1 figure, 1 table omitted
On August 13, 2004, at approximately 3:45 p.m. EDT, Hurricane Charley
made landfall at Cayo Costa, a Gulf of Mexico barrier island west of Cape
Coral, Florida, as a Category 4 storm, with sustained winds estimated at 145
mph.1 Charley was the strongest hurricane to
make landfall in the United States since Hurricane Andrew in August 1992.2 Charley created a 7-foot storm surge in Fort Myers,
then traversed the state in 9 hours, continuing in a northeast direction across
eight counties. This report presents preliminary data from Florida medical
examiners (MEs), which indicated that 31 deaths were associated with Hurricane
Charley. Deaths might be reduced through coordinated hurricane planning, focused
evacuations, and advance communication to the public regarding the environmental
hazards after a natural disaster.
Under Florida law, all deaths related to hurricanes are reportable to
MEs. A directly related death was defined as death caused by the environmental
force of the hurricane. An indirectly related death was a death occurring
under circumstances caused by the hurricane. Natural causes of death were
considered storm related if physical stress during or after the storm resulted
in exacerbation of preexisting medical conditions and death. As of September
1, a total of 31 deaths had been reported; 12 (39%) occurred on the first
day of the storm, and eight (26%) additional deaths occurred during the next
Decedents ranged in age from 6 to 87 years (mean: 54 years; median:
56 years); 24 (77%) were male. Of the 31 deaths, 24 (77%) were classified
as unintentional injury, six (19%) were attributable to natural causes, and
one death was a suicide. Of the 24 unintentional deaths, 17 (71%) were trauma
related, three were caused by carbon monoxide (CO) poisoning, and one each
were caused by electrocution and drowning; two deaths involved at least two
factors in combination (i.e., trauma and electrocution or CO poisoning and
Of the 18 deaths related to trauma and drowning, 11 (62%) occurred on
the day the storm made landfall. Of those 11 deaths, nine were directly related
to the storm, and two were indirectly related (i.e., an automobile crash in
which a traffic light was out and a fall by an evacuee in a hotel room). Four
trauma deaths resulted from motor-vehicle crashes, four from falls, three
from implosion of a shelter (i.e., mobile home or shed), two from falling
trees, two from flying debris, one from an uncertain cause, and one from a
Of the six deaths related to natural causes, four resulted from exacerbation
of cardiac conditions and two from exacerbation of preexisting pulmonary conditions.
Two persons lost power during the storm and did not have access to their needed
oxygen. One man likely had a heart attack during cleanup. Three men died of
heart failure, one during the storm and two in the days after the storm. Of
these three deaths, two were associated with exposure to extreme heat. The
suicide death involved a man who became despondent after losing his home and
possessions to Hurricane Charley; his death resulted from a witnessed self-inflicted
gunshot wound to the head.
KT Jones, Office of Vital Statistics, Jacksonville; M Grigg, Office
of Planning, Evaluation & Data Analysis; LK Crockett, MD, Div of Disease
Control; L Conti, DVM, Div of Environmental Health; C Blackmore, DVM, Bur
of Community Environmental Health; D Ward, A Rowan, DrPH, R Sanderson, MPH,
M Laidler, MPH, J Hamilton, MPH, Bur of Epidemiology, Florida Dept of Health.
J Schulte, DO, Epidemiology Program Office; D Batts-Osborne, MD, National
Center for Environmental Health; D Chertow, MD, EIS Officer, CDC.
Preliminary findings from examining the 31 deaths associated with Hurricane
Charley in Florida revealed that hurricane wind effects rather than flooding
or rain led to the majority of deaths. The majority of fatalities involved
blunt trauma caused by injuries from falling trees, flying debris, and destroyed
physical structures. Similar to Hurricane Andrew, which devastated sections
of Florida in 1992, only one death was caused by drowning.2 The
mortality and morbidity associated with hurricanes can vary according to particular
characteristics of a storm. Strong winds instead of a huge storm surge with
subsequent flooding occurred with Hurricane Charley.
Advance hurricane warnings, practiced disaster plans, and coordinated
evacuation procedures are crucial to limiting the adverse effects of severe
weather-related events. Although forecasting systems have improved, the predicted
storm paths might still change with short notice. Surrounding counties outside
of the predicted path should be prepared to coordinate evacuation of residents,
especially of vulnerable populations such as older adults, in a timely manner.
Regional planning should include instruction on the importance of evacuation,
especially of less stable structures such as mobile homes and tool sheds.
In addition, the risk of operating a motor vehicle during and immediately
after a hurricane should be emphasized.
The findings in this report are subject to at least one limitation.
A standardized, universally accepted definition of hurricane-related death
does not exist, so characterization of mortality caused by natural disasters
such as hurricanes often is based on ME classification. In this case, deaths
were classified as unintentional injury, intentional (e.g., suicide), or natural.
Local disaster plans and public health messages that address populations
with special needs (e.g., older adults) should be strengthened. In this case,
approximately 42% (13 of 31) of the decedents were persons aged >60 years.
Older adults are more likely to have preexisting medical conditions (e.g.,
cardiac and respiratory problems) and are more likely to require medical supplies
or equipment that depend on electricity to operate. All of the natural causes
of death could be attributed to exacerbation of chronic medical conditions
or to the lack of electricity, leading to extreme heat exposure or interruption
of supplemental oxygen supply. The Florida Department of Health, with assistance
from CDC, also conducted rapid assessments of needs of the older adult population
in affected counties.3
CO poisoning from improperly located generators, electrical injuries
from downed power lines, and injuries incurred during cleanup activities can
occur in the aftermath of disasters. Crisis intervention for persons who experience
loss of family, friends, neighbors, pets, and property is critical. Public
health messages should emphasize safety precautions and should be delivered
in advance of the storm, before vital services and lines of communication
Preliminary Medical Examiner Reports of Mortality Associated With Hurricane Charley—Florida, 2004. JAMA. 2004;292(17):2075-2076. doi:10.1001/jama.292.17.2075