Lightning injuries are
injuries
An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or o ...
caused by a
lightning strike
A lightning strike or lightning bolt is an electric discharge 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- ...
.
Initial symptoms may include
heart asystole and
respiratory arrest.
[ While the asystole may resolve spontaneously fairly rapidly, the respiratory arrest is typically more prolonged.][ Other symptoms may include ]burn
A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur ma ...
s and blunt injuries.[ Of those who survive, about 75% have ongoing health problems as a result, such as ]cataracts
A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble w ...
and hearing loss
Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken ...
.[ If death occurs it is typically from either an ]abnormal heart rhythm
Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
or respiratory failure
Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...
.[
Lightning injuries are divided into direct strikes, side splash, contact injury, and ground current.][ Ground current make up about half of cases and occurs when the lightning strikes nearby and travels to the person through the ground.][ Side splash makes up about a third of cases and occurs when lightning strikes nearby and jumps through the air to the person.][ Contact injury occurs when the person is touching the object that is hit.][ Direct strikes make up about 5% of injuries.][ The mechanism of the injuries may include ]electrical injury
Electrical injury is a physiological reaction caused by electric current passing through the body. The injury depends on the density of the current, tissue resistance and duration of contact. Very small currents may be imperceptible or produce a ...
, burns from heat, and mechanical trauma.[ Diagnosis is typically based on history of the injury and examination.][
Prevention includes avoiding being outdoors during a ]thunderstorm
A thunderstorm, also known as an electrical storm or a lightning storm, is a storm characterized by the presence of lightning and its acoustic effect on the Earth's atmosphere, known as thunder. Relatively weak thunderstorms are some ...
, and sheltering in a fully enclosed structure (such a closed building or metal car). 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. When indoors the use of devices connected to electrical outlets and contact with water is not recommended.[ Among those who appear in ]cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and poss ...
and have no central pulse
Central Pulse are a New Zealand netball team based in Wellington. Between 2008 and 2016, they played in the ANZ Championship. Since 2017 they have represented Netball Central in the ANZ Premiership. Netball Central is the governing body that r ...
, cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spon ...
(CPR) should be started.[ In those who have a central pulse but are not breathing artificial ventilation, such as mouth to mouth, is recommended.]
It is estimated that lightning injuries occur 240,000 times a year with 24,000 deaths. Areas with mountainous terrain and moisture-heavy airflow, such as Central Africa
Central Africa is a subregion of the African continent comprising various countries according to different definitions. Angola, Burundi, the Central African Republic, Chad, the Democratic Republic of the Congo, the Republic of the Congo ...
, have the highest rates of lightning strikes. Among pregnant women who are hit by lightning, the death of the fetus occurs in about half.[ In the United States about 1 in 10,000 people are hit by lightning during their lifetime.][ Males are affected 4 times more often than females.][ The age group most commonly affected is 20 to 45 years old.][
]
Signs and symptoms
Common injuries caused by lightning include: muscle pains, broken bones
A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...
, cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and poss ...
, confusion, hearing loss
Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken ...
, seizures
An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with l ...
, burns, behavioral changes, and ocular cataracts. Loss of consciousness is very common immediately after a strike.
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
A Lichtenberg figure (German ''Lichtenberg-Figuren''), or Lichtenberg dust figure, is a branching electric discharge that sometimes appears on the surface or in the interior of insulating materials. Lichtenberg figures are often associated w ...
. The marks are formed when capillaries
A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...
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. The brief duration of the exposure frequently limits the damage to the outer layer of skin.
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.[
Just as heat can cause expanding air in the lungs, the explosive ]shock wave
In physics, a shock wave (also spelled shockwave), or shock, is a type of propagating disturbance that moves faster than the local speed of sound in the medium. Like an ordinary wave, a shock wave carries energy and can propagate through a me ...
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'. 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.
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. Lightning is neither a DC or an AC current but best described as a unidirectional massive current impulse of electrons.
Lightning strikes are grouped in four categories: direct strikes, side splash, contact injury, and ground current.
* Direct strike: lightning directly hits the person
** Orifice entry: may occur if lightning strike occurs near the head entering eyes, ears and mouth to flow internally
* Side splash: lightning jumps from the location of primary strike to a nearby person
* Contact injury: injury that occurs when a person is touching an object on the pathway of lightning
* Ground current: lightning strikes nearby and the current travels through the ground to the person
Lightning injury may occur by these electrical mechanisms or by secondary blunt trauma as a result of the strike.
Diagnosis
Diagnosis is typically based on history of the injury and examination.[
]
Prevention
Preventing lightning injury involves avoiding being outdoors during a thunderstorm
A thunderstorm, also known as an electrical storm or a lightning storm, is a storm characterized by the presence of lightning and its acoustic effect on the Earth's atmosphere, known as thunder. Relatively weak thunderstorms are some ...
. 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. 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. It is dangerous to shelter under isolated trees, cliffs or other rocks. Lying on the ground is also dangerous. 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). Signs of an impending strike nearby can include a crackling sound, sensations of static electricity in the hair or skin, the pungent smell of ozone
Ozone (), or trioxygen, is an inorganic molecule with the chemical formula . It is a pale blue gas with a distinctively pungent smell. It is an allotrope of oxygen that is much less stable than the diatomic allotrope , breaking down in the lo ...
, or the appearance of a blue haze around persons or objects (St. Elmo's fire
St. Elmo's fire — also called Witchfire or Witch's Fire — is a weather phenomenon in which luminous plasma is created by a corona discharge from a rod-like object such as a mast, spire, chimney, or animal hornHeidorn, K., Weather Element ...
). For large groups of people, it is recommended that individuals spread out to avoid mass casualties. When indoors, the use of devices connected to electrical outlets and contact with water is discouraged.
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.
Organized groups and individuals are encouraged to prepare lightning safety plans in advance. Specific tips are available for various situations, such as outdoor recreation, boating and other water activities, and organized sporting events.
Treatment
Immediate
The most critical injuries are cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and poss ...
and respiratory failure
Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...
. This will often require prompt emergency care. It is safe to provide care immediately, as the affected person will not retain an electrical charge
Electricity is the set of physical phenomena associated with the presence and motion of matter that has a property of electric charge. Electricity is related to magnetism, both being part of the phenomenon of electromagnetism, as described ...
after the lightning has struck.[
Many people who are unconscious and appear lifeless die of suffocation.] Chances of survival may be increased if cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spon ...
(CPR) is started immediately, and continued without interruption until return of spontaneous circulation (ROSC).
Long-term
A complete physical examination by paramedics or physicians may reveal ruptured eardrums. Ocular cataract
A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble ...
s may later develop, sometimes more than a year after an otherwise uneventful recovery. Long-term injuries are usually neurological in nature, including memory deficit
Amnesia is a deficit in memory caused by brain damage or disease,Gazzaniga, M., Ivry, R., & Mangun, G. (2009) Cognitive Neuroscience: The biology of the mind. New York: W.W. Norton & Company. but it can also be caused temporarily by the use o ...
, mood disturbance, and fatigue.[ NOAAbr>Lightning Safety Facts]
/ref>
Prognosis
Approximately 10% of lightning strikes are lethal. Survivors of lightning strike may suffer long-term injury or disability.
Epidemiology
It is estimated that lightning injuries occur 240,000 times a year with 24,000 deaths.[ Among pregnant women who are hit by lightning, the death of the baby occurs in about half.][ In the United States about 1 in 10,000 people are hit by lightning during their lifetime.][ Males are affected 4 times more often than females.][ The age group most commonly affected is 20 to 45 years old.][
]
References
External links
(provided by the Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
)
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