At least 43 people have been killed across four states after Hurricane Helene barrelled its way across southeastern US.

Emergency crews are racing to rescue people trapped in flooded homes after Helene struck the coast of Florida as a highly destructive Category 4 storm.

It generated a massive storm surge, wreaking a trail of destruction extending hundreds of miles north.

Millions are without power in Florida and neighbouring states.

Meanwhile, dozens of patients and staff have been rescued from the roof of a flooded Tennessee hospital following a “dangerous rescue operation”.

Tennessee Senator Bill Hagerty said more than 50 people are now safe after becoming stranded on the Unicoi County Hospital.

The hospital was engulfed in “extremely dangerous and rapidly moving water”, according to Tennessee’s Ballad Health, making a boat rescue too treacherous.

A police helicopter was ultimately able to land on the roof after other helicopters failed to reach the hospital due to the storm’s winds.

Local official Michael Baker told Sky News the flooding was “unprecedented”.

“We’ve never seen anything like this,” he said.

As of early afternoon, Helene, which has been downgraded to a tropical depression, was packing maximum sustained winds of 35 mph (55 kph) as it slowed over Tennessee and Kentucky, the National Hurricane Center said.

It struck overnight with maximum sustained winds of 140 mph (225 kph) in the rural Big Bend area, the northwestern part of Florida.

The National Hurricane Center said preliminary information shows water levels reached more than 15ft above ground in that region.

US President Joe Biden has approved emergency declaration requests from the governors of several southern states affected by Helene.

Georgia, Florida, Alabama, North Carolina and South Carolina are being supported by emergency response personnel including search and rescue teams, medical support staff and engineering experts.

Georgia Governor Brian Kemp has said dozens of people are trapped in buildings damaged by the storm, with multiple hospitals in southern Georgia without power.

In western North Carolina, Rutherford County emergency officials have told residents near the Lake Lure Dam to immediately evacuate to higher ground, warning “Dam failure imminent”.

Meanwhile, Florida Governor Ron DeSantis said the damage from Helene in the area appears to be greater than the combined damage of Idalia and Hurricane Debby in August. “It’s demoralizing,” he said.

Many stranded in places like Tampa could only be reached by boat, with officials warning the water could contain live wires, sewage, sharp objects and other debris.

More than four million properties are without power across Florida, Georgia, the Carolinas, Virginia, Kentucky, Tennessee and Ohio, according to the logging website, PowerOutage.

Why this hurricane season is defying forecasts

Tom Clarke

Science and technology editor

@t0mclark3

Despite Helene’s power, this hurricane season has been more remarkable for its lack of activity.

At the start of the hurricane season, which runs from 1 June to 30 November, sea surface temperatures were (and remain) off-the-charts warm.

It’s this ocean heat that fuels tropical storms.

This combined with a developing La Nina phenomenon led the US forecasters to predict 2024 would be a major hurricane season. Between 17 and 24 storms were expected, with eight to 13 developing into hurricanes.

Hurricane Beryl grazed the coast of Jamaica in July as a Category 5 hurricane. It was the earliest storm of that size ever recorded and was seen as a harbinger of the prediction. But, so far at least, it’s failed to materialise.

There have been just six hurricanes so far this year – slightly below average. But why?

It seems to be due to what’s happening on the other side of the Atlantic where ocean warming forced the African monsoon further north than usual.

This led to catastrophic flooding in central and west Africa displacing millions, but it also shifted the weather system that usually spawns hurricanes and spins them across the Atlantic.

There’s already abundant evidence our warming oceans and atmosphere are making storms more intense – but predicting where they will occur and how often is never simple – and perhaps getting even harder as our planet gets hotter.

Prior to the hurricane making landfall, officials in Florida begged residents to evacuate. The sheriff’s office in rural Taylor County issued a chilling warning to those who refused to leave.

“Please write your name, birthday, and important information on your arm or leg in a permanent marker so that you can be identified and family notified,” the post on Facebook said.

Forecasters now expect the storm to continue weakening across Tennessee and Kentucky.

It is feared heavy rain over the Appalachian Mountains could cause mudslides and flash flooding.

A Swiss teenage cyclist with “a bright future ahead of her” has died a day after suffering a serious head injury at the world championships.

Muriel Furrer crashed while competing on rain-slicked roads in the junior women’s road race in her home country.

The 18-year-old rider fell heavily on Thursday in a forest area south of the city of Zurich and was airlifted to hospital by helicopter, reportedly in a critical condition.

Race organisers announced on Friday she had died.

They said in a statement: “Muriel Furrer sadly passed away today at Zurich University Hospital.”

The UCI governing body for world cycling paid tribute to her in a statement on its website, entitled “The cycling world mourns the loss of Muriel Furrer”.

It read: “It is with great sadness that the Union Cycliste Internationale (UCI) and the Organising Committee of the 2024 UCI Road and Para-cycling Road World Championships today learned the tragic news of the death of young Swiss cyclist Muriel Furrer.

“With the passing of Muriel Furrer, the international cycling community loses a rider with a bright future ahead of her. We offer sincere condolences to Muriel Furrer’s family, friends and her Federation Swiss Cycling.”

Swiss Cycling said in a post on X: “Our hearts are broken, we have no words. It is with a heavy heart and infinite sadness that we have to say goodbye to Muriel Furrer today.

“We are losing a warm-hearted and wonderful young woman who always had a smile on her face. There is no understanding, only pain and sadness.”

At a news conference, a director of the Swiss organising committee Olivier Senn said he could not confirm exactly where the crash happened.

Police and the public prosecutor’s office were investigating the incident, Mr Senn said.

Furrer had finished in 44th position in the junior women’s time trial earlier in the week.

The rider’s family has asked for the championships – which last for nine days – to continue, said UCI sports director Peter van den Abeele.

The women’s and men’s elite races, scheduled for Saturday and Sunday respectively, will use the same stretch of road where the fatal crash happened.

A UCI gala event scheduled for Saturday evening has been cancelled, along with public events to mark races planned for Friday.

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Second Swiss cyclist death

Furrer is the second Swiss cyclist to die in just over a year after crashing on home roads.

At the Tour de Suisse in June 2023, Gino Mader went off the road and down a ravine during a descent. The 26-year-old died from his injuries the next day.

“Obviously it is another tragic death,” Mr Senn said. “There are a lot of similarities, similar feelings. Today is about Muriel.”

The threat of an all-out conflict between Israel and Hezbollah seems to be edging closer after Israel rejected Lebanon ceasefire plans.

The Iranian-backed militant group has been a force in Middle East politics and conflict for decades, but has suffered heavy losses in the last few weeks after Israeli attacks.

Niall Paterson speaks to Sky’s international affairs editor Dominic Waghorn about how much support Hezbollah has within Lebanon and Iran’s role with the group. Plus, defence and security editor Deborah Haynes talks to Niall about how significant Hezbollah’s military capabilities are.

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