North America suffers some of the most severe tornado disasters of any location on the planet. Significant injury and economic impact may result from these storms, particularly in rural areas. Tornadic storms present unique problems for prehospital and Emergency Department personnel. Soft tissue injuries seen after tornadoes are contaminated with polymicrobial flora and may require delayed primary closure. Fractures are a frequent cause of hospital admission and head injury is a frequent cause of death. Advanced warning and proper sheltering actions by a population are the most significant factors in reducing morbidity and mortality. This article reviews the pertinent literature on the medical impact of tornadoes and details the mechanisms of injury, nature of injuries, pre-hospital and ED planning points associated with tornadic storms.