Tree-related injuries associated with response and recovery from hurricane sandy, New Jersey, 2011-2014

Elizabeth G. Marshall, Shou En Lu, Abimbola O. Williams, Daniel Lefkowitz, Marija Borjan

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives: Extreme weather events require extensive tree removal and disposal, tasks associated with severe injury risks among workers and residents. To help understand the risks of such activities, we evaluated the impact of a large and destructive storm (Hurricane Sandy in 2012) on the incidence of tree-related injuries. Methods: We searched chief-complaint text fields for patients aged 18-65 from 2011-2014 emergency department visit records submitted by New Jersey hospitals through the state-based syndromic surveillance system. Tree-related keywords (eg, saw, branch, wood chip, woodchip, tree) identified possible injuries that we then reviewed to exclude unrelated cases and classify mechanisms of tree-related injury. We used Poisson regression analysis to evaluate changes in the rates of probable tree-related injuries, adjusting for total emergency department visits and seasonal variation. Results: We identified 698 probable tree-related injuries from 2011-2014 among patients aged 18-65, including 104 (14.9%) falls, 241 (34.5%) machine-related injuries, 311 (44.6%) struck-by injuries, and 42 (6.0%) other tree-related injuries. Treerelated injuries increased significantly in the quarter immediately after Hurricane Sandy (November 2012-January 2013) compared with the same quarter the year before (rate ratio [RR] 1/4 1.67; 95% confidence interval [CI], 1.13-2.47) and the year after (RR 1/4 2.47; 95% CI, 1.62-3.78) Hurricane Sandy, especially for struck-by injuries compared with the year before (RR 1/4 2.74; 95% CI, 1.47-5.12) and the year after (RR 1/4 4.17; 95% CI, 2.09-8.32) Hurricane Sandy. More than one-third of the injuries (33.4%) involved chainsaws. Conclusions: A major hurricane was associated with an increase in tree-related injuries in emergency departments, especially for mechanisms consistent with handling downed and damaged trees. Further research should confirm these findings and evaluate opportunities for preventing tree-related injuries.

Original languageEnglish (US)
Pages (from-to)266-273
Number of pages8
JournalPublic Health Reports
Issue number3
StatePublished - Jan 1 2018

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health


  • Epidemiology
  • Injuries
  • Occupational injuries
  • Population surveillance
  • Trees

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