Lightning injuries

[GarryDrold]

A lightning injury occurs after brief exposure to the very intense current of the strike.

About 10% of people who are struck by lightning die because the heart stops beating and breathing stops.
In some people who survive severe lightning injury, an electrocardiogram is done to monitor the heartbeat, and blood or imaging tests are needed.
Once the person is resuscitated, burns and other injuries are treated.

Lightning delivers a massive electrical pulse over a fraction of a millisecond. Electrical current passing through the body generates heat, which burns and destroys tissues. Burns can affect skin and sometimes internal tissues. The brief duration of the exposure frequently limits the damage to the outer layer of skin. In addition, lightning is much less likely to cause internal burns than electrical injuries from generated electricity. However, it can kill a person by instantaneously short-circuiting the heart. Lightning can also damage the nervous system, including the brain, causing seizures, loss of consciousness, or other abnormalities.
Lightning is the second most frequent cause of storm-related deaths in the United States, resulting in about 30 deaths and several hundred injuries each year. Some injuries result in permanent disability.
Lightning tends to strike tall or isolated objects, including trees, towers, shelters, flagpoles, bleachers, and fences. A person may be the tallest object in an open field. Metal objects and water do not attract lightning but easily transmit electricity once they are hit. Electricity from lightning can travel from outdoor power or telephone lines to electrical equipment or telephone lines inside a house.
Lightning can injure a person in several ways:

Lightning can strike a person directly.
Electricity from lightning can reach a person who is touching or near an object that has been struck.
Electrical current can reach a person through the ground.
The shock can throw a person, causing blunt injuries.

[Zipporah Schumaker]

Lightning injuries include cardiac arrest, loss of consciousness, and temporary or permanent neurologic deficits; serious burns and internal tissue injury are rare. Diagnosis is clinical; evaluation requires ECG and cardiac monitoring. Treatment is supportive.
Although injury and deaths due to lightning strikes have decreased significantly over the last 50 years, lightning strikes still cause about 30 deaths and several hundred injuries annually in the US. Lightning tends to strike tall or isolated objects, including trees, towers, shelters, flagpoles, bleachers, and fences. A person may be the tallest object in an open field. Metal objects and water do not attract lightning but easily transmit electricity once they are hit. Lightning can strike a person directly, or the current can be transferred to the person through the ground or a nearby object. Lightning has been observed to strike 10 or more miles away from a storm, even in areas with clear skies, creating the potential for unexpected risk (1). Lightning can also travel from outdoor power or electrical lines to indoor electrical equipment or telephone lines. The force of a lightning strike can throw the person up to several meters.
Because the physics of lightning injury is different from that of generated electrical energy, knowledge of the effects of exposure to household current or high voltage cannot be extrapolated to lightning injuries. For example, damage from lightning injury is not determined by voltage or amperage. Although lightning current contains a large amount of energy, it flows for an extremely brief period (1/10,000 to 1/1000 second). It rarely, if ever, causes serious skin wounds and seldom causes rhabdomyolysis or serious internal tissue damage, unlike high-voltage and high-current electrical injury from generated sources. Patients may have intracranial hemorrhage resulting from secondary injury or, rarely, from lightning itself.
Lightning can affect the heart but primarily affects the nervous system, damaging the brain, autonomic nervous system, and peripheral nerves.