A lightning strike is a catastrophic electrical event, and a person struck by lightning requires immediate intervention to survive. The surge of energy can cause the heart to stop or result in respiratory failure. Unlike common misconceptions, a person struck by lightning does not retain an electrical charge, meaning it is safe to touch them and begin administering care without fear of electrocution. Swift action is paramount because the primary cause of death is immediate cardiac arrest, which is often reversible with prompt resuscitation.
Prioritizing Scene Safety and Calling Emergency Services
Before approaching the victim, your safety must be the first consideration, as the immediate area may be highly susceptible to a secondary strike. If the storm is still active, you must move the victim to a safer location, such as a substantial building or a fully enclosed metal vehicle, if it can be done without causing further injury. Lightning can strike the same place repeatedly, and ground current can travel more than 100 feet from the strike point, making the open ground dangerous. Metal objects or water sources near the victim can also conduct a secondary current and must be avoided.
Once the scene is safe, immediately call for emergency medical services and provide a precise location. State clearly that the person was struck by lightning, as this information is relevant to the responding medical teams. If there are multiple victims, a “reverse triage” approach is necessary. First attention must be given to those who are unresponsive and appear lifeless.
This reverse triage prioritizes victims in cardiac or respiratory arrest because they have a high chance of survival if immediately resuscitated. Victims who are conscious, talking, or moving are likely to survive the strike and can receive care after the unresponsive individuals.
Immediate Life Support Actions
The immediate danger following a lightning strike is the abrupt cessation of the heart and breathing, requiring a rapid assessment. Check for a response by gently shaking the victim and shouting, then look, listen, and feel for normal breathing for no more than ten seconds. Check for a central pulse, such as the carotid pulse in the neck. If the victim is unresponsive, not breathing, or only gasping, assume they are in cardiopulmonary arrest.
The lightning current often causes an asystolic cardiac arrest, a state where the heart has no electrical activity. If there is no pulse and no breathing, begin high-quality cardiopulmonary resuscitation (CPR) immediately. Start with chest compressions, pushing hard and fast in the center of the chest at a rate of 100 to 120 compressions per minute.
If the victim has a pulse but is not breathing, the primary intervention is rescue breathing, as the respiratory center may be paralyzed. Deliver one rescue breath every five to six seconds for an adult, watching for the chest to rise. If an Automated External Defibrillator (AED) is available, use it immediately, as the electrical energy can cause a shockable rhythm like ventricular fibrillation.
Addressing Specific Injuries
Once life support is underway or the victim is stable, attention must shift to the secondary injuries resulting from the strike. The immense mechanical force from the blast wave or the subsequent fall can cause significant blunt trauma. Always assume that the victim has suffered a spinal injury, and move them as little as possible, stabilizing the neck and back until professional help arrives. Fractures and dislocations are common due to powerful muscle contractions or being thrown by the concussive force.
Lightning causes two types of burns: thermal burns from clothing catching fire and superficial burns where the current enters and exits the body. Look for entry and exit wounds, which may appear as small, charred areas, or a distinctive, fern-like pattern on the skin called Lichtenberg figures. Cover any burns with a sterile, non-adhesive dressing or a clean cloth, but never apply ice, creams, or ointments, as this can worsen the injury. Do not attempt to remove clothing stuck to the burn.
A condition called Keraunoparalysis, a temporary paralysis and numbness of the limbs, may also be present. Treat the victim for shock by keeping them warm with blankets and elevating their legs, provided a spinal injury is not suspected. Continuous monitoring of the victim’s level of consciousness and breathing is necessary.