title: Community emergency department utilization following a natural disaster (the Goderich Tornado).
abstract: On 21 August 2011 an F3 tornado hit the Canadian town of Goderich, Ontario, leaving 40 people injured and one dead. Specific medium-term changes in utilization of health care following a disaster have not been analyzed in medical literature. Documenting the emergency department utilization through this subacute period would be helpful to enable institutions and healthcare practitioners to be better prepared for future events.
  
  
  
  A medical chart review was conducted at theAlexandra Marine and General Hospital in Goderich. All emergency department visits made during the 30 days after the Tornado in 2011 (intervention group), 30 days prior to the tornado in 2011 (primary control group), and during the similar calendar period of 30 days after the tornado in 2010 (seasonal control group) were reviewed. Medical diagnoses of all patients who presented at the emergency department were collected and compared.
  
  
  
  Fewer people presented to the emergency department following the tornado than during the control periods, and those who did were significantly older than those who presented in the control periods (p<0.001). A significantly greater number of patients presented with undiagnosed medical problems, many came to refill their medications, and significantly fewer people left the emergency department without being seen (p<0.001).
  
  
  
  This study identifies the medical conditions that are most likely to be seen in an emergency department following a tornado in a rural Ontario community. This information serves to inform the medical community and other hospitals how to increase their level of preparedness should a comparable disaster occur again in the future.
authors.affiliation: Schulich School of Medicine and Dentistry University of Western Ontario; Goderich Teaching Site; Alexandra Marine and General Hospital, Goderich, Ontario, Canada. dappavoo@ryerson.ca.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Appavoo
authors.affiliation: Alexandra Marine and General Hospital, Goderich, Ontario, Canada. alexkhemlin@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Khemlin
authors.affiliation: Ryerson University, Toronto, Ontario, Canada. dappavoo@uwaterloo.ca.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Appavoo
authors.affiliation: Gateway Rural Health Research Institute, Seaforth, Ontario, Canada. candi.flynn@medportal.ca.
authors.forename: Candi J
authors.initials: CJ
authors.lastname: Flynn
mesh_terms: D003153:Community Health Services / Q000706:statistics & numerical data*; D004190:Disasters; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario; D055869:Tornadoes
keywords: Administrator; Emergency Care; Environmental Health; Evidence-based Care; General/Family Practice; Medical; North America; Nursing; Primary Health Care