Wednesday, October 17, 2012

Post Lightning Injuries

    When I was in high school, one of the students a year or two younger than I was, was struck by lightning.  He had been on an open field during a ball practice when a storm appeared to be in the distance. It appeared not to have arrived yet, and final directions were being given to the team before they were being sent inside. Then, a bolt of lightning which prefaced the storm came out of nowhere, and knocked down eight students on the open field. Seven arose and ran inside, and one remained unconscious in the field, steaming.  The school nurse began CPR while the coach ran in, in those pre-cellphone days to call an ambulance.  The student was picked up by Emergency Services, taken to an excellent hospital a distance from there, and survived.  He did however, not remain on the honor roll, as he had been.  At the time, from the perspective of a teen-ager, I thought the only hurdle was keeping him alive that day. I thought that survival was the only challenge. Although I did appreciate the miracle of my classmate's survival, I had no appreciation of how hard his road to recovery might be.
          Now, many years later, I am afraid that I know more about lightning injury than I ever cared to consider.  In medicine, the specialty of treating those who have been injured by direct or indirect lightning strike is called keraunomedicine. The focus of this post will not be the immediate emergent care of lightning strike victims. Those who are struck and who are pulseless and breathless will require immediate CPR and ambulance transport to a competent hospital with a good Emergency Room and  an Intensive Care Unit. This post will focus on what is not mentioned very much in literature for the general public, and that is the devastating and sometimes permanent damage sustained by those who received a glancing or direct lightning strike.
        Scientists estimate that worldwide there are 24,000 human deaths from lightning strikes each year. It is estimated that 240,000 people sustain lightning injuries worldwide, but since not all strikes occur in places where they will be reported to any one central body, this is likely to be an artificially low figure.  Some unlucky individuals have been struck by lightning repeatedly.   There is truly no safe location out of doors to avoid lightning strike. People may be struck directly or indirectly while out of doors. Direct lightning strikes are almost always fatal. Indirect strikes occur when something else takes the brunt of the strike and some of the overwhelming and powerful energy travels through objects to ground, and one of the items on the way to doing so, is a human being.  This is why people are advised not to shelter underneath a tree during a lightning storm. If the tree is struck, then some of the energy dissipating toward ground will pass through the human being sheltered under the tree. There are a number of different indirect strikes that a person can receive, and what type of strike they receive will impact the level of damage they receive. The victim can also receive many different types of injuries from lightning. These can be splash injuries, grounding injuries, or even blast or concussive injuries.   There can be very wide ranging injuries in those struck by lightning.  Some have no evidence of injury other than a cardiac arrest. Others have clear injuries where skin injury where skin injury and significant burns are evident, or where the lightning strike entered the body is clearly seen, and where it exits is clearly seen also.  Most have injuries which may be temporary or permanent, to their eyes and to their ears.75%-80% of people who are struck by lightning, sustain permanent injuries. Also interesting is that a person who is struck by lightning and seems fairly well today, can have serious medical results from it which develop over the following weeks as the body tries to heal damage which is not immediately seen.  True injuries and the full extent of neurologic injuries cannot be fully assessed for days or weeks beyond the strike itself. A majority of those struck by lightning experience serious depression afterward.
          Most surprisingly to many is that we may not always be safe from lightning injury inside our homes or inside buildings. Some people are struck by lightning while using a landline telephone. Although these people only comprise 1% of lightning injuries, their ear and neurologic damage can be significant.  People have also been struck while using a toilet or shower,(primarily connected to copper or other metal pipes),  or by standing near a window. People have been struck while working the drive up window of fast food restaurants. Some have been struck inside metal structures or simply metal framed structures. People have been struck while working on agricultural fencing.   My eldest son was struck inside a very solid post and beam style wooden building which happened to have a steel roof. and posts with beams that were treated with copper arsenate, which seem to be quite conductive when struck.
         Horses, dogs and other animals are also killed by occasional lightning strikes.


(from "Lightning Injuries to Humans in France" by Dr. Elisabeth Gourbière of the Electricité de France, Service des Etudes Médicales)

Lightning deaths (~20%)
-Asystole/Ventricular fibrillation
-Inhibition of brainstem respiratory centers
-Multi-system failure (delayed death)
Cardio-pulmonary injuries
-Arrhythmias - Arterial pressure changes
-Electrocardiographic changes
-Myocardial damages (infarction)
-Cardiac dysfunction
-Pulmonary edema - Respiratory distress syndrome
Neurologic/psychiatric injuries
-Loss of consciousness/coma
-Electroencephalographic abnormalities
-Brain/Cerebellum damages
-Numbness/Weakness in limbs/Partial or complete (but temporary) paralysis      Tremors
-Neuropathy/Pain syndromes
-Spinal cord injury/Parkinsonism
-Sleep and memory disorders/Concentration
disturbances/Irritability/Depression/Various other disturbances such as headaches, tiring easily, lightning storm phobia, etc.
-Post traumatic Stress Disorder
Burns and Cutaneous marking
-Small, deep entry/exit points (typical)
-Contact, metal chain heating (typical)
-Superficial linear
-Lichtenberg figures (arborescent, fern-like markings):pathognomonic(on trunk, arms, shoulders)
Clothing, shoes
-Exploded off, torn off, shredded, singed…
Blunt traumas (explosion)
-Contusion, internal hemorrhage (brain, lungs, liver, intestine…)
-(rarely) Fractures (skull, cervical spinal column, extremities…)
Auditory and ocular injuries
-Tympanic membrane ruptured (typical)
-Transient blindness/Photophobia-Conjunctivitis - Corneal damage
-Retinal abnormalities (macular hole) - optic neuritis
"Lightning injuries are varied and take many different forms. The most dangerous (and possibly fatal) immediate complications are cardiovascular and neurologic. It must be kept in mind that only immediate and effective cardiorespiratory resuscitation (started by rescuers), followed as soon as possible by emergency medical treatment, can save victims who are in cardiopulmonary arrest, or avert the serious consequences of cerebral hypoxia. Some victims remain in a coma despite intensive resuscitation and die of secondary causes including hemorrhages and multiple lesions (encephalic, cardiac, pulmonary, intra-abdominal)."

           Following our son's lightning strike one year ago, we have met two people locally who have also been treated for similar injuries.  One has permanent eye and ear damage from answering a phone during a storm.  The other has experienced what seems like a complete recovery following a direct witnessed strike through his head !   Although it's good to know that a complete recovery is possible, most people are not so lucky.  The best strategy remains avoidance of being struck.

Other posts in the Rational Preparedness series concerning lightning, and lightning abatement can be found here:

More articles concerning this phenomena and on lightning abatement etc. :


What if it's today? - A survivalist's blog said...

A little over a year ago I wrote about lightning safety, just in case you blow it and are stuck in an unsafe place.

JaneofVirginia said...

Thanks. I'll take a look. I started a series on various aspects of it after my adult son was struck here on the farm, while inside a building. The fact is that we can mitigate risk, not prevent all strikes. It's a scarier world that even I had thought ! Thanks for posting.

Jerry E Beuterbaugh said...

"Rational Preparedness" has been included in the Sites To See for this week. I hope this helps to point many new visitors in your direction.

JaneofVirginia said...

Thanks Jerry, I appreciate the vote of confidence !

lotta joy said...

Since moving to Florida (the lightning capitol of the world) I had to learn things I never knew before - and doubted until I read your post. My oldest sister was once injured when a lightning strike went down the chimney, through the fire place and out into the living room where she was sitting.
The problem in Florida is the fact that there is no storm, or warning, required for lightning to strike.

JaneofVirginia said...

Lotta Joy, Yes, Florida is indeed the lightning capital. Interestingly, it is said that it is not the availability of water which makes it so, but the geology. Nova Scotia, with all its water you might think would be a major lightning hazard, is not, because it's geology is different than Florida's. I am glad your sister survived her strike. Within the past year we have met many people who have experienced glancing blows from lightning while sitting indoors.
I have read that lightning seems to strike in Florida without fair warning. Glad to have you home, and safe. LOVE your blog.

MMM said...

Thank you for sharing your blog and outlook on things like this. I myself (22 yr old) was struck by lightning almost a year ago. I was over seas volunteering not even two weeks when it happened. I was in the Dominican Republic so it was down pooring the worse rain I have ever seen. I was bare foot standing in water when I asked if it was ok to use the stove. The minute i turned on the gas and grabbed ahold of the metal grate with both hands, the lightning got sucked right in through the open window next to me. It all happened so fast I didnt even realize I had carried the grate out into the middle of the room before I could let go of it. After it left my body you could see the streams of electricity jumping from metal to metal objects in the house. I blacked out shortly after and didnt wake up until I arrived at the foreign hospital. After a week of skipping heart beats and the worst muscle seizures, they released me. I dont know how I did it but i stayed 4 months after my accident before returning to the states. It took me about a month to learn to walk again. All of the work I did I did on my own. There is no such things as physical therapy where I was. But I have slowly but surely started my long climb up hill. No doctor I have seen has any idea of what to do with me. I have decided to go a natural way with my treatment. I just started acupuncture, which I am very optimistic about. Im in the chronic group as far as damage, because it has only gotten worse and not better. laying in that hospital bed wondering if I would ever walk again....and I promised myself two things. 1: ride 2 days of Ragbrai (I use to ride 200 miles a week before) and 2: Run a 5k, both within a year of my accident. At that time i still couldnt even walk but I knew I would run, as crazy as that sounds. This has affected every part of my life, in a lot of ways. But its people like you, with stories like yours, that give me hope. I read other peoples stories and I know It could have been so much worse for me. And I know I will never be alone in this. So thank you for sharing you story. I know its helped more then just me. :)

JaneofVirginia said...

How are you now ? A lot of people have long lasting effects from lightning strikes for many years. My son still has effects from the strike, although he too is positive. Please take good care and stay in touch ! You can write us privately also by clicking the blue writing with my name. Best wishes,

MMM said...

Because I was over seas when this happened, the doctors all told me I would be fine. But I knew I wasnt. 2 weeks after my accident they said I should be fine and couldnt find any reason why I wasnt fine. All they told me was to give it time. Well its a year later next month and It has taken me this long to feel like Im on my way to having a grip on things. I have been seeing a chyro at least once a week since returning in january. I still have bad neuropathy which I am trying to control on my own. I am on a ton of different supplements that the accident has caused me to lose. I have been doing acupuncture, which I feel like is helping a lot. But I just found out last week that i tore muscle and ligaments in my lower back and hips (assuming from my accident). I was told that the muscle that holds my hips in place are dying which is why my back wont stay in place. I also found out that i only have 10% rotation in my hips when i should have 90%. I was told I am in the danger zone for something worse happening the next time my hips pop out. So its just another things I have to add to my list of things to work on to improve.

JaneofVirginia said...

My son was here in the US and saw a world class major medical center just after and they did exactly the same thing ! Because his heart rhythm was normal afterward, they made the assumption that no other damage had taken place. This was far from true, and the damage took time for them to note. Neuropathy has also been an issue. It took several myelograms before they would notate and believe this. Write me privately if you wish to talk more about this.