LIGHTNING ​

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Lightning injuries are classified as direct strike, contact injury, side splash, or ground current. [WMS2014]

Direct Strike: occurs when there is an uninterrupted connection between a lightning bolt and an individual.

Contact Injury: occurs when a person is touching an object that is struck.

Side Splash: occur when the current “splashes” or jumps from a nearby object to the recipient’s body; such splashes follow the path of least resistance when compared with the initially struck object such as a tree.

Ground Current: also known as ‘step voltage’, occurs when lightning strikes an object or the ground near a person and travels through the ground from the strike point to the victim.

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Signs and Symptoms include:

• Heart damage or cardiac arrest

• Keraunoparalysis - a temporary paralysis unique to lightning strike

• Superficial burns

• Broken bones and/or dislocations

• Skull fractures and/or cervical spine injuries from associated blunt trauma

• Lung damage causing shortness of breath

• Eye injury causing immediate visual problems or delayed cataract formation

• Ruptured eardrum causing pain, hearing loss, and dizziness.

• Lichtenberg figures are fern-like patterns that may appear on the skin of lightning strike victims that disappear in 24 hours. A lightning strike can also create a large Lichtenberg figure in grass surrounding the point struck.

Prevention: Behavioural Strategies

• Shelter: “When thunder roars, go indoors” 

• Lightning Position: sitting or crouching with knees and feet close together to create only one point of contact with the ground. Only when a lightning strike is imminent 

• Group Safety: WMS [2014] recommends the separation of group members by approx. 10m to limit potential mass casualties

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Treatment: 

1. "Reverse Triage": priority is initially given to those individuals without vital signs or spontaneous respirations. NOTE: Victims of lightning strike do not carry residual electrical charge

2. Full DRSABCD assessment, manage ABC as necessary. Avoid delays or interruptions to CPR (if required). If practical, locate the closest AED and bring it to the patient.

3. Treat individual injuries as indicated (eg: splinting, etc)

4. Pre-empt onset of shock- treat for environment

5. Stay hyper-alert to weather conditions; activate extrication from scene for rescuer/patient safety ASAP.