At least 43 people have died, and millions have been left without power as Hurricane Helene wreaked havoc across the southeastern United States, Azernews reports, citing BBC. The storm, one of the most powerful on record, slammed into Florida’s Big Bend region before sweeping northward into Georgia and the Carolinas.

Rescue efforts are underway, with officials deploying boats, helicopters, and large vehicles to assist those trapped by rising floodwaters. In one incident, approximately 50 workers and patients were stranded on the roof of a flooded Tennessee hospital.

Helene, initially a Category 4 hurricane, made landfall on Thursday night and maintained hurricane strength for six hours. The storm brought a storm surge of more than 15 feet (4.5 meters) to parts of the Florida coast, according to the National Hurricane Center (NHC). While the surge is expected to recede, high winds, flooding, and tornado threats remain a concern.

Damage from the storm is projected to reach billions of dollars, with roads and homes submerged. Families have been forced to evacuate, with some swimming to safety. In Florida’s coastal Pinellas County, at least five people have died, and the state’s governor, Ron DeSantis, confirmed additional casualties, including deaths caused by a fallen road sign and a tree crashing into a home.

Though the hurricane has weakened, forecasters warn that up to 20 inches (50 cm) of rain could still fall in certain areas, raising concerns about further flooding and potential landslides.