Lightning Injuries
1. History / Incidence
2000 thunderstorms occur worldwide at any moment
Lightning strikes the earth > 100 times/sec
1000 deaths worldwide/year
100 deaths US/year (range 50 300)
More lightning deaths is US per year than any other natural disaster
25-40% deaths are work related
Summer months
70% between noon and 6 pm
Non urban areas most affected
2. Prevention (Outdoors)
Be aware of whether conditions
Seek shelter in a substantial building, an automobile, or low areas with thick growth of trees
Remove wet clothing and shoes with metal cleats
Avoid power lines, steel structures, tall isolated trees, hilltops, clearings, standing water
If on/in the water seek shore
If in a large group separate
If in the open crouch down, kneel, or roll up in a ball
3. Prevention (Indoors)
If indoors avoid:
Open doors/windows
Fireplaces
Metal objects of any kind (pipes, sinks, radiators, "plugged-in"electrical appliances
Telephones
Computer with modem
4. Lightning Injuries
Lightning is dangerous for four reasons:
High Voltage
Extreme Heat
Electromagnetism
Explosive Force
5. Five Mechanisms of Lighting Injury
Direct Hit (person out in open)
Splash jumps from object directly hit (most common)
Contact conducted through an object
Step voltage ground current
Blunt trauma blast effect
6. Types of Lighting Injuries
Minor (last seconds to days with complete recovery)
Extremity numbness/tingling
Confusion
Amnesia
Temporary deafness or blindness
Muscle pain
Ear drum rupture
Skin/muscle bruising
7. Effects of Moderate Lighting Injury
(May last hours or become permanent)
Confusion
Paralysis/numbness/weakness of extremities
Seizures
1st and 2nd degree burns
Spinal injuries
Skull fractures
Extremity fractures
Sleep distrubances
Difficulty concentrating
8. Effects of Severe Lighting Injury
(severe disability or death)
Cardiac arrest
3rd degree burns
Brain damage
Severe blunt trauma (ruptured spleen, collapsed lungs, bleeding in brain)
9. Field Management of Lightning Injury
Diagnosis is often difficult or missed
May mimic stroke, seizure, heart attack
If unsure of severity seek medical attention
If severe injuries call 9-1-1
Begin CPR if necessary
Basic First Aid
Place patient on back
Once on back do not move if spine injury is suspected
Splint fractures
Dress burns
Control bleeding with direct pressure
10. Emergency Room Management
What to expect depends on severity
Minor/Moderate Injuries IV, IV fluids, blood work, monitoring, x-rays
Severe injuries may require breathing tube, ventilator, surgical procedures, burn center care
12. Common Myths & Misconceptions
"All lightening strikes are fatal"
"The most common time to get struck is at the peak of a storm"
"Only those directly hit by lightning are injured"
"I am immune from lightning in a building"
"If you're not killed by the lightning, you'll be ok"
"If there are no outward signs of injury, you'll be ok"
"Lightning victims are still electrified"
"Lightning never strikes twice in the same place"
(Lightning once struck the Empire State Building 47 times during one storm!)
References
Auerbach PS (ed).
Wilderness Medicine: Management of Wilderness and Environmental Injuries
. 1995:3