Elsevier

Burns

Volume 34, Issue 5, August 2008, Pages 585-594
Burns

Review
Lightning injury: A review

https://doi.org/10.1016/j.burns.2007.11.006Get rights and content

Abstract

Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries.

Introduction

Injuries secondary to lightning strike are rare, and feature an unusual presentation, high mortality, and significant long-term morbidity. The American Burn Association recommends referral to a burn center for victims of lightning strike; thus, burn-care providers should be familiar with the characteristics and treatment of these injuries. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries for burn-care providers.

Section snippets

Epidemiology

Lightning strikes the earth more than 100 times each second or 8 million times per day. About 50,000 thunderstorms occur each day that may result in fires and injury (Okafor, 2005 #17708) [91]. Worldwide, lightning strike density is highest in Africa, where some regions experience more than 50 lightning strikes/km2 each year [1]. The risk of being struck by lightning is a function of strike and population densities, as well as terrain features that may protect or expose occupants of a

Lightning physics

Lightning is generated when the voltage difference between a cloud and the ground or another object exceeds 2 million V/m. At this point, arcing occurs. Factors that determine the site and severity of electric trauma include the magnitude of energy delivered; voltage; resistance to current flow; type of current; duration of contact with the current source; and current pathway. The electric current involved in lightning strikes is direct current (DC), as opposed to the alternating current (AC)

Clinical presentation and care

Lightning causes death in 10–30% of casualties, and results in permanent disability in the majority of survivors. Many vital structures may be affected. Persons struck by lightning usually show evidence of multiorgan derangement, with the most dramatic effects involving the central nervous and cardiovascular systems.

Prevention

Clearly, prevention of these highly lethal injuries is paramount. A high level of precaution for individuals working or engaging in recreational activities outdoors during the thunderstorm season must be observed. Travel guides and weather-related websites are good resources for determining the timing and duration of rainy seasons for various locations worldwide. Although lightning is associated with cumulonimbus rain clouds, it may precede the rainstorm and has been known to strike with blue

Resources

Resources for survivors of lightning injury include Lightning Strike and Electric Shock Survivors, International (http://www.lightning-strike.org/), which has been helpful for many survivors and their families with long-term sequelae [78]. Additional information is available from the Lightning Data Center at St. Anthony Hospitals, Denver, CO, USA (http://www.stanthonyhosp.org/), the National Oceanic and Atmospheric Administration (NOAA) of the U.S. government (http://www.noaa.gov/), and the

Conclusion

In summary, patients with lightning injury, like those with high-voltage electric injury, should be considered to have sustained high-energy blunt trauma with certain additional unique features. Airway and cardiopulmonary status must be stabilized and maintained, and patients may require spinal precautions. They should be thoroughly evaluated for blunt trauma, as if they had sustained a high-speed motor-vehicle crash. Large-bore IV access should be obtained, and fluid resuscitation should begin

Conflict of interest

None.

Acknowledgement

This work was funded in part by the Combat Casualty Care research program of the US Army Medical Research and Materiel Command, Ft. Detrick, MD.

References (91)

  • M.E. Norman et al.

    Ophthalmic manifestations of lightning strike

    Surv Ophthalmol

    (2001)
  • Anonymous. Where lightning strikes. National Aeronautics and Space Administration (n.d.). Available at:...
  • Holle RL, Lopez RE, Curran EB. Distributions of lightning-caused casualties and damages since 1959 in the United...
  • Holle RL. Bibliography on safety and demographics of lightning victims (unpublished document). Oro Valley, AZ: Holle...
  • M. Cherington et al.
  • A.K. Aslar et al.

    Epidemiology, morbidity, mortality and treatment of lightning injuries in a Turkish burns unit

    Int J Clin Pract

    (2001)
  • C.V. Wetli

    Keraunopathology. An analysis of 45 fatalities

    Am J Forensic Med Pathol

    (1996)
  • R. Blumenthal

    Lightning fatalities on the South African Highveld: a retrospective descriptive study for the period 1997 to 2000

    Am J Forensic Med Pathol

    (2005)
  • R.J. Fantus

    Zeus on the 18th hole

    Bull Am Coll Surg Dec

    (2006)
  • P.J. Duclos et al.

    Lightning-related mortality and morbidity in Florida

    Public Health Rep

    (1990)
  • P.J. Duclos et al.

    An epidemiological description of lightning-related deaths in the United States

    Int J Epidemiol

    (1990)
  • S. Nizamuddin

    Deaths caused by lightning in India

    Weather

    (1992)
  • L. Coates et al.

    Lightning fatalities in Australia, 1824–1991

    Nat Hazard

    (1993)
  • S.A. Prentice

    Lightning fatalities in Australia

    IEA Electr Eng Trans

    (1972)
  • J.E. Pakiam et al.

    Lightning fatalities in Singapore

    Meteor Mag

    (1981)
  • Holle RL, Lopez RL, Navarro BC. U.S. lightning deaths, injuries, and damages in the 1890s compared to the 1990s (NOAA...
  • E.B. Curran et al.

    Lightning casualties and damages in the United States from 1959 to 1994

    J Climate

    (2000)
  • D.M. Elsom

    Deaths caused by lightning in England and Wales, 1852–1990

    Weather

    (1993)
  • Anonymous. Medical aspects of lightning. National Weather Service (n.d.). Available at...
  • Centers for Disease Control and Prevention

    Lightning-associated injuries and deaths among military personnel–United States, 1998–2001

    Morb Mort Wkly Rep

    (2002)
  • Center for Disease Control and Prevention

    Lightning-associated deaths—United States, 1980–1995

    Morb Mort Wkly Rpt

    (1998)
  • N. Adekoya et al.

    Struck-by-lightning deaths in the United States

    J Environ Health

    (2005)
  • E.P. Krider

    Benjamin Franklin and lightning rods

    Phys Today Jan

    (2006)
  • M. Cherington

    Lightning and transportation

    Semin Neurol

    (1995)
  • M. Cherington et al.

    Deaths and injuries as a result of lightning strikes to aircraft

    Av Space Environ Med

    (1995)
  • M. Bier et al.

    Biophysical injury mechanisms associated with lightning injury

    Neurorehabilitation

    (2005)
  • R.C. Lee et al.

    Biophysical injury mechanisms in electrical shock trauma

    Annu Rev Biomed Eng

    (2000)
  • D. Whitecomb et al.

    Lightning injuries

    South Med J

    (2002)
  • M.A. Cooper

    A fifth mechanism of lightning injury

    Acad Emerg Med

    (2002)
  • T.D. Epperly et al.

    The physical effects of lightning injury

    J Fam Pract

    (1989)
  • Cooper MA. Disability, not death, is the main problem with lightning injury. Address presented at the National Weather...
  • C.J. Andrews et al.

    Lightning injury—a review of clinical aspects, pathophysiology, and treatment

    Adv Trauma

    (1989)
  • M. Cherington et al.

    Ball lightning encephalopathy

    J Burn Care Rehab

    (2003)
  • G. Selvaggi et al.

    Ball lightning burn

    Ann Plast Surg

    (2003)
  • M. Cherington et al.

    Lightning-induced injury on an airplane: coronal discharge and ball lightning

    J Trauma

    (2002)
  • Cited by (120)

    • Cardiac Arrest in Special Populations

      2023, Emergency Medicine Clinics of North America
    • A shocking injury: A clinical review of lightning injuries highlighting pitfalls and a treatment protocol

      2022, Injury
      Citation Excerpt :

      An evidence-based treatment protocol based on the clinical presentation, risks, and particularities of treating lightning strike patients is presented in Appendix C. Approximately 75% of all lightning strike victims suffer from permanent disabilities [1,4,10,12,25,27,32,34,37,57]. Table 4 indicates which sequelae can present and whether follow-up is required.

    View all citing articles on Scopus

    The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as representing the views of the Department of the Army or Department of Defense.

    View full text