Lightning injury

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Lightning injury
Other namesEffects of lightning
Lightning3.jpg
Multiple lightning bolts strike a populated area.
Specialty Emergency medicine
TypesDirect strikes, side splash, contact injury, ground current [1]
Causes Lightning strike [1]
Diagnostic method Based on history of the injury and examination [1]
PreventionAvoiding the outdoors during a thunderstorm; [2] sheltering in a fully-enclosed structure; [3] if still outdoors, assuming 'lightning position' before a strike [3]
Treatment CPR, artificial ventilation [1]
Frequency240,000 a year [1]
Deaths24,000 a year [1]

Lightning injuries are injuries caused by a lightning strike. [4] Initial symptoms may include heart asystole and respiratory arrest. [1] While the asystole may spontaneously resolve fairly rapidly, the respiratory arrest is typically more prolonged. [1] Other symptoms may include burns and blunt injuries. [1] Of those who survive, about 75% have ongoing health problems as a result, such as cataracts and hearing loss. [1] If death occurs it is typically from either an abnormal heart rhythm or respiratory failure. [1]

Contents

Lightning injuries are divided into direct strikes, side splash, contact injury, and ground current. [1] Ground current occurs when the lightning strikes nearby and travels to the person through the ground. [1] Side splash makes up about a third of cases and occurs when lightning strikes nearby and jumps through the air to the person. [1] Contact injury occurs when the person is touching the object that is hit. [1] Direct strikes make up about 5% of injuries. [1] The mechanism of the injuries may include electrical injury, burns from heat, and mechanical trauma. [1] Diagnosis is typically based on history of the injury and examination. [1]

Prevention includes avoiding being outdoors during a thunderstorm, and sheltering in a fully enclosed structure (such a closed building or metal car). [2] [5] If being outdoors is unavoidable, bringing the feet and knees together is recommended (if possible, while crouching low in the 'lightning position'— crouched low, hands over ears, feet touching if possible) so as to provide only one point of contact with the ground. [2] [5] When indoors the use of devices connected to electrical outlets and contact with water is not recommended. [2] Among those who appear in cardiac arrest and have no central pulse, cardiopulmonary resuscitation (CPR) should be started. [1] In those who have a central pulse but are not breathing artificial ventilation, such as mouth to mouth, is recommended. [1] [6]

As of 2019, it has been estimated that lightning injuries occur 240,000 times a year with 24,000 deaths. [1] Areas with mountainous terrain and moisture-heavy airflow, such as Central Africa, have the highest rates of lightning strikes. [3] Among pregnant women who are hit by lightning, the death of the fetus occurs in about half. [1] In the United States, about 1 in 10,000 people are hit by lightning during their lifetime. [1] Males are affected four times more often than females. [1] The age group most commonly affected is 20 to 45 years old. [1]

Signs and symptoms

A person who was affected by a nearby lightning strike. Note the slight branching redness traveling up the victim's leg from the effects of the current. Lightning injury.jpg
A person who was affected by a nearby lightning strike. Note the slight branching redness traveling up the victim's leg from the effects of the current.

Common injuries caused by lightning include: muscle pains, broken bones, cardiac arrest, confusion, hearing loss, seizures, burns, behavioral changes, and ocular cataracts. [4] [3] Loss of consciousness is very common immediately after a strike. [7]

Lightning burns result from energy caused by lightning strikes, and are characterized by a unique pattern of skin lesions. These tree-like lesions resemble feathering or ferning, and are also called Lichtenberg figures. [8] The marks are formed when capillaries beneath the skin rupture due to the electrical discharge and they usually appear "within hours" of the strike though they tend to disappear within a few days. They also generally occur on the upper body. [9] The brief duration of the exposure frequently limits the damage to the outer layer of skin. [10]

The intense heat generated by a lightning strike can burn tissue, and cause lung damage, and the chest can be damaged by the mechanical force of rapidly expanding heated air. [4]

Just as heat can cause expanding air in the lungs, the explosive shock wave created by lightning (the cause of thunder) can cause concussive and hearing damage at extremely close range. Other physical injury can be caused by objects damaged or thrown by the lightning strike. For example, lightning striking a nearby tree may vaporize sap, and the steam explosion often causes bark and wood fragments to be explosively ejected.

Lightning strikes can also induce a transient paralysis known as 'keraunoparalysis'. [3] Signs and symptoms of keraunoparalysis include lack of pulse, pallor or cyanosis, and motor and sensory loss in the extremities. However, keraunoparalysis usually resolves within a few hours. [3]

Pathophysiology

Although the current flow of a lightning strike occurs only over a short period, the current has an extremely high voltage of some 30 million volts. [11] Lightning is neither a DC or an AC current but best described as a unidirectional massive current impulse of electrons. [11]

Lightning strikes are grouped into four categories: direct strikes, side splash, contact injury, and ground current. [1]

Lightning injury may occur by these electrical mechanisms or by secondary blunt trauma as a result of the strike. [12]

Diagnosis

Diagnosis is typically based on history of the injury and examination. [1]

Prevention

Preventing lightning injury involves avoiding being outdoors during a thunderstorm. [2] [3] While no place is entirely safe from lightning strikes, it is recommended to seek shelter in a substantial, fully-enclosed building (preferably with electrical attachments and plumbing) or a closed metal vehicle, such as a car. [3] [5] [13] If being outdoors is unavoidable, staying away from metal objects (including fencing and power lines), sheets of water (ponds, lakes, etc.), tall structures, and open, exposed areas (including high ground, hills, etc.) is strongly recommended. [2] [3] It is dangerous to shelter under isolated trees, cliffs or other rocks. [2] Lying on the ground is also dangerous. [2] When a lightning strike seems imminent, a 'lightning position' can be taken by "sitting or crouching with knees and feet close together to create only one point of contact with the ground" (with the feet off the ground if sitting; if standing is necessary, the feet have to be touching). [5] Signs of an impending strike nearby can include a crackling sound, sensations of static electricity in the hair or skin, the standing of hair on end, the pungent smell of ozone, or the appearance of a blue haze around persons or objects (St. Elmo's fire). [14] [3] For large groups of people, it is recommended that individuals spread out to avoid mass casualties. [3] [13] When indoors, the use of devices connected to electrical outlets and contact with water is discouraged. [2]

In the United States, recreational fishing poses the greatest risk of death from lightning of any activity, accounting for 10 percent of all lightning deaths between 2006 and 2019. [15]

Organized groups and individuals are encouraged to prepare lightning safety plans in advance. [3] Specific tips are available for various situations, such as outdoor recreation, boating and other water activities, and organized sporting events. [2]

Treatment

Immediate

The most critical injuries are cardiac arrest and respiratory failure. This will often require prompt emergency care. [7] It is safe to provide care immediately, as the affected person will not retain an electrical charge after the lightning has struck, contrary to popular belief. [6] [16]

Many people who are unconscious and appear lifeless die of suffocation. [5] Chances of survival may be increased if cardiopulmonary resuscitation (CPR) is started immediately, and continued without interruption until return of spontaneous circulation (ROSC). [17]

Long-term

A complete physical examination by paramedics or physicians may reveal ruptured eardrums. Ocular cataracts may later develop, sometimes more than a year after an otherwise uneventful recovery. Long-term injuries are usually neurological in nature, including memory deficit, mood disturbance, and fatigue. [18] [19]

Prognosis

Approximately 10% of lightning strikes are lethal. [1] Survivors of lightning strike may suffer long-term injury or disability. [20]

Epidemiology

It is estimated that lightning injuries occur 240,000 times a year with 24,000 deaths. [1] Among pregnant women who are hit by lightning, the death of the fetus occurs in about half. [1] In the United States about 1 in 10,000 people are hit by lightning during their lifetime. [1] Males are affected four times more often than females. [1] The age group most commonly affected is 20 to 45 years old. [1]

Related Research Articles

<span class="mw-page-title-main">Ground (electricity)</span> Reference point in an electrical circuit from which voltages are measured

In electrical engineering, ground or earth may be a reference point in an electrical circuit from which voltages are measured, a common return path for electric current, or a direct physical connection to the Earth.

<span class="mw-page-title-main">Personal protective equipment</span> Equipment designed to help protect an individual from hazards

Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, electrical, heat, chemical, biohazards, and airborne particulate matter. Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities. Protective clothing is applied to traditional categories of clothing, and protective gear applies to items such as pads, guards, shields, or masks, and others. PPE suits can be similar in appearance to a cleanroom suit.

<span class="mw-page-title-main">Electrostatic discharge</span> Sudden flow of electric current between two electrically charged objects by contact

Electrostatic discharge (ESD) is a sudden and momentary flow of electric current between two differently-charged objects when brought close together or when the dielectric between them breaks down, often creating a visible spark associated with the static electricity between the objects.

Thunder is the sound caused by lightning. Depending upon the distance from and nature of the lightning, it can range from a long, low rumble to a sudden, loud crack. The sudden increase in temperature and hence pressure caused by the lightning produces rapid expansion of the air in the path of a lightning bolt. In turn, this expansion of air creates a sonic shock wave, often referred to as a "thunderclap" or "peal of thunder". The scientific study of thunder is known as brontology and the irrational fear (phobia) of thunder is called brontophobia.

<span class="mw-page-title-main">Hypothermia</span> Human body core temperature below 35 °C (95 °F)

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<span class="mw-page-title-main">Electrical injury</span> Physiological reaction or injury caused by electric current

An electrical injury, or electrical shock is damage sustained to the skin or internal organs on direct contact with an electric current.

<span class="mw-page-title-main">Drowning</span> Respiratory impairment caused by submersion in liquid

Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer assistance. After successful resuscitation, drowning victims may experience breathing problems, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration, or acute respiratory distress syndrome.

<span class="mw-page-title-main">Burn</span> Injury to flesh or skin, often caused by excessive heat

A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ionizing radiation. Most burns are due to heat from hot liquids, solids, or fire. Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids. In the workplace, risks are associated with fire and chemical and electric burns. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence between people (assault).

<span class="mw-page-title-main">Injury in humans</span> Physiological wound caused by an external source

An injury is any physiological damage to living tissue caused by immediate physical stress. Injuries to humans can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or overexertion. Injuries can occur in any part of the body, and different symptoms are associated with different injuries.

<span class="mw-page-title-main">High voltage</span> Electrical potential that is large enough to cause damage or injury

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A flatline is an electrical time sequence measurement that shows no activity and therefore, when represented, shows a flat line instead of a moving one. It almost always refers to either a flatlined electrocardiogram, where the heart shows no electrical activity (asystole), or to a flat electroencephalogram, in which the brain shows no electrical activity. Both of these specific cases are involved in various definitions of death.

<span class="mw-page-title-main">Lightning strike</span> Electric discharge between the atmosphere and the ground

A lightning strike or lightning bolt is a lightning event in which the electric discharge takes place between the atmosphere and the ground. Most originate in a cumulonimbus cloud and terminate on the ground, called cloud-to-ground (CG) lightning. A less common type of strike, ground-to-cloud (GC) lightning, is upward-propagating lightning initiated from a tall grounded object and reaching into the clouds. About 25% of all lightning events worldwide are strikes between the atmosphere and earth-bound objects. Most are intracloud (IC) lightning and cloud-to-cloud (CC), where discharges only occur high in the atmosphere. Lightning strikes the average commercial aircraft at least once a year, but modern engineering and design means this is rarely a problem. The movement of aircraft through clouds can even cause lightning strikes.

<span class="mw-page-title-main">Arc flash</span> Heat and light produced during an electrical arc fault

An arc flash is the light and heat produced as part of an arc fault, a type of electrical explosion or discharge that results from a connection through air to ground or another voltage phase in an electrical system.

<span class="mw-page-title-main">Stray voltage</span> Electrical potential between unexpected places

Stray voltage is the occurrence of electrical potential between two objects that ideally should not have any voltage difference between them. Small voltages often exist between two grounded objects in separate locations by the normal current flow in the power system. Contact voltage is a better defined term when large voltage appear as a result of a fault. Contact voltage on the enclosure of electrical equipment can appear from a fault in the electrical power system, such as a failure of insulation.

<span class="mw-page-title-main">Lightning rod</span> Metal rod intended to protect a structure from a lightning strike

A lightning rod or lightning conductor is a metal rod mounted on a structure and intended to protect the structure from a lightning strike. If lightning hits the structure, it is most likely to strike the rod and be conducted to ground through a wire, rather than passing through the structure, where it could start a fire or even cause electrocution. Lightning rods are also called finials, air terminals, or strike termination devices.

<span class="mw-page-title-main">Physical hazard</span> Hazard due to a physical agent

A physical hazard is an agent, factor or circumstance that can cause harm with contact. They can be classified as type of occupational hazard or environmental hazard. Physical hazards include ergonomic hazards, radiation, heat and cold stress, vibration hazards, and noise hazards. Engineering controls are often used to mitigate physical hazards.

<span class="mw-page-title-main">Electrical burn</span> Burn to the skin caused by electricity

An electrical burn is a burn that results from electricity passing through the body causing rapid injury. Approximately 1000 deaths per year due to electrical injuries are reported in the United States, with a mortality rate of 3-5%. Electrical burns differ from thermal or chemical burns in that they cause much more subdermal damage. They can exclusively cause surface damage, but more often tissues deeper underneath the skin have been severely damaged. As a result, electrical burns are difficult to accurately diagnose, and many people underestimate the severity of their burn. In extreme cases, electricity can cause shock to the brain, strain to the heart, and injury to other organs.

<span class="mw-page-title-main">Wildfire emergency management</span>

Wildfires are outdoor fires that occur in the wilderness or other vast spaces. Other common names associated with wildfires are brushfire and forest fire. Since wildfires can occur anywhere on the planet, except for Antarctica, they pose a threat to civilizations and wildlife alike. In terms of emergency management, wildfires can be particularly devastating. Given their ability to destroy large areas of entire ecosystems, there must be a contingency plan in effect to be as prepared as possible in case of a wildfire and to be adequately prepared to handle the aftermath of one as well.

Many laboratories contain significant risks, and the prevention of laboratory accidents requires great care and constant vigilance. Examples of risk factors include high voltages, high and low pressures and temperatures, corrosive and toxic chemicals and chemical vapours, radiation, fire, explosions, and biohazards including infective organisms and their toxins.

Electric shock drowning is a term used in the US to describe a cause of death that occurs when swimmers are exposed to electric currents in the water. In some cases the shock itself is fatal, since the person will suffocate when their diaphragm is paralyzed, while in others it incapacitates the swimmer causing them to drown. The main cause of electric shock drownings is faulty electrical wiring on boats or piers that causes electric current to leak into the water. Electric shock drownings occur most often in fresh water, which is conductive due to dissolved minerals and impurities. The increased conductivity of saltwater reduces the fraction of the electric current that flows through a submerged person, whose body has a much smaller conductivity than the saltwater. In this case, the current to cause electric shock drowning would be so great that current-limiting circuit breakers would trip and shut off the current, thereby protecting against electric shock drowning in saltwater.

References

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  2. 1 2 3 4 5 6 7 8 9 10 "Lightning Safety Tips". CDC. 23 January 2019. Retrieved 11 November 2019.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 Davis C, Engeln A, Johnson EL, et al. (December 2014). "Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update". Wilderness & Environmental Medicine. 25 (4 Suppl): S86–95. doi: 10.1016/j.wem.2014.08.011 . PMID   25498265.
  4. 1 2 3 Mallinson T (2013). "Understanding the correct assessment and management of lightning injuries". Journal of Paramedic Practice. 5 (4): 196–201. doi:10.12968/jpar.2013.5.4.196.
  5. 1 2 3 4 5 Ritenour AE, Morton MJ, McManus JG, Barillo DJ, Cancio LC (August 2008). "Lightning injury: a review". Burns: Journal of the International Society for Burn Injuries. 34 (5): 585–594. doi:10.1016/j.burns.2007.11.006. ISSN   0305-4179. PMID   18395987. S2CID   19198991.
  6. 1 2 "First Aid Recommendations Lightning". CDC. 23 January 2019. Retrieved 11 November 2019.
  7. 1 2 Mallinson T (2010). "Lightning Injuries". Focus on First Aid (16): 15–16. Archived from the original on 11 March 2012. Retrieved 2010-09-30.
  8. ↑ "DynaMed". www.dynamed.com. Retrieved 2019-11-25.
  9. ↑ "How do you recover from being struck by lightning?". BBC News. 8 August 2013. Retrieved 9 August 2013.
  10. ↑ "Lightning Injuries - Injuries and Poisoning". Merck Manuals Consumer Version. Retrieved 2019-11-25.
  11. 1 2 Auerbach, Paul S. (2011). Advanced wilderness life support : prevention, diagnosis, treatment, evacuation (7th ed.). Utah: Wilderness Medicine Society. ISBN   978-0-615-49608-5. OCLC   829392080.
  12. ↑ O'Keefe KP, Semmons R (2018). Electrical and Lightning Injuries in Rosen's emergency medicine: concepts and clinical practice (9th). St. Louis, Missouri: Mosby. pp. 1765–1772.
  13. 1 2 Auerbach PS (May 1992). "Wilderness medicine epidemiology". Journal of Wilderness Medicine. 3 (2): 111–112. doi:10.1580/0953-9859-3.2.111. ISSN   0953-9859. S2CID   72099106.
  14. ↑ US Department of Commerce N. "Lightning Safety". www.weather.gov. Retrieved 11 March 2023.
  15. ↑ Jensenius JS Jr (2020). "Detailed Analysis of Lightning Deaths in the United States from 2006 through 2019" (PDF). National Lightning Safety Council.
  16. ↑ "Lightning Myths". National Weather Service . Retrieved July 6, 2024.
  17. ↑ Dayton, L (1993). "Science: Secrets of a bolt from the blue", New Scientist, 18 December 1993.
  18. ↑ Ritenour AE, Morton MJ, McManus JG, Barillo DJ, Cancio LC (August 2008). "Lightning injury: A review" (PDF). Burns. 34 (5): 585–594. doi:10.1016/j.burns.2007.11.006. PMID   18395987. S2CID   19198991. Archived (PDF) from the original on February 3, 2022.
  19. ↑ NOAA Lightning Safety Facts
  20. ↑ Sanford A, Gamelli RL (2014), "Lightning and thermal injuries", Neurologic Aspects of Systemic Disease Part II, Handbook of Clinical Neurology, vol. 120, Elsevier, pp. 981–986, doi:10.1016/b978-0-7020-4087-0.00065-6, ISBN   978-0-7020-4087-0, PMID   24365365

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