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Effective hospital disaster planning should ensure that casualties are effectively triaged and distributed throughout the local medical system (33).
Studies have shown that tornado-related injuries tend to be severe soft-tissue injuries in the form of contusions, complex lacerations, and multiple fractures, particularly of long bones (7,8,34). Because people with these tornado-related soft-tissue injuries also tend to develop wound infections caused by gram-negative bacilli commonly found in soil (7,35), tornado-related wounds should be considered highly contaminated and handled appropriately. Wound management may include debridement, secondary closure, and appropriate tetanus prophylaxis (e.g., passive or active immunization depending on a patient's immunization status). Antibiotic treatment for tornado-related wound infections should include coverage for gram-negative bacterial organisms (36). In addition to infectious disease problems associated with tornadoes, mental health problems among both responders and victims may be a significant public health issue and should be considered during disaster planning (see chapter on the Mental Health Consequences of Disasters [Chapter 7]).