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.

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(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
-Amnesia/Anxiety/Confusion/Aphasia/Seizures
-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
-Flash
-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)
-Deafness/Tinnitus/Vertigo
-Transient blindness/Photophobia-Conjunctivitis - Corneal damage
-Retinal abnormalities (macular hole) - optic neuritis
-Cataract
"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)."
                                        
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           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:



http://rationalpreparedness.blogspot.com/2012/02/exploring-possibility-of-adding.html

http://rationalpreparedness.blogspot.com/2012/02/protection-from-lightning-hazards.html

http://rationalpreparedness.blogspot.com/2012/04/professional-lightning-protection.html

http://rationalpreparedness.blogspot.com/2012/05/lightning-protection-for-trees.html

http://rationalpreparedness.blogspot.com/2012/10/on-resiliency-and-hope.html




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

http://science.nasa.gov/science-news/science-at-nasa/1999/essd18jun99_1/

 http://blog.lightning.org/