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

Abstract

To provide guidance to clinicians about best practices, the Wilderness Medical Society 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 strikes and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded based on the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians.

Lightning Burns

“…Witnesses of lightning strike are instrumental in getting victims through the initial period and to appropriate care. 1 All high-risk patients after lightning strike should get a screening ECG and echocardiography. Cardiovascular changes range from transient abnormalities such as atrial fibrillation or ST elevation that typically resolve within 3 days to cardiovascular collapse and death.…”

“…The most common recommendation is to remain in a comfortable seated position on an insulated camping mat or pack without metal parts. 1 Death from lightning strike results generally from simultaneous cardiac and respiratory arrest. Electrical depolarization causes cardiac asystole and paralysis of the medullary respiratory center.…”

Struck by Lightning

“…2 Cardiac dysfunctions, including severe biventricular failure and substantial pericardial effusion with tamponade, are mechanical consequences of this event. 3 The direct current of a lightning strike can cause cardiac depolarization and asystole.…”

Prevention of lightning related adverse effects: knowledge, attitudes and practices among residents in Kiriella Medical Officer of Health area

“…It may cause headache, sleep disturbances, emotional impairment and fluctuation of blood pressure as well as major consequences related to cardiovascular, neurological and psychological health (7)(8). Burns, ocular injuries, rupture of the tympanic membrane and deafness are the commonly encountered acute effects, while the late manifestations are memory loss, poor concentration ability and cataracts.…”

“…Treatment of these injuries is based on acute management using lifesaving procedures. Since excellent prognosis can be achieved if breathing is supported, resuscitation should be considered in all such victims (8). This makes lightning injuries in developing countries a more complex task than in countries where these facilities are freely available and lightning-safe structures and vehicles are commoner (4).…”