi square analysis did not show significance (Table 5) and no further evaluation was required. Included in this group were overdoses, drownings, foreign bodies, cardiac arrests, patients dead on arrival, electrocutions, cardiac admissions, surgical 13:5 May 1984
admissions, animal bites, gunshot wounds, assaults, motor vehicle accidents, and patients leaving against medical advice.
DISCUSSION The overall increase in patient visits Annals of Emergency Medicine
to the emergency department after Hurricane Frederic was due to two factors. First, there were increased risks for illness and injury due to clean-up activities, lack of electricity, and potential c o n t a m i n a t i o n of food and water supplies. Second, m a n y local physicians were unable to open their offices for several days after the hurricane. Consequently the emergency department became the sole source of medical care for m a n y patients. The predominance of entities showing a s t a t i s t i c a l l y significant increase (Group 1) indicates a need for back-up professionals skilled in handling trauma. Chain saw injuries were not impressive in terms of numbers, but they required such a large amount of time to repair that on some days they were the m o s t i m p o r t a n t type of injury treated. Although the post-Frederic increase in the Group 2 problems was not statistically significant, it suggests the need for increased support in these areas. There was an increase in the number of obstetrical emergency department visits in the week preceding the hurricane as well as during the two weeks after, explaining the lack of statistical significance by the method of analysis employed. These figures would indicate that increased obstetrical support is required both immediately before and after a hurricane. It is easy to understand w h y obstetrical patients require medical consultation while planning evacuation procedures or while staying in the disaster environment, both before and after a hurricane. Only one obstetrical emergency run (to transport a patient in labor from a shelter to the hospital) was required during the actual hurricane. The number of patients presenting with psychiatric complaints did not achieve statistical significance using the accepted criteria of P > .05; however, the P value of < .10 and > .05 is close to significance and suggests the need for increased psychiatric support. A previous study indicated such a need following extensive flooding33 During the hurricane, the most glaring waste and risks were incurred while responding to emergency calls that were not actually emergencies. This problem has been identified in a previous report. 6 The decision of ambulance dispatch is a critical one, and should be entrusted to an experienced emergency physician. When ambulances were dispatched, we found that the standard van-type vehicle was to336/51
HURRICANE FREDERIC Longmire & Ten Eyck
tally inadequate to navigate during a S a f f i r / S i m p s o n C l a s s III h u r r i c a n e . T h i s p r o b l e m was s o l v e d w i t h assistance rendered by a local National Guard unit. These men, with their a m p h i b i o u s vehicles (Figure 2}, were able to rescue our rescue personnel and their patients. Further rescue runs were clone in m i l i t a r y vehicles. Personal experience with rescue m i s s i o n s in civilian a m b u l a n c e s (tot a l l y horrifying) a n d large m i l i t a r y amphibious vehicles (only moderately f r i g h t e n i n g ) h a s c o n v i n c e d us t h a t only the large m i l i t a r y vehicles should be used if they are available during a Saffir/Simpson hurricane of Class III or greater. The use of m i l i t a r y equipment and p e r s o n n e l was n o t u n i q u e to t h i s storm.7-1o T h e m i l i t a r y ' s c o m m a n d structure and ability to move people and supplies under adverse conditions m a k e it an ideal source of help during a hurricane. A t no t i m e did any person refuse to enter the storm in order to rescue another. However on two occasions rescue teams and vehicles were used to check on the families of m e d i c a l or m i l i t a r y personnel. This w o u l d indicate that rescue personnel are more effective when they can be convinced to move their families out of i m m e d i a t e danger. CONCLUSIONS Hurricane Frederic, a Saffix/Simpson Class III hurricane, placed severe extra d e m a n d s on our c o m m u n i t y ' s emerg e n c y d e p a r t m e n t for at l e a s t t w o weeks after the storm. T h e greatest need was for additional physicians and n u r s e s s k i l l e d in o u t p a t i e n t t r a u m a m a n a g e m e n t . T h e r e was also a need for additional obstetrical and psychiatric support. E m e r g e n c y d e p a r t m e n t s in a r e a s subject to these storms should prearrange a g r e e m e n t s w i t h local p h y s i cians to insure adequate n u m b e r s of a p p r o p r i a t e s p e c i a l i s t s to m e e t demands similar to those found in our experience. T h e large m i l i t a r y amphibious troop carriers were shown to be the m o s t effective rescue vehicles during Frederic. Civil defense officials s h o u l d m a k e p r o v i s i o n s in d i s a s t e r p l a n n i n g to e m p l o y such a s s i s t a n c e from local military and National Guard facilities when possible. The authors thank Tsgt Stan Davis for his illustrative work, Mrs Susan McNamara52/337
TABLE 4. Areas showing too m u c h random variance to attribute significance to post-Frederic period
Category of Complaint
x2
P Level
Degrees of Freedom
Obstetrics
1x 9 1x 7
30.01 21.07
.001 .01
8 6
Fractures
1x 9 1 x 7
20.05 27.91
<.02 >.01 .001
8 6
Eye injuries
1x 9 1x 7
24.43 16.16
.01 .02
8 6
Psychiatric
1 x 9 1x 7
14.49 2.66
<.10 >.05 NS*
8 6
*Not significant.
TABLE 5. Areas showing no significant variance
1 x 9 x2
P Level
Degrees of Freedom
Overdose
6.89
NS*
8
Drowning
0.91
NS*
8
Foreign bodies
9.67
NS*
8
Dead on arrival
10.60
NS*
8
Category of Complaint
Electrocutions
7.93
NS*
8
Cardiac admissions
4.64
NS*
8
Surgical admissions
13.60
P <.10 >.05
8
6.67
NS*
8
Dog bites
10.57
NS*
8
Snake bites
ENT
7.66
NS*
8
Cardiac arrests
3.64
NS*
8
Leaving AMA
7.68
NS*
8
Motor vehicle accidents
11.75
NS*
8
Gunshot wounds
9.94
NS*
8
Assaults *Not significant.
8.90
NS*
8
Ten Eyck for her photographic work, and Mrs Tate Gooden for her clerical assistance in p r e p a r i n g t h i s manuscript. Special thanks to Mrs Elizabeth Haas for her many hours of research in compiling our data.
REFERENCES 1. 3380th Air Base Group/DW: Survival in a hurricane. Killer from the sea. ATC Keesler 1-1723: 1-4, March 1979. 2. Funk B: Hurricane! National Geographic 1980;158:346-367. 3. Eliot JL: Into the eye of David. NaAnnals of Emergency Medicine
tional Geographic 1980;158:368-371. 4. Ifill D: Dominica's Hurricane David. Nursing Times, June 1980, p 130-131. 5. Friedman E: Gulf Coast hospitals withstand Hurricane Frederic barrage. Hospitals, October 16, 1979, p 17-18. 6. Bower E, Denico M: Two versions of the 1938 hurricane. R I M e d [ 1972;55: 321-322. 7. Pharmacy alert: In the wake of the hurricane. American Pharmacy Association 1965;5:545. 8. Bouzarth W: Flood revisited: Lessons 13:5 May 1984
Fig. 2. N a t i o n a l Guard a m p h i b i o u s vehicles used for rescue.
12. Some Devastating North Atlantic Hurricanes of the 20th Century. US D e p a r t m e n t of Commerce, N a t i o n a l Oceanic and Atmospheric Administration, 1977. 13. Logue J, Hansen H, 8trueming E: Emotional and physical distress following Hurricane Agnes in Wyoming Valley of Pennsylvania. Public Health Rep 1979; 94:495-502. "unlearned" from Hurricane Agnes. Pa Med May 1974;77:61-62. 9. Foster CL Jr: Texas hospital battles Hurricane Beulah. Hospital Management 1967;104(6): 74.
10. Peary JE: Hurricane Beulah. A m J Public Health 1970;60:481-484. 11. Mortality from tornadoes, hurricanes, and floods. Metropolitan Life Insurance Co Statistical Bulletin 1974;155:4-7.
14. Bennett J: Jackson County's comprehensive planning and research organization, in Statistical Compendium, Jackson County, Mississippi. Jackson County Planning Commission; September 1978.
Emergency M e d i c i n e Week September 16-22, 1984 ]?oradditional information, contact the ACEP Public Relations Department, PO Box 619911, Dallas, Texas 75261-9911; 214/659-0911.
13:5 May 1984
Annals of Emergency Medicine
338/53
Morbidity of Hurricane Frederic On September 12, •979, Hurricane Frederic struck the Gulf Coasts of Mississippi and Alabama. A retrospective review of emergency department logs for a three-week period surrounding the storm was conducted to determine the amount and type of back up needed for an emergency department to cope with the results of such a disaster. There was a significant increase in the number of patients presenting to the emergency department for at least two weeks after the storm, with the greatest demand being for professionals skilled in outpatient trauma management. The nature of hurricanes is discussed, as are specific items to be considered in disaster planning'for areas subjected to these storms. [Longmire AW, Ten Eyck RP: Morbidity of Hurricane Frederic. Ann Emerg Med May 1984;13:334-338.]
INTRODUCTION Hurricanes strike our Gulf and Atlantic coasts frequently. On an average, four hurricanes form each year.1 The mortality in this century is estimated at 45,000, including 13,000 in the United States. 2 Hurricanes develop from storms in the Atlantic from June to November. The dynamics of these storms are described in detail by Eliot.3 In essence, the easterly trade winds are heated at the surface of the warm ocean waters. As the heated air rises, the pressure at the surface drops and the earth's rotation creates a spiral pattern forming a counterclockwise rotation in the Northern Hemisphere (Figure 1). If the cycle perpetuates itself to sustained winds of 39 mph, a tropical storm is formed and it is given a name. When sustained winds of 74 mph are achieved, the storm is upgraded to a hurricane. Although these killer storms are primarily a threat to coastal areas, they have caused significant damage inland, as evidenced by the Wilkes-Barre, Pennsylvania, floods from Hurricane Agnes in 1972. Hurricanes are classified by a disaster potential scale, the Saffir/Simpson Scale, according to their wind velocity and tidal surge. 1 A Saffir/Simpson Scale I hurricane has winds of 74 to 95 mph and a storm surge of tides four to five feet above normal. A Saffir/Simpson Scale V hurricane has sustained winds greater than 155 mph and a tidal surge greater than 18 feet above normal (Table 1}. This study was prompted by problems that we noted in dealing with the aftermath of Hurricane Frederic. There are few available guidelines for the operation of an emergency department and an emergency medical services (EMS) system under these conditions. We believe that a study of the number of patients and the nature of their complaints following a hurricane of a specific intensity should be helpful for an emergency department in planning medical support. A review of the literature fails to reveal any systematic attempt to quantitate injuries or illnesses following a hurricane. Previous publications have been concerned with anecdotal descriptions, 4-6 problems with communications and logistics, 7-1o death counts, n, 12 or emotional response,ts An increase in gastroenteritis, dysentery, rheumatic fever, and pneumonia were alluded to after Hurricane David in Dominica, 4 but the number of patients and their times of presentation after the hurricane were not documented to anticipate emergency department requirements for future storms.
13:5May 1984
Annals of Emergency Medicine
Atkinson W Longmire, MD, LTC, USAF* Pascagoula, Mississippi Raymond P Ten Eyck, MD, MAJ, USAF1Biloxi, Mississippi From the Department of Emergency Medicine, Singing River Hospital, Pascagoula, Mississippi, and the 3343rd Army Reserve Hospital, Mobile, Alabama;* and the Department of Emergency Medicine, Keesler AFB Medical Center, Biloxi, Mississippi.t Received for publication August 18, 1983. Accepted for publication November 8, 1983. The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Air Force, the Department of the Army, or the Department of Defense. Address for reprints: Atkinson W Longmire, MD, Emergency Department, Singing River Hospital, Pascagoula, Mississippi 39567.
334/49
HURRICANE FREDERIC Longmire & Ten Eyck
Fig. 1. The structure of a hurricane.
MATERIALS A N D M E T H O D S The Singing River Hospital Emergency Department is the only emergency facility serving approximately 100,000 people14 on the eastern edge of the Mississippi Gulf Coast and the extreme western edge of the Alabama Gulf Coast. On September 12, 1979, this area was hit directly by Hurricane Frederic, a Saffir/Simpson Scale III hurricane. Class 1II denotes sustained winds of 111 to 130 mph and a storm tidal surge of nine to 12 feet. A retrospective analysis of emergency department logs was performed for a period of nine weeks. The intervals analyzed were the week prior to Hurricane Frederic and the two weeks post Frederic (1,185 patients). The corresponding three-week periods were analyzed for both 1978 and 1980 (772 and 671 patients, respectively) (Table 2). T h e chief c o m p l a i n t s considered were those that were believed to have a possible change in incidence due to the storm or that were shown to increase in previous reports. The results were evaluated for statistical significance using chi square analysis. Expected frequency was calculated by averaging the total n u m b e r for the nine weeks for each e n t i ~ The average was considered the best estimate of the expected frequency if the null hypothesis of cells coming from the same population were true. A 1 x 9 chi square was used to d e t e r m i n e whether the scores showed significant variation. When significance was found, the two cells representing the post-Frederic weeks in 1979 were excluded and a 1 x 7 chi square was performed on the remaining cells. Lack of significance in the 1 x 7 chi square indicated t h a t the two weeks post Frederic represented the significant difference. RESULTS There was a dramatic increase in the number of patients seen each day beginning directly after the hurricane and lasting approximately two weeks, with a gradual return toward normal census afterward. The average during this period was approximately 160 per day, compared with the normal average of 120 per day. Similar increases were not seen in 1978 and 1980. The data fell into three groups. 50/335
m
=_-
-~
_.
• ~___~~----
I I
~ - - ~
__=-
I I
-
- r--~
L
I
J
I
I
l
r
I I
I
-~,.'~
I
I
EYE rCALM) 5 - 25 MPH
I
I
t..,,~,---DL-STRUCTIVE W/NDS 500-500M/LE DIA.'
--
I
I I
Group 1 consisted of those entities showing a significant difference in the 1 x 9 analysis and no significance in the 1 x 7 analysis (Table 3). This group r e p r e s e n t e d t h o s e p r o b l e m s thought to have a significantly increased incidence due to Hurricane Frederic, and included lacerations, puncture wounds, chain saw injuries, burns, gasoline aspiration, gastrointestinal complaints, stings, and spouse abuse. Group 2 was composed of entities with significant chi square scores in both the 1 x 9 and 1 x 7 analysis (Table 4). This group had too m u c h random variance to conclude that the post-Frederic weeks showed a statistically significant difference. This Annals of Emergency Medicine
TABLE 1. Saffir/Simpson hurricane scale
Class
Winds (mph)
Tidal Surge (ft)
I II III IV V
74-95 96-110 111-130 131-155 > 155
4-5 6-8 9-12 13-18 > 18
group included obstetrical problems, fractures, eye injuries, and psychiatric complaints. Group 3 consisted of those entities 13:5 May 1984
TABLE 2. Number of patients seen per week with complaints showing
significant variance
Complaint
Weeks in 1978" 1 2 3
Weeks in 1979" 1 2 3
Weeks in 1980" 1 2 3
Stings
4
3
6
9
15
11
2
2
4
Gasoline aspiration
0
0
0
0
3
0
0
0
0
Gastrointestinal complaints
10
12
7
7
20
19
4
10
7
Lacerations
68
88
77
78
167
133
71
66
76
0
0
0
1
8
6
0
0
0
Chain saw injuries
/
Puncture wounds
11
7
4
10
36
15
5
11
9
5
7
6
11
16
10
7
3
3
0
3
1
0
0
0
Burns
Spouse 0 assaults 0 0 "1 = week preceding September 12. 2 = first week after September 12. 3 = second week after September 12.
TABLE 3. Areas showing significant variance post Frederic
Category of Complaint
x2
P Level
Degrees of Freedom
Stings
1 x 9 1 x 7
26.38 8.60
.001 NS*
8 6
Gasoline aspiration
1 x 9 1 x 7
27.00 0.00
.001 NS*
8 6
Gastrointestinal complaints
1 x 9 1 x 7
23.02 5.29
.01 NS*
8 6
Lacerations
1 x 9 1 x 7
105.29 4.43
.001 NS*
8 6
Puncture wounds
1 x 9 1 x 7
29.83 5.03
.001 NS*
8 6
Chain saw injuries
1 x 9 1 x 7
47.53 0.10
.001 NS*
8 6
Burns
1 x 9 1 x 7
18.43 7.60
.02 NS*
8 6
Spouse abuse *Not significant.
1 x 9 1 x 7
18.52 0.00
.02 NS*
8 6
in which the I x 9 chi square analysis did not show significance (Table 5) and no further evaluation was required. Included in this group were overdoses, drownings, foreign bodies, cardiac arrests, patients dead on arrival, electrocutions, cardiac admissions, surgical 13:5 May 1984
admissions, animal bites, gunshot wounds, assaults, motor vehicle accidents, and patients leaving against medical advice.
DISCUSSION The overall increase in patient visits Annals of Emergency Medicine
to the emergency department after Hurricane Frederic was due to two factors. First, there were increased risks for illness and injury due to clean-up activities, lack of electricity, and potential c o n t a m i n a t i o n of food and water supplies. Second, m a n y local physicians were unable to open their offices for several days after the hurricane. Consequently the emergency department became the sole source of medical care for m a n y patients. The predominance of entities showing a s t a t i s t i c a l l y significant increase (Group 1) indicates a need for back-up professionals skilled in handling trauma. Chain saw injuries were not impressive in terms of numbers, but they required such a large amount of time to repair that on some days they were the m o s t i m p o r t a n t type of injury treated. Although the post-Frederic increase in the Group 2 problems was not statistically significant, it suggests the need for increased support in these areas. There was an increase in the number of obstetrical emergency department visits in the week preceding the hurricane as well as during the two weeks after, explaining the lack of statistical significance by the method of analysis employed. These figures would indicate that increased obstetrical support is required both immediately before and after a hurricane. It is easy to understand w h y obstetrical patients require medical consultation while planning evacuation procedures or while staying in the disaster environment, both before and after a hurricane. Only one obstetrical emergency run (to transport a patient in labor from a shelter to the hospital) was required during the actual hurricane. The number of patients presenting with psychiatric complaints did not achieve statistical significance using the accepted criteria of P > .05; however, the P value of < .10 and > .05 is close to significance and suggests the need for increased psychiatric support. A previous study indicated such a need following extensive flooding33 During the hurricane, the most glaring waste and risks were incurred while responding to emergency calls that were not actually emergencies. This problem has been identified in a previous report. 6 The decision of ambulance dispatch is a critical one, and should be entrusted to an experienced emergency physician. When ambulances were dispatched, we found that the standard van-type vehicle was to336/51
HURRICANE FREDERIC Longmire & Ten Eyck
tally inadequate to navigate during a S a f f i r / S i m p s o n C l a s s III h u r r i c a n e . T h i s p r o b l e m was s o l v e d w i t h assistance rendered by a local National Guard unit. These men, with their a m p h i b i o u s vehicles (Figure 2}, were able to rescue our rescue personnel and their patients. Further rescue runs were clone in m i l i t a r y vehicles. Personal experience with rescue m i s s i o n s in civilian a m b u l a n c e s (tot a l l y horrifying) a n d large m i l i t a r y amphibious vehicles (only moderately f r i g h t e n i n g ) h a s c o n v i n c e d us t h a t only the large m i l i t a r y vehicles should be used if they are available during a Saffir/Simpson hurricane of Class III or greater. The use of m i l i t a r y equipment and p e r s o n n e l was n o t u n i q u e to t h i s storm.7-1o T h e m i l i t a r y ' s c o m m a n d structure and ability to move people and supplies under adverse conditions m a k e it an ideal source of help during a hurricane. A t no t i m e did any person refuse to enter the storm in order to rescue another. However on two occasions rescue teams and vehicles were used to check on the families of m e d i c a l or m i l i t a r y personnel. This w o u l d indicate that rescue personnel are more effective when they can be convinced to move their families out of i m m e d i a t e danger. CONCLUSIONS Hurricane Frederic, a Saffix/Simpson Class III hurricane, placed severe extra d e m a n d s on our c o m m u n i t y ' s emerg e n c y d e p a r t m e n t for at l e a s t t w o weeks after the storm. T h e greatest need was for additional physicians and n u r s e s s k i l l e d in o u t p a t i e n t t r a u m a m a n a g e m e n t . T h e r e was also a need for additional obstetrical and psychiatric support. E m e r g e n c y d e p a r t m e n t s in a r e a s subject to these storms should prearrange a g r e e m e n t s w i t h local p h y s i cians to insure adequate n u m b e r s of a p p r o p r i a t e s p e c i a l i s t s to m e e t demands similar to those found in our experience. T h e large m i l i t a r y amphibious troop carriers were shown to be the m o s t effective rescue vehicles during Frederic. Civil defense officials s h o u l d m a k e p r o v i s i o n s in d i s a s t e r p l a n n i n g to e m p l o y such a s s i s t a n c e from local military and National Guard facilities when possible. The authors thank Tsgt Stan Davis for his illustrative work, Mrs Susan McNamara52/337
TABLE 4. Areas showing too m u c h random variance to attribute significance to post-Frederic period
Category of Complaint
x2
P Level
Degrees of Freedom
Obstetrics
1x 9 1x 7
30.01 21.07
.001 .01
8 6
Fractures
1x 9 1 x 7
20.05 27.91
<.02 >.01 .001
8 6
Eye injuries
1x 9 1x 7
24.43 16.16
.01 .02
8 6
Psychiatric
1 x 9 1x 7
14.49 2.66
<.10 >.05 NS*
8 6
*Not significant.
TABLE 5. Areas showing no significant variance
1 x 9 x2
P Level
Degrees of Freedom
Overdose
6.89
NS*
8
Drowning
0.91
NS*
8
Foreign bodies
9.67
NS*
8
Dead on arrival
10.60
NS*
8
Category of Complaint
Electrocutions
7.93
NS*
8
Cardiac admissions
4.64
NS*
8
Surgical admissions
13.60
P <.10 >.05
8
6.67
NS*
8
Dog bites
10.57
NS*
8
Snake bites
ENT
7.66
NS*
8
Cardiac arrests
3.64
NS*
8
Leaving AMA
7.68
NS*
8
Motor vehicle accidents
11.75
NS*
8
Gunshot wounds
9.94
NS*
8
Assaults *Not significant.
8.90
NS*
8
Ten Eyck for her photographic work, and Mrs Tate Gooden for her clerical assistance in p r e p a r i n g t h i s manuscript. Special thanks to Mrs Elizabeth Haas for her many hours of research in compiling our data.
REFERENCES 1. 3380th Air Base Group/DW: Survival in a hurricane. Killer from the sea. ATC Keesler 1-1723: 1-4, March 1979. 2. Funk B: Hurricane! National Geographic 1980;158:346-367. 3. Eliot JL: Into the eye of David. NaAnnals of Emergency Medicine
tional Geographic 1980;158:368-371. 4. Ifill D: Dominica's Hurricane David. Nursing Times, June 1980, p 130-131. 5. Friedman E: Gulf Coast hospitals withstand Hurricane Frederic barrage. Hospitals, October 16, 1979, p 17-18. 6. Bower E, Denico M: Two versions of the 1938 hurricane. R I M e d [ 1972;55: 321-322. 7. Pharmacy alert: In the wake of the hurricane. American Pharmacy Association 1965;5:545. 8. Bouzarth W: Flood revisited: Lessons 13:5 May 1984
Fig. 2. N a t i o n a l Guard a m p h i b i o u s vehicles used for rescue.
12. Some Devastating North Atlantic Hurricanes of the 20th Century. US D e p a r t m e n t of Commerce, N a t i o n a l Oceanic and Atmospheric Administration, 1977. 13. Logue J, Hansen H, 8trueming E: Emotional and physical distress following Hurricane Agnes in Wyoming Valley of Pennsylvania. Public Health Rep 1979; 94:495-502. "unlearned" from Hurricane Agnes. Pa Med May 1974;77:61-62. 9. Foster CL Jr: Texas hospital battles Hurricane Beulah. Hospital Management 1967;104(6): 74.
10. Peary JE: Hurricane Beulah. A m J Public Health 1970;60:481-484. 11. Mortality from tornadoes, hurricanes, and floods. Metropolitan Life Insurance Co Statistical Bulletin 1974;155:4-7.
14. Bennett J: Jackson County's comprehensive planning and research organization, in Statistical Compendium, Jackson County, Mississippi. Jackson County Planning Commission; September 1978.
Emergency M e d i c i n e Week September 16-22, 1984 ]?oradditional information, contact the ACEP Public Relations Department, PO Box 619911, Dallas, Texas 75261-9911; 214/659-0911.
13:5 May 1984
Annals of Emergency Medicine
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