A powerful tornado tore through southern Indiana and parts of Kentucky early on Sunday, killing at least 23 people and injuring more than 200, many caught sleeping when the twister hit, officials said. At least five people were confirmed dead in Warrick County and at least 18 were killed in Vanderburgh County, according to county officials. Three area hospitals reported treating more than 220 people. At St. Mary’s Medical Center in Evansville, the closest hospital to the destruction, at least 30 were admitted with serious injuries, and twelve people were in critical condition. Deaconess Hospital in Evansville had at least 15 people in critical condition, officials there said.

“We’ve had severe damage,” said Newburgh Assistant Fire Chief Chad Bennett. “Homes were totally devastated. There are a lot of people thankful to be alive today.” Officials said the death toll would likely climb as rescue workers picked through rubble in house-to-house searches and scoured farm lands. About 130 Indiana National Guard troops were called in to assist in recovery efforts and to help provide security and clean up debris. At least two people were found dead in a soybean field in Warrick County, according to the Newburgh fire department.

The Eastbrooke mobile home park in Evansville was one of the places hardest hit when the storm struck well before dawn. Many homes there were reduced to twisted piles of metal that lay mixed with the remains of downed trees, smashed cars, and other debris. In one trailer home, rescue workers found a young mother alive, but her husband and daughter dead and her two-year-old missing, said Eric Williams, chief deputy of the sheriff’s department in Vanderburgh County.

Search teams at the trailer park were cheered briefly when they happened across a young child alive in a ditch tightly entangled in shards of metal and other debris, Williams said. The child was flown to a nearby hospital but neither the child’s identity nor condition were immediately known. An apartment complex in nearby Warrick County was also hit hard, with the top floors ripped off, said Vanderburgh County Sheriff’s office spokesman Lt. John Strange.

“It is pretty widespread damage,” he said. In Henderson County, Kentucky, the Ellis Park racetrack suffered major damage. The grandstand was ripped away, several barns were damaged and at least three horses were killed. Some 25,000 people were left without power because of the storm, which government weather officials said was the worst to hit the state in 17 years. Through September, killer tornadoes were reported in Georgia, Arkansas, Wyoming, Wisconsin and Mississippi this year, with a total of 10 dead in those storms. On average, tornadoes kill about 70 people annually in the United States. The single deadliest tornado in U.S. history killed 689 people in Missouri, Illinois and Indiana in March 1925, according to the storm prediction center.