Burns, Lightning Injuries

Lightning's power has been a subject of awe since primitive times. Ancient Greeks saw it as an expression of the wrath of Zeus. Since lightning is caused by common meteorological conditions, anyone is a potential victim. Lightning strikes the earth more than 100 times each second and 8 million times per day. Worldwide, approximately 50,000 thunderstorms occur per day that may result in forest fires and injury to animals and people.

The National Weather Service estimates that 100,000 thunderstorms occur in the United States each year. Lightning is evident in all thunderstorms. A cloud-to-ground lightning strike is the most destructive form of lightning and occurs when the electrical difference between a thunder cloud and the ground overcomes the insulating properties of the surrounding air. The danger of lightning may not be apparent to an individual because lightning has struck 10 miles away from the rain of a thunderstorm.¹

In the United States, cloud-to-ground lightning strikes occur approximately 30 million times each year.² In the United States, lightning strikes are most common in Florida and along the southeastern coast of the Gulf of Mexico.³ Data from the National Oceanic and Atmospheric Administration (NOAA) identified an average of 93 deaths and 257 injuries attributable to lightning from 1959 to 1990.⁴

Lightning injury is the second most common cause of weather-related death in the United States (behind flash floods).⁵ According to data from NOAA, in the years from 1959 to 1994, lightning was responsible for over 3,000 deaths and nearly 10,000 casualties. The actual number of lightning casualties may be higher because up to 50% may go unreported. Lightning kills more people each year than hurricanes, volcanoes, blizzards, and earthquakes combined.

Thunderstorms and lightning are most common from June through September. Lightning strikes usually occur in the afternoon and evening, coinciding with times when people are active and outdoors. Hikers, campers, golfers, and other outdoor sports enthusiasts most often sustain lightning injuries. Lightning injuries are more common in rural or exposed environments than in the city, where high buildings have metal frames and lightning-protection devices. Most lightning injuries occur in areas with the greatest number of thunderstorms, such as the South; Rocky Mountain area; Gulf Coast; and Ohio, Mississippi, and Hudson river valleys. Following the worldwide interest in mobile phones, concerns arose that mobile phones may enhance the risk of lightning strike. NOAA has indicated that lightning is not attracted to people carrying mobile phones.

The most important characteristic features of lightning injuries are multisystem involvement and widely variable severity. This article discusses the physics of lightning and the pathophysiology and treatment of lightning injuries.⁶ Because persons struck by lightning have a better chance of survival than persons who experience cardiopulmonary arrest from other causes, resuscitation for persons struck by lightning must be instituted immediately, followed by a comprehensive treatment program of the other systemic manifestations.⁷ (Click here to complete a Medscape CME activity on CPR.)