Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries: 2014 Update

Abstract

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.

Wilderness Neurology

“…Eighty percent of lightning victims are male, the majority between ages 25 and 45 years. [30][31][32] Lightning is an extremely high voltage, fast, and direct current charge. The voltage is the difference between the negative and positive charge, often between a cloud and the earth.…”

“…The bigger the difference, the higher the voltage; lightning strikes can be over 10 million volts. 30 Charge follows the path of least resistance. The same clumped charges and voltage gradient can occur between clouds and within clouds.…”

“…Auditory findings are marked by up to a 60% risk of tympanic membrane rupture, which may add additional challenge when managing a chaotic multicasualty scene. 30 Pregnant victims of a lightning strike have a 50% fetal mortality rate and are also at risk for premature rupture of membranes or premature labor. 30 Risk mitigation may be the only thing a group can do; lightning can reach almost any place and there is no foolproof method of reducing the risk to zero.…”

“…30 Pregnant victims of a lightning strike have a 50% fetal mortality rate and are also at risk for premature rupture of membranes or premature labor. 30 Risk mitigation may be the only thing a group can do; lightning can reach almost any place and there is no foolproof method of reducing the risk to zero. If unable to move to a safe location, a group should spread at least 20 feet apart, but within auditory proximity of each other, and get into a position to minimize the effect of a possible lightning injury (crouching low, feet together, and hands over ears) while avoiding the highest trees or objects in the area.…”

Lightning During Golden Spike of the Anthropoceneepoch: The Study of Vulnerability Odisha, India in the Global Context

“…Lightning may cause injury to the audio-vestibular system, rupturing tympanic membrane and Sensory-neural deafness may occur and may also affect lungs. The immediate attention to the patient must be given on airway, breathing, circulation, vaso-spasmand CPR if necessary.Medical assistance are given when the victim is unconscious, paralyzed, getting cardiac pain, lowering of breath, back or neck ache, deep burns and fractures Davis et al 2014 [51] .…”