Deaths Associated with Hurricanes Marilyn and Opal -- United States, September-October 1995

The 1995 hurricane season was one of the most severe in U.S. history and included 11 hurricanes. During a 2-week period, the two most damaging storms -- hurricanes Marilyn and Opal -- made landfall in the United States. To characterize the deaths attributed to these storms, CDC contacted medical examiners/coroners (ME/Cs) in the affected areas. This report summarizes the findings of these investigations.

Hurricane-related deaths can occur before (preimpact), during (impact), and after (postimpact) a hurricane strikes land. Deaths determined by local ME/Cs to be "disaster-related" are those directly (i.e., resulting from the environmental force of the hurricane) or indirectly (i.e., death caused by an injury or illness associated with hurricane-related events such as evacuation, clean-up, or loss of electricity {1}) related to the storm.

Hurricane Marilyn, September 1995

On September 15, Hurricane Marilyn, a category two (on a scale of one to five) storm with sustained winds of 105 mph, made landfall in the U.S. Virgin Islands (USVI). The hurricane passed directly over St. Thomas (1990 population: 48,166) and affected St. John (1990 population: 3504) and St. Croix (1990 population: 50,139) in the USVI, and the islands of Culebra (1990 population: 1542) and Vieques (1990 population: 8602) in the Commonwealth of Puerto Rico (Figure_1). Gale-force winds, heavy rains, and storm surges of 3-5 feet resulted in damages reported at approximately $3 billion; more than 80% of the residential dwellings in St. Thomas were damaged or destroyed (2).

ME/C offices in the USVI and the Institute of Forensic Sciences in Puerto Rico provided information about hurricane-related deaths reported from September 15 through October 4. Specific information included characteristics about decedents (e.g., age and sex) and the circumstances of death (e.g., date of injury, date of death, location, cause of death, and other circumstances).

ME/Cs reported 10 deaths that were related, directly or indirectly, to Hurricane Marilyn (Table_1). The mean age for the seven decedents whose ages were known was 56.5 years (range: 17-107 years); eight were male. Of these 10 deaths, six were reported by the ME/Cs from St. Thomas and St. John, two from St. Croix, and two from Puerto Rico.

One death occurred preimpact; the other nine occurred during the impact phase of the hurricane. The preimpact death occurred in Puerto Rico when the decedent was electrocuted while moving a TV antenna in preparation for the storm. Eight of the deaths, including the second death in Puerto Rico, were boat-related (i.e., the victims were on boats when the hurricane struck). Drowning was reported as the cause of seven of these boat-related deaths; head trauma was reported as the cause of one death. A 107-year-old woman died in an emergency shelter in the USVI; her death, although possibly precipitated by the circumstances of the hurricane, was attributed to natural causes.

Hurricane Opal, October 1995

On October 4, Hurricane Opal, a category three storm with sustained winds of 115 mph, moved across the Gulf of Mexico and made landfall approximately 20 miles east of Pensacola, Florida. Gale-force winds and storm surges of 10-15 feet caused severe damage throughout the panhandle of Florida; the coastal areas were affected most severely (M. Mayfield, National Hurricane Center, personal communication, 1995). Although the hurricane was downgraded to a tropical storm (i.e., sustained wind speeds of 39-74 mph) soon after landfall, accompanying heavy rains and high winds caused extensive damage as the storm moved northward across southern and northeastern Alabama, through northwestern Georgia, and into North Carolina (Figure_2). In addition to the seven counties in Florida that were initially declared federal disaster areas, disaster declarations also had been issued for 37 counties in Alabama, 47 counties in Georgia, and 13 counties and the eastern band of the Cherokee Reservation in North Carolina (3).

Data on deaths reported during October 4-25 attributed to the storm were provided by the offices of the ME/Cs in all counties in Alabama, Florida, and Georgia for which state or federal disaster declarations were issued, and in other counties without disaster declarations where hurricane-related deaths were reported; in addition, CDC contacted counties adjacent to those meeting the above criteria. In North Carolina, the chief ME in the State Department of Environment, Health, and Natural Resources was contacted for information on the entire state. ME/Cs were asked to provide information about decedents and circumstances of any death attributed to the hurricane. All eligible counties except one in Alabama and one in Georgia were contacted.

A total of 27 hurricane-related deaths were reported by the ME/Cs: two deaths occurred in Florida, 12 in Alabama, 11 in Georgia, and two in North Carolina. Of these, one occurred during the preimpact phase of the storm, 13 during the impact phase, and 13 during the postimpact phase. Decedents ranged in age from 4 years to 87 years, and 21 were male. For the 26 decedents aged 20-87 years, the mean age was 52.4 years.

Of the 27 deaths, the cause of death for 24 was considered accidental *; the other three deaths were attributed to natural causes but were considered hurricane-related because circumstances created by the hurricane contributed to the deaths. One death resulted from exacerbation of chronic obstructive pulmonary disease following strenuous activity during clean-up activities, and two deaths resulted from myocardial infarctions that also were attributed to strenuous clean-up activities.

Thirteen deaths were related to falling or fallen trees; of these, nine occurred during the impact phase when victims were struck by trees falling on or near their residence (six), place of employment (one), or motor vehicle (two). Three occurred when vehicles struck trees lying in the road, and one occurred when the decedent was struck while cutting down a tree that had partially fallen during the storm.

Four deaths were attributed indirectly to power outages: one death from carbon monoxide poisoning associated with the use of a gas generator and three from house fires started by candles (two) or a propane cooking device (one). Motor vehicles were implicated in seven of the deaths, including persons in motor vehicles that were struck by falling trees or that ran into downed trees (five). Five other deaths occurred during the postimpact phase: one person drowned in a swollen creek; one was electrocuted while repairing a downed power line; one sustained massive chest trauma after a tractor overturned; and two suffered heart attacks while repairing damage and clearing debris.

Table_2 Deaths attributed to Hurricane Opal, by phase of storm,

location, age, sex, and cause and circumstance of death -- Alabama, Florida, Georgia, and North Carolina, October, 1995

Reported by: N George-McDowell, MD, F Landron, MD, St. Thomas, St. John; J Glenn, MD, St. Croix, US Virgin Islands. MS Conte Miler, MD, Institute of Forensic Sciences, C Deseda, MD, Commonwealth Epidemiologist, Puerto Rico Dept of Health. CF McConnell, MD, District 1; M Herman, MD, District 14; R Hopkins, MD, State Epidemiologist, Florida Dept of Health and Rehabilitative Svcs. W Moncrief, Autauga County; HA Mack, Sr, Baldwin County; D Childs, Barbour County; D McGee, Bibb County; G Long, Blount County; T May, Bullock County; P Tuctchtone, Jr, Butler County; B Hulsey, Calhoun County; D Collier, Jr, Chambers County; B Rodgers, Cherokee County; W Lathan, Clarke County; RD Rush, Clay County; EL Dryden, Cleburne County; T Whitehead, Coffee County; J Harper, Conecuh County; AW Wingfield, Coosa County; N Hobson, Covington County; RK Turner, Crenshaw County; E Bankston, Dale County; T Wilson, DeKalb County; T Ellison, Elmore County; RH Johnson, Escambia County; W Phelps, Etowah County; K Mixon, Geneva County; ND Holman, Henry County; R Byrd, Houston County; RM Brissie, MD, Jefferson County; JW Story, Lee County; W Pringle, Lowndes County; HE Bentley, Macon County; DC Hibbs, Marshall County; L Riddick, MD, Mobile County; W Chambless, MD, Montgomery County; J Williams, Pike County; RT Gibbs, Randolph County; J Key, Russell County; J Wyatt, Saint Clair County; J Jones, Shelby County; J Castelberry, Talladega County; D Philips, Jr, Tallapoosa County; K Warner, MD, Tuscaloosa County; RD Green, Jr, Walker County; R Scherer, Bur of Health Care Standards, D Williamson, MD, Alabama Dept of Public Health. DG Starnes, Bartow County; R Ballard, Butts County; SH Eady, Carroll County; T Headrick, Catoosa County; BT Chancellor, Chattahoochee County; E Rainwater, Chattooga County; E Darby, Cherokee County; M Lindsey, Clay County; AP Dickson, Clayton County; JL Burton, MD, Cobb County, DeKalb County, and Gwinnett County; D Williams, Coweta County; J Gray, Dade County; WO Burnham, Dawson County; R Daniel, Douglas County; RC Vollrath, MD, Fannin County; CJ Mowell, Jr, Fayette County; F Talley, Floyd County; RA Ingram, Jr, Forsyth County; SA Zaki, MD, Fulton County; JB Hensley, Gilmer County; J Carver, Gordon County; D Wall, Habersham County; M Merck, Hall County; RB Hightower, Sr, Haralson County; JC Kindon, Harris County; LF Hooks, Heard County; R Stewart, Henry County; JF Smith, Lamar County; B McKinney, Lumpkin County; H Tante, Marion County; JE Worley, Meriwether County; LM Ballew, Murray County; JD Kilgore, Muscogee County; R Wheeler, Newton County; S Clark, Paulding County; F Chapman, Pickens County; L Litesey, Polk County; J Belflower, Quitman County; L Hunter, Rabun County; BF Lunsford, Randolph County; HS Ellison, MD, Rockdale County; JL Hall, Spalding County; E Stone, Stewart County; JC Cosby, Talbot County; R Stahlkuppe, Towns County; EM Smith, Troup County; B Erwin, MD, Union County; WE McGill, Walker County; JC Rowe, Walton County; R Barrett, White County; BJ Dixon, Whitfield County; KE Toomey, MD, State Epidemiologist, Div of Public Health, Georgia Dept of Human Resources. JD Butts, MD; M Moser, MD, State Epidemiologist, North Carolina Dept of Environment, Health, and Natural Resources. Federal Emergency Response Agency. American Red Cross, Falls Church, Virginia. Emergency Response Coordination Group, Office of the Director; Surveillance and Programs Br, and Disaster Assessment and Epidemiology Section, Health Studies Br, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Before Hurricane Hugo in 1989, most hurricane-related deaths occurred during the impact phase, usually along the coastline, and were attributed to drowning from hurricane-related storm surges. For example, following Hurricane Camille, which struck the Gulf of Mexico coast in 1969, most of the 256 storm-related deaths were attributed to drowning that resulted from 25-foot storm tides near the coast and flash floods further inland (4). Since then, however, improvements in forecasting technology and evacuation procedures have decreased the number of deaths attributed to drowning from storm surges during recent hurricanes (5). Consequently, an increasing proportion of deaths occurring during the impact phase of recent hurricanes have been attributed to the effects of the high winds rather than storm surges (1). In addition, since Hurricane Hugo, the proportion of deaths that occur during the postimpact phase has increased. Many of these deaths and nonfatal injuries result from electrocutions from contact with downed power lines, chain saw lacerations, and trauma from falling trees (6,7).

During Hurricane Marilyn, no deaths directly related to the impact phase of the storm occurred on any of the islands, possibly reflecting the effectiveness of measures to evacuate and shelter the population at risk. However, eight of nine persons who died during the impact of the storm were at sea at the time of death, suggesting that warnings should be strengthened to emphasize risks of being aboard a vessel during a hurricane. In USVI and other areas where substantial numbers of persons reside on boats, these persons should be encouraged to evacuate to shelters on land.

Many of the deaths attributed to Hurricane Opal occurred among persons in inland counties after the hurricane had been downgraded to a tropical storm, suggesting that persons in these areas may not have recognized or been fully informed about the risks associated with severe storms. In particular, because the use of motor vehicles during and after the storm was associated with several deaths, risks related to driving during or immediately following a severe storm should be emphasized, and persons should be encouraged to remain off the roads. In addition, because many deaths occurred after the storm during surveying efforts or clean-up activities, emergency notifications should stress the persistent risks of environmental hazards (e.g., downed trees and power lines) even after the storm has passed.

References

1. CDC. Preliminary report: medical examiner reports of deaths associated with Hurricane Andrew -- Florida, August 1992. MMWR 1992;41:641-4.

2. Federal Emergency Management Agency. Situation reports, Hurricane Marilyn, 1995. Washington, DC: Federal Emergency Management Agency, 1995.

3. Federal Emergency Management Agency. Situation reports, Hurricane Opal, 1995. Washington, DC: Federal Emergency Management Agency, 1995.

4. French J. Hurricanes. In: Gregg MB, ed. Public health consequences of disasters. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1989.

5. CDC. Deaths associated with Hurricane Hugo -- Puerto Rico. MMWR 1989; 38:680-2.

6. CDC. Update: work-related electrocutions associated with Hurricane Hugo

• Puerto Rico. MMWR 1989;38:718-20,725.

7. Philen R, Combs D, Miller L, Sanderson L, Parrish RG, Ing R. Hurricane Hugo-related deaths: South Carolina and Puerto Rico, 1989. Disasters 1992;16:53-9.

When a death occurs under "accidental" circumstances, the preferred term within the public health community is "unintentional injury."

TABLE 1. Deaths attributed to Hurricane Marilyn, by phase of storm *, location, age,
sex, and cause and circumstance of death -- U.S. Virgin Islands and Puerto Rico,
September 1995
==================================================================================================
Phase                          Age            Cause
  of storm      Location      (yrs)   Sex    of death              Circumstance of death
------------------------------------------------------------------------------------------------
Impact          St. Thomas      62     M     Drowning          On boat during impact; body
                                                                 found washed up on shore

Impact          St. Thomas      46     M     Drowning          On boat during impact; body
                                                                 found washed up on shore

Impact          St. Thomas     50 +    M     Drowning          On boat during impact; body
                                                                 found washed up on shore

Impact          St. Thomas    55-65 +  M     Drowning          On boat during impact; body
                                                                 found washed up on shore

Impact          St. Thomas      50 +   M     Head trauma       On boat when mast or other part
                                                                 of boat broke and struck him
                                                                 on head; body found washed
                                                                 up on shore

Impact          St. John        48      F    Drowning          On boat during impact,

Impact          St. Croix       59      M    Drowning          On boat during impact; body
                                                                 found washed up on shore

Impact          St. Croix      107      F    Natural causes    In shelter and died during impact

Preimpact       Puerto Rico     17      M    Electrocution     Received an electric shock while
                                                                 on roof removing a TV antenna

Impact          Puerto Rico     53      M    Asphyxia by       On boat during impact; body
                                               submersion        found 4 days later
------------------------------------------------------------------------------------------------
* Deaths were categorized as occurring before the hurricane made landfall (preimpact), during
  the storm (impact), or after the storm had passed (postimpact).
+ The exact age could not be determined by the medical examiner.
==================================================================================================

TABLE 2. Deaths attributed to Hurricane Opal, by phase of storm *, location, age, sex,
and cause and circumstance of death -- Alabama, Florida, Georgia, North Carolina,
October, 1995
========================================================================================================
Phase                        Age                Cause
  of storm  State/County    (yrs)   Sex        of death              Circumstance of death
------------------------------------------------------------------------------------------------------
Impact      Ala., Henry      28      M       Thermal burns     House fire started by candle used
                                                                 during the storm

Impact      Ala., Jefferson  30      M       Multiple blunt    Working on train. Train accident +
                                               force injury      caused victim to be ejected and run
                                                                 over by train

Impact      Ala., Jefferson  51      M       Carbon monoxide   Using a gas generator in an
                                               poisoning         unventilated space because of
                                                                 power outage

Impact      Ala., Etowah     33      F       Multiple trauma   Tree fell on mobile home

Impact      Ala., Etowah     35      M       Multiple trauma   Tree fell on mobile home

Postimpact  Ala., Coffee     73      M       Multiple blunt    While surveying damage, struck
                                               force trauma      by automobile that ran into a tree

Postimpact  Ala., Coffee     58      F       Multiple blunt    While surveying damage, struck
                                               force trauma      by automobile that ran into a tree

Postimpact  Ala., Clay       86      M       Massive trauma    Tractor overturned while clearing
                                               to chest          debris

Postimpact  Ala., Chambers   34      M       Electrocution     Electrocuted while repairing a
                                                                 downed power line

Postimpact  Ala., Chambers   61      M       Cardiac arrest    Suffered a heart attack while repairing
                                                                 damaged fence

Postimpact  Ala., Lee        87      M       Myocardial        Suffered a heart attack while
                                               infarction        cleaning up debris

Postimpact  Ala., Coffee     70      M       Chronic           Strenuous exercise during clean-up
                                               obstructive       activities exacerbated lung condition
                                               pulmonary
                                               disease

Preimpact   Fla., Okaloosa   76      F       Multiple blunt    Mobile home hit by tornado
                                               injuries to
                                               head

Impact      Fla., Escambia   36      M       Crushing head     Hit by falling tree while
                                               injury            working at gas station
                                                                 during storm

Impact      Ga., Carroll     20      F       Blunt force       Pinned by falling tree and bled
                                               trauma            to death once tree was removed

Impact      Ga., Cobb        50      M       Asphyxia due to   Outside when struck by falling
                                               mechanical        tree
                                               impairment of
                                               respiration

Impact      Ga., Fulton      74      M       Multiple blunt    Tree fell through roof of
                                               force trauma      residence and crushed legs

Impact      Ga., Spaulding   45      M       Blunt force       Tree fell on cab of pickup while
                                               trauma to head    in motor vehicle

Impact      Ga., Haralson    26      M       Massive head and  Tree fell on cab of truck while
                                               neck trauma       in motor vehicle

Impact      Ga., Haralson    55      F       Massive head      Motor vehicle accident
                                               trauma            attributed to rain from storm

Postimpact  Ga., Gilmer      53      M       Blunt force       Struck by a tree he was cutting
                                               trauma to head    down in yard

Postimpact  Ga., Fulton      34      M       Blunt force       Hit fallen tree in the road
                                               trauma            while riding motorcycle

Postimpact  Ga., Floyd       58      F       Multiple blunt    Traffic lights not working due to
                                               force trauma      power outage. Motor vehicle
                                                                 accident occurred in an intersection

Postimpact  Ga., DeKalb      4       M       Thermal burns     House fire started by candles used for
                                                                 light after storm

Postimpact  Ga., Murray      62      M       Smoke inhalation  Explosion caused by propane cooking
                                                                 device used because of power
                                                                 outage

Impact      N.C., Buncombe   60      M       Compressional     Tree fell on mobile home
                                               asphyxia

Postimpact  N.C., McDowell   68      M       Drowning          Fell into swollen creek while
                                                                 surveying damage
------------------------------------------------------------------------------------------------------
* Deaths were categorized as occurring before the hurricane made landfall (preimpact), during
  the storm (impact), or after the storm had passed (postimpact).
+ When a death occurs under "accidental" circumstances, the preferred term within the public
  health community is "unintentional injury."
========================================================================================================

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