Nebraska Tornado Quick Response: Assessing Community Impacts and Evaluating Early Warnings

Background. A tornado outbreak occurred on April 26, 2024, impacting communities from Central Nebraska to Central Iowa. As part of the storm system, the National Weather Service (NSW) in Omaha issued 42 tornado warnings and assessed 19 tornado tracks across the region. This outbreak produced the strongest tornadoes in eastern Nebraska in a decade, with the Douglas and Washington counties EF-4 tornado reaching maximum windspeeds of 165 miles per hour, a maximum width of one mile, and a path length of over 31 miles. While interpersonal violence, negative mental health outcomes, and changes in substance use have been studied within the larger context of disasters, site and event-specific studies are limited. Further, there is very little rapid response research investigating needs, mental and physical health impacts, and lived experiences om communities affected by tornadoes, with morbidity and mortality studies frequently utilizing hospital records and death certificates. However, rapid response research is a critical component of public health action that allows both public health and emergency management practitioners to make community-driven, evidence-informed decisions throughout response and in future risk reduction and preparedness developmental and operationalization. Methods. We conducted rapid needs assessments in Douglas and Washington Counties, using different adaptations of the Community Assessment for Public Health Response to collect perishable data in rural and otherwise hard to access areas. For both Douglas and Washington County surveys, questions were developed in collaboration with partners at local public health departments – Douglas County Health Department and Three Rivers. Survey questions were asked at the household level and covered physical and mental wellbeing, preparedness, early warnings and protective action, communications, and recovery resources. We also included four standard individual-level questions on health and well-being. For sampling in both counties, we used a 2-mile buffer around the tornado path. Damage surveys and publicly available tax parcel data from the Douglas County Assessor’s Office were used to identify residential addresses in the Douglas County sampling frame, and we sent out postcard invitations to participate in virtual and telephonic surveys to 648 households selected from damage surveys and 1,864 from tax parcel data. The survey was open from May 22 – June 24, 2024. For Washington County, we conducted surveys in the field from May 16 – 18, 2024. Households were randomly selected from 97 census blocks within the 2-mile buffer with households and then stratified based on median number of households in each cluster. To supplement the limited number of surveys in the most impacted areas, we followed-up field surveys with postcard mailouts. Online and telephonic surveys were open May 24 – June 17, 2024. Surveys for both counties were conducted via REDcap and imported into SAS v 9.4 for analysis. Data were weighted by inverse probability of selection to provide estimate the number and percentage of similar households within the sampling frame. Individual health and wellbeing questions were weighted based on the individual probability of selection to estimate the number and percentage of similar individuals within the sampling frame. This project was determined to be exempt by the University of Nebraska Medical Center’s Institutional Review Board given that it related to public health surveillance and actions. Results. There was a total of 138 surveys completed for Washington County, and 150 surveys for Douglas County. Individual health and wellbeing were negatively impacted by the tornado, with roughly 17% of individuals in both counties estimated to feel down, depressed, or hopeless for at least several days within the 2-weeks prior to the survey. Responding households in both counties indicated non-zero levels of exacerbated allergies, pre-existing mental health conditions, poor sleep quality, agitated behavior, and concentration problems. Complex medical needs were reported for 10.8% of Douglas County households and roughly 13% of Washington County households. Only 34.0% and 29.0% of households had emergency supply kits prepared prior to the tornado for Douglas and Washington Counties, respectively. Television and automated text and/or phone notifications were the most common media through which households received tornado warning communications in Washington County, and television and internet/online news were the most common in Douglas. Barriers to communications, such as impaired hearing and vision were reported for over 10% of houses in Washington County. Discussion and Conclusions. While these surveys assessed the immediate health impacts of the tornado, the information can and should be used to inform longer term public health action within the affected communities, especially around the promotion of resources and support for mental health and wellbeing. These warnings and alerts undoubtedly protected lives and prevented significant injuries. However, it is important to note that this tornado occurred during daylight hours, when many individuals were commuting from school or their workplaces, heightening situational awareness. Given that climate change can result in more storm systems with tornadic capacity, as well as more nocturnal tornadoes, it is vital to engage with community members of the development of more robust and redundant warning systems. In Washington County specifically, there were significant challenges with debris collection, removal, and drop-off locations. Over time, this could contribute to increased fire and other environmental, as well as injury, risks. While many respondents from both Washington and Douglas Counties had positive reflections on the immediate response to the tornado, both counties noted the need for more mid- and long-term recovery resources, including ways of accessing state and federal funds for recovery. The use of adapted rapid needs assessment methods in response to the Arbor Day tornado outbreak was a successful means of not only capturing perishable data but also building partnerships between public health practitioners in academic and practice settings. This approach can give local health departments and county officials information to make evidence-informed decisions for this and future disaster events.