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Chapter 14
LIGHTNING INJURIES
Recommendations are considered Category 1B by the WMS Panel of Expert Reviewers
I. GENERAL INFORMATION
One bolt of lightning may generate 300,000 amps and 2 billion volts--an awesome power
capable of great destructive force. A single strike often injures or kills more than one
person. Lightning injures or kills in one of four ways: 1) direct strike, 2) splash after
striking a nearby object, 3) ground current, 4) trauma from the blast of exploding air or,
5) direct contact with an object carrying current. Lightning causes serious injury or death
in about one-third of its victims and permanent sequelae of some sort in about two-thirds
of survivors. The factors related to a fatal outcome include immediate cardiopulmonary
arrest, acute neurologic and/or traumatic injuries or leg or head burns. Because any
electrical current takes the shortest path between contact points, multiple organ systems
may be injured. The duration of a lightning strike is so brief (less than one millisecond)
that it may not penetrate, but "flash over" the patient's skin.
Although lightning strikes are unpredictable, there are ways to reduce the chance
of injury. During an electrical storm: 1) avoid open areas where you are one of the tallest
objects, 2) do not seek shelter under a single tree or bush or rock that stands in an open
area, 3) avoid extremes of high or low ground, 4) avoid contact with metal objects, 5)
seek shelter deep in a dry cave, staying away from the sides and roof, 6) seek shelter
among trees or bushes or rocks of uniform size, 7) if boating, attempt to get to shore,
waves and shore-line permitting, 8) squat with your feet close together or sit in a compact
position on a non-conductive material, such as a foam pad or rope coil, and 9) spread out
a group but stay close enough to maintain visual contact with each other.
II. GUIDELINES FOR ASSESSMENT
Victims of lightning strikes are not electrically charged and pose no threat to rescuers.
Patients typically fall into one of three categories: 1) minimally injured, requiring little
immediate care other than psychological support, although they must receive a thorough
examination when time allows, 2) seriously injured, often initially unconscious, requiring
immediate attention to airway and obvious injuries, including appropriate stabilization for
possible head and spine injuries, and 3) maximally injured, in cardiopulmonary arrest.
Initiate rescue breathing and chest compressions (CPR) immediately on all pulseless,
breathless victims of lightning strike. Following a severe electrical shock, respiratory
paralysis may persist long after cardiac activity returns. Rescuers must be prepared to
provide prolonged rescue breathing, but no more than 30 minutes of chest compressions.
If there are multiple victims, institute
reverse triage principles, i.e., treat seemingly dead
victims first.
Therapy for increased intracranial pressure (see Traumatic Brain Injury and
Spinal Injury) may be necessary.
For conscious patients capable of safely tolerating oral fluids, hydrate appropriate
to safeguard against the rarely encountered but possible rhabdomyolysis.
