As night fell in Oklahoma, a massive search and rescue operation was underway to locate survivors from the mile-wide tornado that ripped through the Oklahoma City suburb of Moore on Monday afternoon, killing at least 51 people and injuring many others.
"We have got massive devastation in the community of Moore. Homes, schools and a hospital have been hit," said Terri Watkins, a spokeswoman for the Oklahoma Department of Emergency Management. "Responders are out there responding to people trapped under debris. They're still out actively doing this operation."
The Oklahoma Medical Examiner's office Monday night adjusted the death toll to 51, with "multiple children" among the fatalities.
PHOTOS: Tornadoes hit Oklahoma
Hospitals in the region are taking in scores of casualties — including some children — injured during the tornado, which came with winds of 200 miles per hour. The tornado's path was similar to the route of the most powerful tornado in recorded history on May 3, 1999.
Workers were clawing though a mountain of debris that used to be Plaza Towers Elementary school, some digging by hand in their search for survivors. Authorities have asked news helicopters to stay away from the site so rescuers can hear cries for help.
Jayme Shelton, a spokesman for the city of Moore, said authorities were awaiting reports from police and fire officials on casualties at the school.
Responders include police and fire responders from across the state, and the National Guard has been activated to aid in the search.
Local organizations were struggling to respond to the emergency after suffering damage of their own. The tornado ripped off the second floor of the Moore Medical Center, said Kelly Wells, a spokeswoman for Norman Regional Medical Center.
"We had a direct hit from the tornado that pretty much demolished the second floor of the hospital," she said. There were about 30 patients in the hospital when the tornado tore through, but all had been moved to a safer bottom floor.
The OU Medical Center has received 20 patients, according to spokesman Scott Coppenbarger. The casualties included 12 adults and 8 children, with injuries ranging from minor to critical, he said.
The state's only Level 1 trauma hospital began taking in patients 30 minutes after the tornado hit and has put all of its medical staff on standby.
The Moore Medical Center was also damaged. Authorities set up a triage center at the Warren movie theater in Moore, which was also damaged.
Facilities around the region have mobilized to aid recovery operations. The housing office at the University of Oklahoma has taken a couple of dozen calls from people who have been displaced by the tornado, said Rebecca Hooper, a 19-year-old junior.
The university is preparing to possibly take in people left homeless by the twister.
"We're taking down names, phone numbers, ages, genders and whether families have animals," Hooper said.
All 160 police and fire officers from the city of Moore were aiding in the search and rescue operations.
The tornado sounded "like a freight train," said Shelton, who was in a command center six blocks from where the tornado tore through town.
"You could hear the winds, see the winds," he said.
Monday's storm ranks "right up there" with tornadoes that hit the town in 1999 and 2003, Shelton said. The historic 1999 tornado destroyed 850 homes and killed five people.
The city of Moore had ample warning that severe storms were hitting the area, Shelton said. The National Weather Service predicted moderate to severe storms three days ago, and at 11 a.m., a briefing confirmed that. The town sounded its siren four times in the half hour before the tornado hit, Shelton said.
The town did not evacuate its schools though; sheltering in place is a more effective strategy than sending kids home, where they might be alone, he said.
The schools, which included Briarwood Elementary and Highland East Jr. High, have centralized hallways down the middle of the buildings away from windows and doors where students and teachers are instructed to shelter.
Shelton was awaiting reports from police and fire on injuries at the school.