3.4.2. The occurrence, causes and nature of the injuries

When did the injuries occur ?

Table 23: Time of Injury

Time	No. of cases	% of total
Disaster day a.m.	101	39.5
			55.6 %
Disaster day p.m.	52	20.3
2-7 days later	68	26.6
			40.2 %
8 days - 1 month later	35	13.7
Total	256	100.0

On the 29th August, the hurricane swept Dominica from mid-morning until late afternoon, and while 40 % were injured in the first few hours, 20 % were injured later in the day (Table 23). A surprisingly large proportion of injuries, 40 %, occurred after the cyclone had passed, in the days and even in the following weeks.

Where did the injuries occur ?

Three-quarters of all injuries happened to people who were outside in the open air. One quarter occurred inside. Of these, 4/5 were in the home and 1/5 in other, public buildings.

What were people doing when they were injured?

Table 24: Activity and Injury

Activity	No. of cases	% of total
Running to safety or escaping from falling house	95	43.4
Clearing debris, putting roof back on	47	21.5
Looking at damage	23	10.5
Helping others (to safety etc...)	13	5.9
Closing windows and doors	8	3.7
Other (playing, cultivating, travelling, sleeping etc...)	33	15.0
Total	219	100.0

As shown in Table 24, most of the injuries occurred when people were trying to seek protection from the force of the hurricane. Next in frequency came injuries that occurred during the process of clearing up and reconstructing homes. The third most common group of injuries were to those who were carrying out no m al activities unconnected with the disaster as such.

Included in the category of those who were injured while running to safety was one person who was hurt while trying to obtain medical aid and three people injured while wading through flood water. Because of the steeply sloping nature of the land, there was comparatively little flooding associated with hurricane David. Nevertheless, storm waves destroyed roads and coastal facilities as well as, in some areas, houses close to the shore.

Table 25 shows what people were doing at different times. On disaster day, over 70 % of all the injuries for which we have details occurred when running for shelter. Later, over 40 % of the injuries happened during the process of clearing up and a further 20 % when examining the damage.

Table 25: Injury According to Time and Activity

Activity	Disaster day			Later
	No. of cases		% of each activity	No. of cases		% of each activity
	a.m.	p.m.		days 2-7	days 8-1 mth
Running to safety or escaping from falling house	65	25	95	3	2	5
Clearing debris, putting roof back on	4	5	19	32	6	81
Looking at damage	2	1	13	16	4	87
Helping other (to safety etc...)	5	4	69	2	2	31
Cloning windows and doors	5	3	100	-	-	-
Other (playing. cultivating etc...)	4	5	27	8	16	73
Total	85	43		61	30

(X² p < 0.001 for the difference between disaster day and later)

Table 26: Injury According to Time and Place

PLACE

Time	Outside		Inside House
	No. of cases	% of total	No. of cases	% of total
Disaster day a.m.	68	36.4	28	54.9
Disaster day p.m.	40	21.4	8	15.7
2-7 days later	52	27.8	11	21.6
8 days - 1 month later	27	14.4	4	7.8
Total	187	100.0	51	100.0

X² p < 0.05

Table 26 shows the difference in the proportion of injuries occurring outside and inside houses, according to the time at which the injury took place. 70 % of injuries inside the home occurred on the day of the disaster, while only 58 % of those outside happened then. The high proportion of injuries sustained outside and which occurred after the hurricane had passed may be partly explained by the number of injuries caused by wreckage lying on the ground and by the fact that moat house repairs, notably re-roofing (when a fair number of injuries occurred), were carried out externally.

Table 26 excludes the 12 injuries that occurred in buildings other than houses. If these are included, the difference between injuries occurring inside and outside according to time ceases to be significant.

Table 27: Injury According to Activity and Place

Activity	Outside*		Inside house**
	No. of cases	% of total	No. of cases	% of total
Running to safety or escaping from falling house	82	46	7	27
Clearing debris, putting roof back on	41	23	2	8
Looking at damage	21	12	2	8
Helping others (to safety etc...)	11	6	1	4
Closing windows and doors	2	1	4	15
Other (playing, cultivating, sleeping, travelling etc...)	22	12	10	38
Total	179	100	26	100

Note : This table based on partial information excludes the 12 injuries occurring in buildings other than houses.

* Information not available for 8 cases (5 %)
** Information not available for 25 cases (49 %)

The effects of age

Table 28: Time of Injury and Major Age Groups

Time	Age group
	0-19	20-29	40-59	60 +	Total
Disaster day
a.m.	31	34	23	13	101
p.m.	15	17	12	8	52
Total	46	51	35	21	153
	58.2 %	60.0 %	57.4 %	67.7 %	59.8 %
Later
days 2-7	21	19	19	9	68
days 8-1 month	12	15	7	1	35
Total	33	34	26	10	103
	41.8 %	40.0 %	42.6 %	32.2 %	40.2 %
Grand total	79	85	61	31	256
	100.0 %	100.0 %	100.0 %	100.0 %	100.0%

There was no significant difference in time, day of the disaster or later, according to age (Table 28). Compared with the rest of the population, however, those over 60 suffered a slightly higher proportion of their injuries on the disaster day itself.

Table 29: Place of Injury and Major Age Groups

Age groups	Outside		Inside House
	No. of cases	% of total	No. of cases	% of total
0-19	59	31.6	15	29.4
20-39	67	35.8	16	31.4
40-59	40	21.4	10	19.6
over 60	21	11.2	10	19.6
Total	187	100.0	51	100.0

There was no significant difference in the age distribution between, those injured outside or inside, whether one considers houses alone or all buildings (of those injured in other buildings four were aged 0-19, one 20-39 and seven 40-59). However, those over 60 were rather less likely than the rest of the population to have been injured outside and somewhat more likely to have been hurt in their homes (Table 29).

The different age groups showed differences in activity at the time that injuries occurred (Table 30). Over half of those in the youngest and oldest age groups, for whom we have details, were injured while running away. Some youngsters said they got injured while looking at the damage.

Table 30: Activity and Injury According to Major Age Groups

Activity	Age group
	0-19	%	20-39	%	40-59	%	60 +	%	Total	%
Running to safety etc...	35	51	25	34	21	40	14	56	95	43
Clearing debris	9	13	17	23	16	30	5	20	47	21
Looking at damage	10	17	8	11	3	6	2	8	23	11
Helping others	1	2	7	10	5	10	-	-	13	6
Closing windows etc...	-	-	4	6	4	7	-	-	8	4
Other (playing etc...)	13	19	12	16	4	7	4	16	33	15
Total	68	100	73	100	53	100	25	100	219	100

(X² p < 0.05)

The nature of the injury

Table 31: The Immediate Cause of the Injury

Cause	No. of cases	% of total
Nails	63	33.0
Galvanized roofing sheets	50	26.2
Glass	34	17.8
Falling Over	15	7.8
Pieces of wood	13	6.8
Tree	11	5.8
House collapsing	5	2.6
Total	219	100.0

A very high proportion of the injuries, over 80 %, were caused by building materials, which were scattered about when the hurricane-force winds blew houses apart (Table 31).

There was 8 significant difference in the cause of injuries according to age groups (X², p < 0.005). For example, youngsters were more offer injured by nails, while those over 60 were hurt by falling over (or being blown over).

Table 32: The Part of the Body Injured

Part of body	No. of cases	% of total
Feet	116	45.0
Legs	51	19.8
Hands	34	13.2
Heat	20	7.7
Arms	13	5.0
Back	10	3.9
Chest	6	2.3
Abdomen	6	2.3
Shoulders	2	0.6
Total	258*	100.0

(*Two people were injured in more than one part of the body).

Almost two-thirds of injuries affected the lower limbs. Injuries to the upper limbs, particularly the hands, were next in frequency.

Table 33: Type of Injury

Injury	No. of cases	% of total
Cut	109	42.2
Nail wound	82	31.8
Blow	39	15.1
Other	24	9.3
Unknown	4	1.6
Total	258	100.0

Most injuries were caused by cuts from galvanized roofing sheets and by nails fixed on them and on any loose building material.

The description of the nature of the injuries suffered (as given in the preceeding paragraphs) suggests that a certain proportion are likely to have been relatively minor. This should be born in mind when reading the subsequent section on medical aid.