A massive tornado that tore a 6-mile path across southwestern Missouri killed at least 116 people as it smashed the city of Joplin, ripping into a hospital, crushing cars and leaving behind only splintered tree trunks where entire neighborhoods once stood.
It was the deadliest single twister in the U.S. in nearly 60 years and the second major tornado disaster in less than a month.
City Manager Mark Rohr announced the new death toll at a Monday afternoon news conference.
Authorities were prepared to find more bodies in the rubble throughout the town. Gov. Jay Nixon told The Associated Press he did not want to guess how high the death toll would eventually climb. But he said: "Clearly, it's on its way up."
Seventeen people were pulled alive from the rubble. An unknown number of people were hurt.
A fresh round of storms hampered the search for survivors, and strong winds and heavy rain pelted part of the wrecked city with quarter-sized hail. Forecasters said more violent weather may be on the way, with tornadoes possible in Missouri, Arkansas, Kansas and Oklahoma over the next day or so.
Officials said patients were sent to any nearby hospital that could treat them.
The search was on for survivors Monday, with more than 1,500 volunteers helping police, firefighters and other first responders. Heavy equipment helped move some debris while volunteers wearing gloves picked through more fragile scenes of destruction.
Some survivors searched for what could be salvaged from homes that seemed totally destroyed. Glasses. Keys. Stray photographs. One man retrieved a file cabinet from a crawlspace that opened to reveal a treasure chest of personal papers.
To one observer approaching the town Monday, evidence of the wreckage began with obvious debris amid an eerie calm on the outskirts of town. Closer to the tornado zone, it simply looked as if the town had been chewed up in a blender and spit out across miles.
Fire chief Mitch Randles estimated that as much as one-third of the city was damaged, and said his own home was among the buildings destroyed as the twister swept through this city of about 50,000 people some 160 miles south of Kansas City.
Former Mayor Gary Shaw said Joplin looked like a war zone.
"The trees ... they're like somebody's taken a knife and cut all the bark off of them," Shaw told NPR. "We've lost tons and tons of homes, and we have people out trying to uncover the dead right now."
The tornado touched down Sunday evening and cut a path 6 miles long and a half-mile wide through the center of town, ripping off the top of a main hospital, flinging big rigs to the side of the road and reducing neighborhoods to splinters and twisted metal.
Emergency sirens went off 20 minutes before the tornado hit, but many of the homes in the area, built in the 1960s, do not have basements. People were forced to weather the assault in bathrooms and bathtubs.
The Joplin twister was one of 68 reported tornadoes across seven Midwest states over the weekend, from Oklahoma to Wisconsin, according to the National Weather Service's Storm Prediction Center. One person was killed in Minneapolis. But the devastation in Missouri was the worst of the day, reminiscent of the tornadoes that killed more than 300 people across the South last month.
Among the worst-hit locations in Joplin was St. John's Regional Medical Center. The staff had just minutes' notice to hustle patients into hallways before the storm struck the nine-story building, blowing out hundreds of windows and leaving the hospital useless.
In the parking lot, a helicopter lay crushed on its side, its rotors torn apart and windows smashed. Nearby, a pile of cars lay crumpled into a single mass of twisted metal.
"Every window in that building is now broken," City Councilwoman Melodee Colbert-Kean told NPR. "Cars are tumbled all over the parking lot. I do know that the people in there had ... precious few minutes to get out into the parking lot, to get people in the safety corridor of the hospital."
Angie Abner, a paramedic and an emergency room nurse at St. John's, told NPR's Michele Norris that she was in the triage department of the emergency room when the twister struck.
"It was like a train coming through the facility and the wind was so great," she said. "You could hear our computers and things just whipping by us."
Missy Shelton of KSMU reported that the city was eerily quiet, punctuated now and then by the sound of a siren, as people wandered around, bewildered, and took in the destruction.
"They're walking around in a daze," Shelton said. "Even people who've lived here for years and years are having trouble finding their way around because the street signs are gone and nothing looks familiar."
Ryan Royster and his wife were lugging a laundry basket overflowing with clothes — their apartment complex was destroyed.
"It just hurts," Royster said. "Everything you've worked so hard to have is just gone in a second. One minute everything's fine and then you come home and it's gone."
Triage centers and shelters set up around the city quickly filled to capacity. At Memorial Hall, a downtown entertainment venue, nurses and other emergency workers from across the region were treating critically injured patients.
At another makeshift unit at a Lowe's home improvement store, wooden planks served as beds. Outside, ambulances and firetrucks waited for calls. During one stretch after midnight Monday, emergency vehicles were scrambling nearly every two minutes.
Travel through and around Joplin was difficult, with Interstate 44 shut down and streets clogged with emergency vehicles and the wreckage of buildings. There were no working gas pumps, and cars and trucks were lined up 20 deep at stations 15 miles east of the city, Dan Verbeck of KCUR reported.
President Obama said Monday that the Federal Emergency Management Agency was working with state and local agencies, and Missouri Gov. Jay Nixon told CNN that he has dispatched National Guard troops to Joplin to help the city cope with the emergency.
"We stand ready to put additional Guard boots on the ground if necessary, but it's going to be a stark view as people see dawn rise in Joplin, Mo.," Nixon said.
Emergency management officials rushed heavy equipment to Joplin to help lift debris and clear the way for search and recovery operations. Authorities said areas of the city were still dangerous because of downed power lines, jagged debris and a series of gas leaks that caused fires overnight.
Justin Gibson, 30, huddled with three relatives outside the tangled debris field of what remained of a Home Depot. He pointed to a black pickup that had been tossed into the store's ruins and said it belonged to his roommate's brother.
"He was last seen here with his two little girls, ages 4 and 5. We've been trying to get a hold of him since the tornado happened," Gibson told the AP, adding that his own house had been leveled.
"It's just gone. Everything in that neighborhood is gone. The high school, the churches, the grocery store. I can't get a hold of my ex-wife to see how my kids are," he said, referring to his three children, ranging in age from 4 months to 5 years.
"I don't know the extent of this yet," Gibson said, "but I know I'll have friends and family dead."
City Councilwoman Colbert-Kean said scores of people had been unable to contact loved ones as of early Monday and that cellphone coverage was intermittent.
"There have been social media sites set up, to where people are alerting others to say, 'Hey, your loved one has been found,' or posting that someone has been missing. So everyone's just trying to pitch in and help any way they can as far as communication, as far as needing a ride — just anything and anywhere they can help," she said.
"Anything that can be done is needed — water, food, shelter, a hug, a prayer — anything that can be done is needed right now and appreciated."
Reporter Frank Browning, Missy Shelton of member station KSMU and Dan Verbeck of KCUR reported from Joplin, Mo., for this story, which contains material from The Associated Press