Lightning Strike Emergencies Part 1: Triage and Cardiac Emergency

Lightning strikes cause cardiac and respiratory arrest due to the depolarization of all myocardial cells. Although asystole and ventricular fibrillation are the two most common abnormal rhythms observed after strikes, patients can regain return of spontaneous circulation (ROSC) due to the heart’s physiologic automaticity. Once this occurs, the medullary respiratory center may spontaneously return the respiratory drive; however, if respiratory function is not regained then the patient can go into ventricular fibrillation and suffer a second cardiac arrest. Nevertheless, if patients survive the initial lightning strike then they have a high chance of living. Lightning strikes often hit more than one person, as people will often walk in proximity, leading to mass casualty scenario.

 Lightning Strike Emergencies Part 2: Trauma Approach

Like cardiovascular injuries sustained from a lightning strike, neurologic injuries have a wide range from minor transient changes to life threatening. With severe or permanent neurologic injury, there are few successful treatments and long-term rehabilitation care is often required.

 Lightning Strike Injuries

As opposed to most mass casualty incidents where apneic and non-ambulatory patients are deemed “expectant” to succumb to their serious injuries and should not be prioritized in a resource limited situation, the concept of ‘reverse-triage’ is of critical importance and should be employed in lightening-mediated mass casualty events. This schema identifies victims who appear to be in cardiac and respiratory arrest and prioritizes their treatment as they can have good outcomes if immediately identified and treated.

 This is What It Feels Like to be Struck by Lightning

It can rewire your brain and stun your heart—if you survive.

 Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries: 2014 Update

No place is absolutely safe from lightning. However, individuals can choose safer places in an effort to reduce their risk of lightning strike.“When thunder roars, go indoors”is the currently recommended safety maxim of the National Weather Service. In essence, if one can hear thunder, then there is a risk of lightning strikes and one should seek shelter immediately.

Beyond the Basics: Lightning-Strike Injuries

Although one of the safest places to be during lightning is indoors in a substantial improved structure with electrical wiring and plumbing, do not assume that all lightning-strike patients will be found outdoors. If lightning strikes the structure or a nearby object, the electrical energy can be transmitted through plumbing fixtures like a sink, shower or toilet, and electrical devices that are hard-wired to the structure, such as computers, phones and electronic games. The incidence of lightning -strike injuries increased among emergency services call-takers and dispatchers when they began using headsets that were hard-wired into radio consoles.

Death by Lightning a Danger in Developing Countries

Developing countries have long lists of problems—illiteracy, disease, hunger, corruption. There's one more problem that has gotten less attention, until recently: lightning strikes, which cause a disproportionately high number of deaths in developing countries.

Experts warn of lightning-strike injuries with electronic devices

When lightning jumps from a nearby object to a person, it often flashes over the skin. But metal in electronic devices - or metal jewelry or coins in a pocket - can cause contact burns and exacerbate the damage.

Forensic science is unlocking the mysteries of fatal lightning strikes

The exact number of deaths isn’t clear, due to under reporting, but estimates from 28 countries suggest there are up to 24,000 lightning fatalities annually worldwide. Deaths can’t always be definitely attributed to lightning because, while its marks are easy to spot on the skin or in the organs, nobody was sure how to identify its marks on skeletonised remains.

Hit by Lightning: Tales From Survivors

Florida has more lightning strikes and fatalities than any other state. Four tales of survivors with disparate stories that all began with a bolt from the blue.

Lightning Injuries: An Electric Case

The pathophysiology of lightning strikes involves a short-duration, high-energy electrical discharge that is neither alternating (AC) or direct current (DC). Compared with electrical injuries from alternating current (AC) there is less likely to be deep-tissue destruction. The phenomenon of skin flashover explains why some victims may survive with little to no injury. There are several mechanisms of injury from a lightning strike. Return of cardiac automaticity precedes recovery of the respiratory system as the medullary respiratory center remains paralyzed. A second cardiac arrest may occur if ventilation is not well supported.

Lightning Injury

Lightning injury has significantly declined in incidence and as a cause of environmental mortality since the 1950’s. However, when it occurs, it can cause significant end-organ damage. It remains the second most common cause of storm related deaths in the United States and accounts for approximately 40-100 deaths per year as well as approximately 300 injuries. While rare, it is important to outline the must not miss complications, presentation, and management of lightning injury in the emergency department. Unlike other forms of electrical injury, lightning is considered direct current and can carry energy ranging from 30,000 to 110,000 amps. The majority of subjects struck by lightning survive, however, 10% of injuries are fatal

Lightning Injury

In mass casualties due to lightning strikes, implement a reverse triage system as victims are often easily resuscitated and have good survival rates. Due to autonomic dysfunction patients may initially present with fixed and dilated pupils, therefore this is not an accurate indicator for death.

Medical Aspects of Lightning

Lightning is primarily an injury to the nervous system, often with brain injury and nerve injury. Serious burns seldom occur. People who do not suffer cardiac arrest at the time of the incident may experience lesser symptoms, which often clear over a few days:

Unraveling the Mysterious Impacts of Lightning on the Human Body

In the self-proclaimed lightning capital of the world, Johannesburg, South African researchers are conducting experiments to understand how the human body reacts to a lightning strike. Their findings could help doctors learn how to treat victims more effectively and improve education about prevention.

We Asked Someone What It Feels Like to Be Struck By Lightning

After a freak thunderstorm storm in Los Angeles last weekend, 13 people were struck by bolts of lightning. We wanted to know what it felt like. Does your hair stand straight up? Does lightning burn?

What Actually Happens to People Who Are Hit by Lightning?

A lifetime of chronic health issues... The closest most of us have likely ever been to being struck by lightning is watching poor Wile E. Coyote take a blast from an angry cloud. The odds of getting hit by lightning are roughly 1 in 1.9 million– it's just not something most of us worry about. Yet even with those long odds, people do still get hit by lightning. In the U.S., 33 people die every year from a lightning strike, and hundreds more are injured.