The death toll jumped to 116 on Monday after a massive tornado tore through this city on Sunday, leaving six miles of destruction: a forest of splintered tree trunks where neighborhoods once stood; a hospital and high school destroyed; and cars crushed like soda cans.
Emergency crews searched through the night and through a thunderstorm with driving rain on Monday for additional survivors.
"We still believe there are folks alive under the rubble, and we're trying hard to reach them," Missouri Gov. Jay Nixon told reporters in Joplin.
Elsewhere across the country, at least 30 homes were damaged or destroyed in a storm that swept through Tennessee on Monday evening, Stewart County Emergency Management Director Clint Mathis told WSMV-TV. The post office and fire station in the town of Big Rock were also destroyed, Mathis said. Some injuries were reported.
In Pennsylvania, a severe storm and possible tornado on Monday caused extensive damage to barns and homes in the Richfield and McAllisterville areas, . Search dogs were called in to help look for people unaccounted for.
In Joplin, the death toll had been at 90 on Monday morning, but by afternoon officials told reporters it had risen to 116 — making it America's deadliest single tornado in 64 years and the second major tornado disaster in a month.
By the evening, search and rescue workers had found 17 victims alive, but their task was made more miserable by a new thunderstorm Monday morning that pelted part of the city with quarter-sized hail.
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.
Fire chief Mitch Randles estimated that 25 to 30 percent 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.
"It cut the city in half," Randles said of the twister, which was three quarters of a mile wide at times and kicked debris 20,000 feet up into the sky.
Nixon told MSNBC TV that some 2,000 structures saw "significant damage," and that searching for survivors remains a priority.
There's still a "significant potential for saving lives," Nixon said.
More than 1,150 people were treated at local hospitals, the Joplin Globe reported. An estimated 20,000 homes and businesses were without power.
A number of bodies were found along the city's "restaurant row," on the main commercial street, Newton County Coroner Mark Bridges said.
"The loss of life is incredible," said Joplin Mayor Mike Woolston. "We're still trying to find people. The outlook is pretty bleak."
The city's residents were given about 20 minutes notice when 25 warning sirens sounded around 6 p.m. local time, said Jasper County Emergency Management Director Keith Stammers.
But the governor said many people likely were unable to get to shelter in time. "The bottom line was the storm was so loud you probably couldn't hear the sirens going off."
Staff at St. John's Regional Medical Center hustled patients into hallways before the storm struck the nine-story building, blowing out hundreds of windows and leaving the facility useless.
At least six people at the hospital were killed, including five patients and one visitor, officials said. Dr. Jim Riscoe said he arrived at the hospital soon after the tornado hit and said some colleagues who also were injured worked all night long.
On Monday, officers from the city and neighboring towns and counties manned virtually every major intersection. Ambulances came and went, sirens blaring. Rescuers involved in a door-to-door search moved gingerly around downed power lines and jagged debris.
A series of gas leaks caused fires around the city overnight, and Nixon said some were still burning early Monday.
The twister was one of 68 reported across seven Midwest states over the weekend. One person was killed in Minneapolis, Minn. and another in Reading, Kan. But the devastation in Missouri was the worst of the day, eerily reminiscent of the tornadoes that killed more than 300 people across the South over several days last month.
Greg Carbin, a warning coordinator for the U.S. Storm Prediction Center, said that although both storms had high death tolls, the situation in Joplin was different.
"There were other tornadoes that touched down yesterday, but nothing to the extent of a month ago," he said. "It was not the same type of large-scale outbreak."
The National Weather Service later estimated the Joplin tornado had winds up to 198 mph, making it an EF4 — the second strongest category.
More severe storms are coming, Carbin said, with Arkansas, Kansas, Missouri and Oklahoma expected see tornadoes Monday and Tuesday and the bad weather spreading to the East Coast by Friday.
As the toll currently stands, the Joplin tornado is the ninth deadliest on record. It tops the toll from a 1953 storm that killed 115 people in Flint, Mich. An 1899 tornado killed 117 people in Wisconsin.
Triage centers and shelters were set up around the city. At Memorial Hall, a downtown entertainment venue, nurses and other emergency workers from across the region treated critically injured patients.
At another makeshift unit at a Lowe's home improvement store, wooden planks served as beds. Outside, ambulances and fire trucks waited for calls. During one stretch after midnight Monday, emergency vehicles were scrambling nearly every two minutes.
Emergency management officials rushed heavy equipment to Joplin to help lift debris and clear the way for search and recovery operations. Gov. Nixon declared a state of emergency, and President Barack Obama sent condolences to families of those who died.
In the hospital 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.
"We are not sure of the safety of the building," the Springfield News-Leader quoted hospital spokeswoman Cora Scott as saying.
Details about fatalities and injuries were difficult to obtain even for emergency management officials, because the tornado knocked out power, landline phones and some cell phone towers, said Greg Hickman, assistant emergency management director in Newton County.
Debris was carried up to 60 miles away, with medical records, X-rays, insulation and other items falling to the ground in Greene County, said Larry Woods, assistant director of the Springfield-Greene County Office of Emergency Management.