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]).