Deaths Associated with Hurricane Hugo -- Puerto Rico

At 9 a.m. eastern daylight time on Monday, September 18, 1989, the eye of Hugo, the North Caribbean's strongest hurricane (a category four on a scale of five) in a decade, struck the northeast corner of Puerto Rico. Hugo's path extended from the Lesser Antilles and the Virgin Islands (where it struck on September 17) to South Carolina and areas of North Carolina (where it came ashore during the late evening and early morning of September 21-22). Wind velocities in San Juan were measured at up to 100 mph; wind gusts elsewhere measured as high as 140 mph. These winds damaged nearly 25% of homes on Puerto Rico, left approximately 75% of the island without power, and created 30-foot swells off the east coast. Heavy rains accompanying the hurricane caused some flash flooding.

From September 18 to September 29, the medical examiner in Puerto Rico investigated nine deaths considered to be related to the hurricane. One death (case 1) occurred before the storm (preimpact phase); two (cases 2 and 3), during the storm (impact phase); and six (cases 4-9), after the storm (postimpact). The medical examiner categorized the manner of death for all cases as "accident."*

Case 1. A 57-year-old man was electrocuted while trying to remove an outside television antenna before the storm.

Case 2. A 94-year-old woman drowned while waiting out the storm in her home.

Case 3. A 60-year-old man drowned on his boat during the storm. Cases 4-8. Five electric company workmen, ages 28, 30, 35, 37, and 42 years, were electrocuted in five separate incidents while attempting to repair downed power lines after the storm.

Case 9. A 35-year-old man was electrocuted when he contacted an electric cable lying on the ground where he was chopping a tree. Reported by: P Rechani, PhD, Director, Instituto de Sciencias Forenses de Puerto Rico, San Juan; JV Rullan, MD, State Epidemiologist, Div of Epidemiology, Puerto Rico Dept of Health. Div of Field Svcs, Epidemiology Program Office; Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control; Div of Safety Research, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: In the past, hurricane-related mortality has occurred primarily as a result of drownings during the impact phase. Most of these drownings have been associated with storm surges rather than heavy rains (1). For most parts of the world, however, this pattern may be changing. This decrease in impact-phase drownings may be a consequence of improved forecasting and early warnings about approaching hurricanes, as well as increased compliance of persons potentially at risk with effective evacuation programs.

The principal public health response to Hurricane Hugo was early warning and a coordinated evacuation plan. By the evening of Sunday, September 17, Puerto Rican officials had evacuated greater than 18,000 persons who were residing in low-lying, flood-prone areas. Cases 2 and 3 were the only impact-phase deaths in Puerto Rico. Despite repeated pleas from government authorities, these persons refused to leave their property and move to temporary shelters.

The contribution to mortality of causes other than impact-phase drownings was highlighted by Tropical Storm Isabelle, which struck Puerto Rico in 1985. Of the 95 deaths investigated by the medical examiner, 21 (22%) resulted from drowning; the rest resulted from other traumatic injuries, primarily associated with a landslide and collapsed bridges (CDC, unpublished data, 1987).

Public health officials and health-care providers must recognize that the mortality and morbidity risks associated with hurricanes extend beyond the impact phase. Efforts to minimize injury and other health risks for both disaster-relief workers and the general population are crucial. These risks include electric hazards, floodwaters, lacerations from storm debris and unfamiliar equipment (e.g., chain saws), operation of motorized vehicles, use of sump pumps and generators in confined spaces, and exacerbation of existing or unknown medical conditions as a result of fatigue, stress, or unavailable medical support.

CDC and other Public Health Service agencies are providing assistance to the Virgin Islands, Puerto Rico, South Carolina, and other areas affected by Hurricane Hugo. At least five of the seven electrocutions reported here were work-related. A Fatal Accident Circumstance and Epidemiology (FACE) team from the National Institute for Occupational Safety and Health, CDC, has arrived in Puerto Rico to assist local health officials in the investigation of the occupational fatalities that occurred during the postimpact phase.

Reference

1. French J. Hurricanes. In: Gregg MB, ed. Public health consequences of disasters. Atlanta: US Department of Health and Human Services, Public Health Service (in press). *"Manner of death" and "accident" are medicolegal terms used on death certificates that refer to the circumstances under which a death occurs; "cause of death" refers to the injury or illness responsible for the death. When a death occurs under "accidental" circumstances, the preferred term within the public health community for the cause of death is "unintentional injury."

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