Although hurricane victims typically die by drowning, more than half of the 31 people killed in Florida by Hurricane Charley last month died from trauma - in falls, auto crashes or the collapse of their homes, under falling trees, or when they were struck by flying debris - according to state public health officials.
Only one of Charley's victims drowned, a finding that runs sharply counter to data showing that drowning was responsible for more than 80 percent of U.S. hurricane deaths over the past three decades.
The analysis, released Friday by the federal Centers for Disease Control and Prevention, also found that elderly residents with known heart and lung ailments were especially vulnerable. Six of them died - two when their electricity failed and they walked away from their oxygen supplies.
The findings in the CDC's Morbidity and Mortality Weekly Report (MMWR), along with comments by the publication's editors, pointed to a need for improved evacuation plans focusing on vulnerable seniors.
Forty-two percent of those killed by Charley in Florida were age 60 or older.
James Franklin, a hurricane specialist at the National Hurricane Center, said he was not surprised that only one person drowned during Charley's nine-hour passage across the state. "Charley was a very small storm, and it was moving relatively rapidly, so there was not a lot of rainfall associated with Charley," he said.
Over the past three decades, drownings - most due to inland flooding - have accounted for 82 percent of the nation's hurricane deaths, according to a 2000 study by Edward N. Rappaport, deputy director of the Tropical Prediction Center.
Only 16 percent of hurricane deaths nationally were caused by high winds or tornadoes, according to Rappaport's study. But the CDC found that the 145 mph winds were a major factor during Charley's assault on southwest Florida.
Seventeen people died from trauma injuries, including three who were killed when mobile homes or other structures collapsed. Two were crushed by falling trees, and two others were killed by flying debris.
Four people died when their cars struck fallen trees or collided beneath darkened traffic signals. Four were killed in falls, and one person was crushed in an unspecified incident.
The authors of the study, all state and federal public health professionals, called for improved public warnings about the hazards of moving about during a severe storm or too soon after it ends.
The MMWR editors said public health messages "should emphasize safety precautions and should be delivered in advance of a storm, before vital services and lines of communication are interrupted."
Among the non-trauma deaths attributed to Charley, health officials said, three Floridians died from carbon-monoxide poisoning caused by improper use of power generators. One person was electrocuted
Also, one man shot himself in the head six days after the storm. Health officials said he was despondent because Charley destroyed his home and possessions. MMWR editors said crisis intervention is critical for people who suffer the loss of family members, friends or property.
Six Floridians died during or after Charley from causes deemed "natural" by health authorities. These included two elderly people with breathing disorders who inexplicably moved away from their oxygen bottles after their homes lost power.
Three elderly men died of heart failure, two of them as a result of exposure to extreme heat - one inside a mobile home, the other working outside with a chain saw. Another died of a heart attack while cleaning up storm debris.
"Local disaster plans and public health messages that address populations with special needs ... should be strengthened," the MMWR editors wrote.
Dr. Daniel S. Chertow, a Florida-based epidemic intelligence officer with the CDC and co-author of the MMWR report, agreed.
"Clearly, the best way to reduce deaths with hurricanes is through coordinated planning, through focused evacuations and through communication to the public," he said.
"Any deaths is too many deaths," Chertow said. "As long as there are deaths that are preventable, we will continue to try to do more to prevent them."