Lightning Injuries
A lightning injury occurs after brief exposure to the very intense current of the strike.
Lightning delivers a massive, very hot electrical pulse over a fraction of a millisecond. The brief duration of the exposure frequently limits the damage to the outer layer of skin. In addition, lightning is much less likely to cause internal burns than generated electricity. However, it can kill a person by instantaneously short-circuiting the heart or brain. Lightning is the second most frequent cause of storm-related deaths in the United States.
Lightning tends to strike tall objects, including trees, gazebos, towers, shelters, flagpoles, bleachers, and fences. A person may be the tallest object in an open field. Metal objects and water easily transmit electricity. Electricity from lightning can travel from outdoor power or telephone lines to electrical equipment or telephone lines inside a house.
Lightning can injure a person in several ways. Lightning can strike a person directly. In addition, electricity can reach a person who is touching or near an object that has been struck. Current can also reach a person through the ground. The shock can also throw a person, producing blunt injuries.
Symptoms
After a person has been struck by lightning, the heart may stop beating or may beat erratically, and breathing often stops. The heart may beat again on its own, but if breathing has not restarted, the body is deprived of oxygen. The lack of oxygen and, possibly, nervous system damage can cause the heart to stop beating again.
Brain injury usually causes loss of consciousness. If brain damage is severe, coma may develop. Typically, the person awakens but does not remember what happened before the injury. The person may be confused, think slowly, and have difficulty concentrating and remembering recent events. Personality changes may occur.
The eardrums are often perforated. Many eye injuries can develop, including cataracts. Often both legs become temporarily paralyzed, blue, and numb (keraunoparalysis). The skin may sustain minor burns that have a feathering, branching pattern, consist of clusters of tiny pinpoint spots like a cigarette burn, or consist of streaks where sweat has been turned into steam.
Prevention
During the thunderstorm season, listening to weather reports, which is particularly important for organizers of outdoor events, can help in deciding whether to cancel outdoor activities and in planning for any emergencies that may develop.
High winds, rain, and clouds may mean that a thunderstorm is imminent. If thunder from a distant storm becomes louder or if the interval between lightning and thunder becomes less than 30 seconds, shelter should be sought. Shelter in small open structures, such as a gazebo, is not safe. Shelter is safer inside large, enclosed buildings or enclosed metal vehicles--such as cars, vans, or trucks--with the vehicle's windows closed. It is not safe to resume outdoor activities until 30 minutes after the last sound of thunder is heard or lightning is seen.
To prevent lightning injury when outdoors, a person should avoid high ground, metal objects, water, and open spaces, such as a field. If escape from the open is not possible, a person should squat to make himself as low as possible but should not lie on the ground. Staying at least 15 feet away from other people is also advised, as is seeking shelter in the middle of a grove of trees (but not under a solitary tree).
To prevent lightning injuries when indoors, a person should avoid contact with water, talking on the telephone, working on a computer, or using headsets attached by a cable to a sound system. Being away from windows and doors increases safety, as does turning off and unplugging electrical equipment before the thunderstorm arrives.
Treatment and Prognosis
Lightning injuries are often unwitnessed and may be suspected when a person is found unconscious outside during a thunderstorm.
A person struck by lightning does not retain electricity, so there is no danger in providing first aid. People without a heartbeat and who are not breathing need cardiopulmonary resuscitation (CPR) immediately (see Section 24, Chapter 299). Simply providing artificial respiration to a person struck by lightning may provide enough oxygen to keep the heart beating. Many people struck by lightning are in good general health and are more likely to recover if given timely CPR. In the hospital, an electrocardiogram (ECG) is performed to determine whether the heart is beating normally. Burns and other injuries are treated as needed. If resuscitation efforts are not successful within the first 40 minutes, they are unlikely to be.
About 10% of people with lightning injuries die. Almost all deaths result from cardiac arrest and cessation of breathing. Most people whose heartbeat and breathing resume survive. If memory of recent events is impaired or thinking is slow, the person may have permanent brain injury. Keraunoparalysis usually resolves within several hours.
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