What is Lightning Injuries?
Lightning strikes happen quite often, with around 50 flashes happening every second across the globe. Out of these, about 20% hit the ground. Experts can’t tell the exact number, but they estimate that lightning strikes kill about 24,000 people each year and injure ten times as many. The good news is that most of these incidents can be avoided. For medical professionals, it’s crucial to understand the types of injuries lightning can cause and how to treat them properly.
What Causes Lightning Injuries?
Lightning is incredibly powerful. A single lightning bolt can have a voltage of more than 10 million volts and a huge amount of electric current, typically between 30,000 to 110,000 amperes. Not to mention, the temperature of a lightning bolt can reach extremes, as high as 30,000 Kelvin (that’s over 53,000 degrees Fahrenheit!). Lighting can have both negative and positive charges and can either move in a straight line or alternate back and forth. Usually, a person is exposed to lightning for a very brief time, from 1/1000 to 1/10 of a second.
However, not all lightning injuries happen in the same way. The ways in which people can get injured from lightning can be grouped into direct strikes, side splashes, contact injuries or ground currents. Direct strikes are pretty rare, making up about 5% of cases, and this is when a person is hit directly by a lightning bolt, connecting the person and the bolt. Contact injuries happen when a person touches something that gets struck by lightning. Side splash injuries make up about a third of all injuries and this takes place when the electric current from lightning “splashes”, or jumps from something nearby and follows the path of least resistance to a person.
Ground current injuries are the most common, and they make up about half of all injuries. This happens when lightning strikes an object or the ground near a person and the electric current travels through that object or the ground to reach the person.
Risk Factors and Frequency for Lightning Injuries
Lightning doesn’t strike evenly across the globe. Places with more thunderstorms naturally have more lightning strikes. Even the local geography can affect this – hills and mountains tend to get hit more often than flat areas. In the United States, it’s estimated that lightning injures around 400 people and kills about 40 every year. Over 80% of victims are male, and the age group most likely to be fatally struck ranges from 20 to 45. Nearly all fatalities happen within an hour of being struck, most commonly from heart rhythm disorders or respiratory failure. Up to 74% of survivors may end up with some long-term disability. Most lightning accidents in the United States happen from May to September, and almost 70% occur in the afternoon or early evening. While Texas and Florida see the highest number of fatalities, Arizona, Arkansas, Mississippi and New Mexico have the highest rates of lightning incidents. Overall, an American’s chances of getting struck by lightning at some point in their lifetime is roughly 1 in 10,000.
- Lightning doesn’t uniformly strike all parts of the world.
- Areas with more thunderstorms or mountainous terrain have more lightning incidences.
- In the US, around 400 people are injured and 40 are killed by lightning each year.
- More than 80% of victims are males, primarily between 20 to 45 years old.
- Most deaths happen within an hour of the strike, usually from heart rhythm disorders or respiratory failure.
- Up to 74% of survivors may have permanent disabilities.
- Most incidents in the US occur from May to September, in the afternoon or early evening.
- Most deaths occur in Texas and Florida, while most incidents occur in Arizona, Arkansas, Mississippi, and New Mexico.
- The estimated lifetime risk of getting struck by lightning in the US is 1 in 10,000.
Signs and Symptoms of Lightning Injuries
When a patient comes in after a lightning strike, doctors usually ask what the person was doing and where they were at the time. This can help determine if the patient could have sustained additional injuries like falling from a height or being hit by objects. Indications of a lightning injury might also include clothes that are singed, have small holes, are torn, display signs of melted metal, or if there’s evidence of damage in the surrounding area.
The first steps of the initial exam involve checking the patient’s airflow, breathing, and heart rate, while preparing to provide immediate help if necessary. It might be hard to feel a pulse due to a temporary narrowing of blood vessels caused by the lightning strike, so cardiopulmonary resuscitation (CPR) shouldn’t be started until it is confirmed that the patient doesn’t have a central pulse. The doctor will also assess the patient’s neurological state; this is because lightning strikes can damage the nerves, possibly causing abnormalities in sensation or muscle control. These deficits may not match up with each other and can be missed in the first exam and only diagnosed weeks or months later. Also, physicians should note that patients may have temporarily enlarged, unresponsive pupils, a condition that doesn’t necessarily indicate the patient has died.
Generally, people who were struck by lightning experience a certain temporary paralysis known as keraunoparalysis, which typically affects the lower body more than the upper body. It presents with blue, mottled and cold extremities, absence of pulse, and paralysis of the affected areas.
Focusing on the skin, lightning strikes often result in burns, especially in skin folds, creases, and joints. Some patients may present with Lichtenberg figures, which are unique “fern” or “feather” skin patterns. These marks are unique to lightning strikes, but they disappear on their own over time. Furthermore, an examination of hearing capacity, eardrums, eyesight, and back of the eyes should be performed.
It’s also important to check patients for injuries that might have been caused by the lightning strike itself, or by resulting blunt force trauma.
Testing for Lightning Injuries
There are no mandatory tests that all people struck by lightning need to take. However, certain tests are recommended for specific groups of patients.
For example, if you’re seen as “high-risk” like those who got struck directly by lightning, or are experiencing chest pain, shortness of breath, or a past cardiac arrest, your doctor may recommend an Electrocardiogram (ECG) and an echocardiogram. These tests help study your heart’s function and you’ll also be monitored closely for a day. Other suggested tests will be decided based on your medical history and physical exam. Some medical practitioners recommend an ECG for all lightning strike victims, but evidence on this is not clear-cut because many people only show temporary and harmless ECG changes. Heart markers which are substances that can indicate heart damage are often heightened but they aren’t indicative of prognosis, meaning they don’t predict the future course or outcome of the condition. Therefore, routinely checking these markers isn’t significantly beneficial.
Every person struck by lightning should undergo a thorough physical exam to check for any injuries. Depending on your history and particular exam results, you may need additional tests or imaging. For instance, if you lost consciousness, have burns on your head, or exhibit any odd neurological signs, you should get a CT scan of the head because there’s a higher chance of internal bleeding within the brain.
Further tests and imaging may be ordered depending on your medical provider’s judgement, but they’re not always needed for all victims.
Treatment Options for Lightning Injuries
When multiple people get struck by lightning, the initial sorting and treatment should follow a “reverse triage” system. This system helps save more lives as those who survive the initial strike seldom pass away before or after reaching the hospital. Therefore, efforts should focus on those appearing to be in a cardiac arrest or a heart attack. Lightning strike can cause sudden heart and breath stoppage. Often, the heartbeat resumes followed by automatic breathing, but the respiratory system could take time to recover. Therefore, assisting the patient’s breathing as soon as possible can prevent a secondary heart collapse. During this time, care providers should try to find a pulse in the body’s central parts, and if not felt, CPR may be initiated.
Injuries due to lightning strikes should be treated depending on their seriousness. Those showing neurological symptoms—indicating the involvement of nervous system—might need further evaluations and treatment by a specialist called a neurologist if symptoms persist. Burns should be treated following standard guidelines.
Most people who appear well, show no unusual vital signs, or have no injuries requiring hospitalization can be safely discharged if they do not have high-risk factors such as suspected direct strike, loss of consciousness, specific neurological complaint, chest pain, shortness of breath, major trauma, head or significant burns. If necessary, a referral should be made for those with eye, ear, or other injuries.
Lightning strikes are rare in pregnant patients. The mother is more likely to survive, but the unborn child’s risk is high, as high as 50%. Thus, individuals who are 20 weeks or more into their pregnancy should have a fetal screening when they visit a medical facility after a lightning strike.
What else can Lightning Injuries be?
Possible injuries or conditions that can occur include:
- Acoustic injury (damage to the hearing)
- Autonomic nervous system injury (damage to the system controlling body functions like heart rate and breathing)
- Barotrauma (pressure-related injury)
- Blunt and explosive trauma (injuries caused by forceful impact or explosion)
- Cardiorespiratory arrest (heart and breathing suddenly stopping)
- CNS injury or stroke (damage to the central nervous system or a brain attack)
- Electrical injuries (damages caused by electrical shock)
- Intracranial haemorrhage (bleeding within the skull)
- Musculoskeletal injury (damage to muscles, bones, or joints)
- Stroke (a condition where blood supply is cut off to the brain)
