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Tornadoes occur with very little or no advanced warning, causing considerable structural damage, traumatic injury, and death. This chapter reviews risk factors for injury and death, injury patterns, and mass casualty scenarios by using modeling and real event reports. Risk of injury or death has been associated with storm strength, victim age, type of material used for dwelling construction, shelter location, income level, and time of day. Injury patterns can be categorized by the time at which they occur in relation to the storm. This approach may affect treatment strategies. Initial emergency medical services (EMS) transports could then attempt even distribution of the victims to appropriate medical centers, avoiding overloading one facility as much as possible. Research is necessary to develop best practices that guide strategies for designation and management of off-site facilities that can rapidly be converted to temporary shelters for some group of victims.