A lightning strike is a severe medical event. The immense electrical energy can cause instantaneous cardiac arrest, making time a crucial factor in survival. Knowing the correct emergency steps can significantly improve the outcome for the victim. Professional medical help requiring advanced life support must be summoned without delay.
Scene Safety and Calling for Help
You must first ensure that you do not become a second victim. Lightning can strike the same area multiple times, so immediately assess for ongoing danger from the storm before approaching the person.
If the scene is unsafe due to continuous lightning activity, wait for the danger to pass or move the victim to a safe, dry location, such as an enclosed vehicle or building. Move the person with caution, treating them as a trauma patient with a potential spinal injury, unless the lightning danger outweighs the risk of movement.
Once safe, immediately call 911 or the local emergency number. If multiple people have been struck, communicate the number of victims and the nature of the emergency to the dispatcher, as rapid arrival of medical personnel is vital.
Immediate Life Support and CPR
Cardiac arrest is the most frequent cause of death following a lightning strike because the electrical current can instantly stop the heart’s rhythm. Immediate assessment and intervention to restore circulation and breathing are paramount. Unlike other emergencies, a unique concept called “reverse triage” is applied to lightning strike incidents, particularly in mass casualty situations.
Reverse triage means that those who are unresponsive, pulseless, and not breathing are prioritized for resuscitation, even over those who are conscious or breathing but injured. Victims who survive the initial strike without cardiac arrest are likely to recover, but those in cardiac arrest have the greatest potential for survival if CPR is started immediately. If the person is unresponsive and not breathing normally, immediately begin high-quality cardiopulmonary resuscitation (CPR).
If an Automated External Defibrillator (AED) is available, use it immediately, as defibrillation can correct the electrical chaos in the heart. Continue CPR until the AED advises a shock, the person shows signs of life, or emergency medical services take over. Lightning can also cause simultaneous respiratory arrest, requiring continued rescue breathing along with chest compressions, even if the heart spontaneously restarts.
Addressing Specific Injuries
After initiating life support or confirming the victim is breathing and has a pulse, attention must shift to managing the specific injuries caused by the strike. Lightning causes both medical and blunt force trauma. The explosive force of the strike, or the victim being thrown, can cause fractures, dislocations, and head, neck, or spinal injuries.
If a spinal injury is suspected, minimize all movement and maintain the person in the position found, unless necessary for CPR or to move them from immediate danger. Burns are common but often superficial, resulting from the current flashing over the skin or igniting clothing. Look for both entrance and exit wounds, and treat any burns by cooling them with water and covering them with a clean dressing.
Neurological symptoms, such as confusion, seizures, or a temporary paralysis known as keraunoparalysis, are also frequent. This temporary paralysis usually affects the legs and can make the skin appear mottled and cold, but it typically resolves without specific treatment. Continuously monitor the victim’s level of consciousness and keep them warm and comfortable while awaiting the arrival of the emergency team.
Post-Stabilization and Common Misconceptions
While waiting for emergency services to arrive, you should continue to monitor the victim’s breathing and pulse, making note of any changes in their condition or level of consciousness. Documenting the circumstances of the strike and the initial condition of the victim is helpful information to pass on to paramedics. Even if the person appears to recover quickly and without serious injury, they still require a thorough medical evaluation at a hospital.
A misconception to dispel is that a lightning strike victim retains an electrical charge. It is completely safe to touch the person immediately and begin first aid without fear of electrocution, as the body does not store the electricity from the strike. Any person who has been struck by lightning should seek medical follow-up, as some injuries, like cataracts or hearing damage, may not appear until days or even months later.