A lightning strike injury is a traumatic event resulting from the body’s exposure to the massive electrical current of a natural discharge, which can exceed 10 million volts. This high-voltage electrical energy instantly courses through the body, causing an electrical injury that often leads to immediate life-threatening conditions like cardiac arrest and respiratory failure. A common misconception is that a victim retains an electrical charge; however, the energy is discharged through the body and into the ground, meaning the person is safe to touch and requires immediate intervention. Prompt action is directly linked to the victim’s chances of survival and recovery.
Prioritizing Scene Safety and Calling for Help
The first and most important step is to ensure the safety of the rescuer, as the same storm system that produced the initial strike can produce another within minutes. Rescuers must immediately move away from open areas, high ground, and any conductive objects like metal fences, water, or vehicles that could still be energized by the ground current. If thunder is still audible, the danger of another strike remains a real possibility, and the victim should only be approached once the immediate storm threat has passed or the victim can be safely moved.
Once the scene is deemed safe, the immediate activation of emergency medical services is paramount, which means calling 911 or the local emergency number without delay. Lightning strike incidents operate under a principle known as “reverse triage,” which is different from typical mass casualty protocols. In this specific scenario, rescuers should prioritize those who appear lifeless and are not breathing, as their cardiac or respiratory arrest is often reversible with immediate intervention. Only if the scene is completely safe should the victim be moved, for instance, to shield them from ongoing environmental hazards or to begin life-saving measures on a drier surface.
Administering Immediate Life Support
The primary cause of immediate death in lightning strike victims is cardiac arrest, often due to the massive electrical shock instantly depolarizing the heart muscle. Therefore, the moment a safe approach is possible, the rescuer must check for a pulse and normal breathing. If the victim is unresponsive, has no pulse, and is not breathing normally, Cardiopulmonary Resuscitation (CPR) must be initiated immediately and continuously.
Studies have shown that cardiac arrest induced by a lightning strike often carries a better prognosis compared to arrest from other causes, which underscores the importance of prompt, high-quality chest compressions. The lightning current may cause the heart’s rhythm to stop completely (asystole), but the heart often has the potential to restart if oxygenation is maintained through artificial ventilation and compressions. Respiratory arrest, where the victim stops breathing, can be more prolonged than the heart’s electrical malfunction, requiring continued rescue breaths even if a pulse returns.
If an Automated External Defibrillator (AED) is available, it should be attached and used as soon as possible, following the device’s prompts. While the electrical injury itself is the cause, early defibrillation can correct the chaotic electrical activity the strike may have caused in the heart. The combination of immediate CPR and rapid AED deployment significantly increases the chance of a return of spontaneous circulation.
Treating Secondary Injuries and Physical Trauma
While life support is being administered, or once the victim is stabilized, attention must shift to the secondary injuries caused by the intense energy and explosive force of the strike. The lightning current can cause a range of burns, although deep, full-thickness burns are uncommon, as the electrical current often “flashes over” the body. Superficial feathering patterns on the skin, known as Lichtenberg figures, may appear, which are not true burns and usually fade within hours.
Any actual thermal burns present should be covered loosely with a clean, dry dressing to prevent infection. Rescuers should avoid applying ointments, creams, or ice, which can worsen the injury. The explosive shockwave created by the rapid heating of air around the strike can throw the victim, leading to significant blunt trauma, including fractures and internal injuries. Therefore, maintaining spinal immobilization is a priority, treating all victims as if they have a neck or back injury until medical professionals can properly evaluate them.
The victim may enter a state of shock following the trauma, characterized by pallor, rapid pulse, and cold skin. To manage this, the victim should be kept warm with blankets or coats. If no head or spine injury is suspected, the legs can be elevated slightly to promote blood flow to the core organs. A transient paralysis, known as keraunoparalysis, may also occur, where limbs are cold, pale, and pulseless, but this condition typically resolves on its own over several hours.
Long-Term Medical Follow-Up and Neurological Effects
Even a strike that appears minor externally requires comprehensive medical evaluation, as the electrical current can cause unseen internal damage to the nervous and cardiovascular systems. Victims who survive the initial event often face chronic health issues that necessitate long-term medical follow-up. The most common and debilitating effects are neurological, stemming from the current’s impact on the brain and peripheral nervous system.
Survivors frequently report:
- Persistent headaches and chronic pain.
- Significant cognitive deficits, including issues with memory, concentration, and information processing.
- Psychological effects, such as post-traumatic stress disorder, anxiety, and depression, requiring specialized mental health support.
The blast effect can cause permanent damage to sensory organs, leading to hearing loss or the development of cataracts.
Specialists, including neurologists, cardiologists, and audiologists, are often involved in the extended care. This coordinated follow-up is necessary to manage symptoms, monitor for delayed complications, and assist the patient in achieving the best possible functional recovery.