Review PaperThe health impacts of windstorms: a systematic literature review
Introduction
Windstorms, in the forms of cyclones (including tropical, sub-tropical extra-tropical storms and polar lows), local windstorms (such as tornadoes), and downslope windstorms, occur worldwide, and events such as Hurricane Katrina and Hurricane Sandy have emphasized the high impact these events can have on public health.1, 2, 3 Hurricanes, tropical storms and tropical cyclones occur infrequently in Europe. However, Europe is not immune from natural disasters of this sort, given that wind speeds in extra-tropical cyclones can reach ‘hurricane force’ according to the Beaufort wind scale. Although both the Special Report on Managing Risks of Extreme Events and Disasters to Advance Climate Change Adaptations4 and the Climate Change Risk Assessment for the UK5 are inconclusive with regards to the trend in frequency and intensity of windstorms in the UK, these events exist and have significant health impacts. According to the Department of Health,6 ‘floods and windstorms are a regular occurrence in the UK’. Baker and Lee7 considered that over the last 18 years, windstorms had a greater impact in the UK than flooding.
The health impacts of windstorms have been discussed extensively with reference to developing countries4 and the USA.8, 9, 10, 11, 12, 13 These impacts are generally separated into direct and indirect health impacts, thereby referring to the primary effect of the impact of the storm, causing injury and death, and the secondary effects of the impact, through the breakdown of infrastructure.9, 14 These health impacts can be severe,15 and their effects on human health could be significantly reduced by a better understanding of their patterns, which would allow appropriate preparation, emergency planning and public education.16 This paper is a response to the severe lack of peer-reviewed data in relation to events in the UK, where the majority of information is presented by the media,17 rather than evidence-based research.
An issue when researching the health impacts of windstorms is the lack of a consensus or consistent use of the definition of a windstorm. In this paper the following definitions are used:18
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Wind: motion of the air, described by the average motion over 10 minutes, in metres per second, miles per hour, kilometres per hour, knots (kn: nautical miles per hour) or Beaufort Force. Gale force is a wind speed of more than 34 kn (63 km/h). Storm force is a wind speed of more than 56 kn (103 km/h) (Box 1).
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Storm: a disturbed state of the atmosphere of sufficient intensity to present a hazard – always involves wind, but may also involve other weather phenomena.
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Windstorm: a storm in which the primary hazard comes from the wind speed. Three main categories may be identified: cyclones (including tropical and extra-tropical storms and polar lows), local windstorms (such as tornadoes) and downslope windstorms.
Looking specifically at the correlation between wind and health impacts, it is useful to consider the scales used to classify windstorm events. They demonstrate the link between wind speeds and the effects on the environments (see Appendix 1 Fujita tornado scale., Appendix 2 Saffir–Simpson scale of hurricane intensity [excluding effects of flooding]., Appendix 3 Wind gust speed taxonomy.) which in turn can have direct and indirect effects on human health. The impact of the wind force on building structures, for instance, will affect whether a person needs to leave their home.
In most windstorms the hazard does not come exclusively from the wind: much of the data in the literature incorporates the effects on humans caused by storm surges and subsequent flooding. The impacts would be more easily measured if the wind variable occurred in isolation during a windstorm, but this is unfortunately rarely the case. Two hurricane events, however, Ike (2008) and Andrew (1992) have frequently been singled out as predominantly ‘dry’ hurricanes. Thus, the conclusions drawn from these events are particularly pertinent to this paper.
Section snippets
Aim
This paper aims to identify and review current evidence of the impacts of windstorms on human health to support planning, preparation and education of the public and health professionals so as to reduce the adverse impact on health.
Objectives
The objectives of this paper are to
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identify and present evidence of the impacts of high winds on human health;
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provide evidence for reducing these impacts and making recommendations for planners and healthcare professionals; and
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document key themes and areas requiring further work.
Methods
A search strategy was developed to identify published literature relevant to the potential health impacts of windstorms. The following databases were searched: Medline (OvidSP), EmBase (OvidSP) and the Cochrane library, using terms for windstorms and health impacts in the title (keywords and abstract search also used for Cochrane). Medical Subject Headings (MeSH) were used in the Medline database. Searches were also carried out for grey literature, on Google Scholar, CDC, WHO, World
Results
The health effects of high-velocity windstorms range from direct impacts of the wind, including trauma, injury and drowning, to secondary, or indirect effects, including reduced access to healthcare or medicines (and thereby influencing chronic disease), as well as dangers associated with carbon monoxide exposure, electrical risks, psychological impacts and even infection. The health impacts are multifold and Appendix 5 summarizes the evidence providing the article, event, description of the
Direct impacts
Two papers were identified that analysed the health impacts of windstorms in the UK. Illingworth and Illingworth28 reviewed Accident and Emergency (A&E) logs in two hospitals on the day of the gales in 1983 in Leeds, which reached up to 96 mph. There were three deaths, two of which were due to head injuries and one due to multiple fractures, including a crushed chest. They reported 116 casualties, the majority of which had fractures, lacerations, abrasions or contusions. They also reported five
Indirect impacts
Again, there is no uniform consensus on a definition of indirect impacts. In this paper they are defined as health impacts that were caused by the windstorm event, but did not occur during the active exposure to the wind force. Thus, indirect impacts occur predominantly in the pre-impact or post-impact phase of a storm.
Discussion
This review aimed to assess the evidence base of the impacts of windstorms on human health. This is the only identified systematic review of the health impacts of windstorms, providing a compilation of data in one concise table. In addition, a deeper understanding of appropriate preparations and responses to windstorms, both by the general public and healthcare professionals, was sought.
Although the evidence regarding the frequency and intensity with which Europe will be exposed to windstorms
Conclusion
Windstorms have significant impacts on human health. These effects can be divided into direct and indirect impacts, which occur during the pre-impact, impact and post-impact phases of windstorms. Retrospective data collection and analysis of the referenced papers have provided patterns in mortality and morbidity, which can inform policy and decrease the magnitude of these impacts.
Public health advice can reduce morbidity and mortality from windstorms. Findings from this review provide material
Acknowledgements
Many thanks to Carla Stanke, Katie Carmichael, Sheila O'Malley and Kasia Markiewicz for their support during this project.
Ethical approval
None sought.
Funding
Dr. Anouchka Goldman was on an elective placement from St George's University of London with Extreme Events and Health Protection whilst undertaking the systematic literature review. The views expressed are those of the authors and not necessarily those of their funders or employers.
Competing interests
None declared.
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