摘要：Objectives. We describe the demographics of the decedents from the tornado outbreak in Alabama on April 27, 2011; examine the circumstances of death surrounding these fatalities; and identify measures to prevent future tornado-related fatalities. Methods. We collected information about the decedents from death certificates, disaster-related mortality surveillance, and interview data collected by American Red Cross volunteers from the decedent’s families. We describe demographic characteristics, circumstances and causes of death, and sheltering behaviors before death. Results. Of the 247 fatalities, females and older adults were at highest risk for tornado-related deaths. Most deaths were directly related to the tornadoes, on scene, and trauma-related. The majority of the deceased were indoors in single-family homes. Word of mouth was the most common warning mechanism. Conclusions. This tornado event was the third deadliest in recent US history. Our findings support the need for local community shelters, enhanced messaging to inform the public of shelter locations, and encouragement of word-of-mouth warnings and personal and family preparedness planning, with a special focus on assisting vulnerable individuals in taking shelter. Tornadoes are one of the most deadly natural disasters in the United States and continue to be a major public health concern in the Midwestern, South Central, and Southeastern states. 1 Approximately 1200 tornadoes are detected in the United States each year, on average killing 60 to 65 people and injuring 1500 people annually. 2 Since 2007, the United States has used the Enhanced Fujita (EF) scale to categorize tornadoes on a scale of 0 to 5, using wind speed estimates based on structural and tree damage. 3 Although EF-4 (wind speed of 166–200 mph) and EF-5 (wind speed of > 200 mph) tornadoes make up fewer than 1% of all tornadoes detected, they are responsible for 70% of all tornado-related deaths. 2 On April 23, 2011, the National Weather Service forecasted an upcoming storm. This forecast was followed by 351 tornadoes that swept through the Southeastern United States from April 25 to 28, 2011, causing widespread damage and resulting in 338 fatalities in Arkansas, Mississippi, Alabama, Tennessee, and Georgia. 4 The deadliest day was April 27, 2011, when a record number of 62 tornadoes, including 8 EF-4 and 3 EF-5 tornadoes, struck Alabama, resulting in the third deadliest tornado event in the United States since 1950. 5 In Alabama, these tornadoes resulted in more than 200 fatalities, 2000 injuries, and $4.2 billion in property damage. 5 The tornadoes struck Alabama in 3 waves on April 27—starting at 4:01 am , 11:15 am , and 2:40 pm —affecting 35 counties and causing deaths in 19 counties. 6 The last wave was the most destructive, destroying the entire infrastructure of the rural towns of Hackleburg and Phil Campbell, and severely affecting cities including Tuscaloosa and Birmingham. The last wave did not end until 9:50 pm . On that day, several tornadoes traveled more than 100 miles, with the total path for all tornadoes covering a distance of 1206 miles. 6 Although not foreseen to be so destructive, the storm was forecasted days ahead. The average time between public notification and tornado touchdown on April 27 was 2.4 hours for tornado watches and 22 minutes for tornado warnings, exceeding the target time of 15 minutes set by the National Weather Service. 5,7 Yet, the storm resulted in mass fatalities. The objectives of our study were to describe the decedents, examine the circumstances of death, and identify measures to prevent future tornado-related fatalities.
