a. General.

Lightning is a form of electricity, atmospheric electricity.

The patient’s body does not hold an electrical charge from the lightning; therefore, it is safe to touch him in order to treat him. Generally, the longer an individual is in contact with the lightning, the more serious his injuries. Always assume that a victim of a lightning strike has sustained multiple injuries, including spinal cord injuries.

b. Body Injuries.

Electric current can cause these problems:

(1) Nervous system. The patient may be unconscious initially. He may also suffer partial paralysis or respiratory paralysis.

NOTE: Fixed and dilated pupils are a normal reaction and not necessarily a poor diagnosis.

(2) Sensory system. The patient may show loss of sight, hearing, or speech. Tympanic rupture may occur, causing a small amount of blood to drain from the ears.

(3) Skin. Lightening causes a burn that typically is mottled, feathery, or patchy. It appears in a scattered pattern over the skin and looks like tiny flowers.

(4) Heart. Cardiac damage is common. Most serious injury occurs when the current crosses the heart. The current can disrupt the heart’s rhythm or cause the coronary arteries to go into spasm.

(5) Vascular system. The patient may become unresponsive, appear white and mottled, have cool arms and legs, and lose pulses. If the injury is moderate, the condition will correct itself quickly. In severe cases, the blood will coagulate and tissues in the arms and legs may die, leading to eventual amputation. The patient may have renal failure.

c. Treatment for Lightning Injury.

Follow the procedure given below.

(1) Assess breathing and circulation.

(2) Start CPR immediately if there is no pulse. Victims of lightning have been resuscitated as long as thirty minutes after the strike without any residual damage.

(3) If the injury occurred in an open area, move the patient to a protected area to reduce the chance of a second strike. If a group of people have been struck by lightning, disregard normal triage procedure and care for the apparently dead first. Those who display vital signs will probably recover spontaneously.

(4) Survey the scene and assess what happened.

(5) Get a brief history if witnesses are available.

(6) Stabilize the patient’s neck.

(7) Check the patient’s skin color.

(8) If the patient is conscious, check movement in his extremities.

(9) Determine the patient’s reaction to pain.

(10) Examine the patient for open wounds or fractures and provide appropriate care.

(11) Control external bleeding.

(12) Start an IV with D5W.