Friday, June 23, 2006

Day Five - Lightning Safety Awareness Week

"Medical Aspects of Lightning"

How Big A Problem Is This? Statistics

Lightning has been the second largest storm killer in the U.S. for the last 40 years, exceeded only by floods. A lightning strike can result in a cardiac arrest (heart stopping) at the time of the injury, although some victims may appear to have a delayed death a few days later if they are resuscitated but have suffered irreversible brain damage.

According to Storm Data, a National Weather Service publication, over the last 30 years the U.S. has averaged 66 reported lightning fatalities per year. Due to under reporting, the figures are more realistically at least 70 deaths per year. Only about 10% of people who are struck by lightning are killed, leaving 90% with various degrees of disability.

U.S. 2000 Census population 280,000,000
Odds of being struck by lightning in a given year (reported deaths + injuries) 1/700,000
Odds of being struck by lightning in a given year (estimated total deaths + injuries) 1/400,000
Odds of being struck in your lifetime (Est. 80 years) 1/5000
Odds you will be affected by someone being struck (Ten people affected for every one struck) 1/500

Who Gets Injured

While about one third of all injuries occur during work, workers compensation companies are often reluctant to acknowledge the injury or pay related medical expenses. About another third of injuries occur during recreational or sports activities. The last third occurs in diverse situation, including injuries to those inside buildings.

How Do Lightning Injuries Affect People?

Lightning tends to be a nervous system injury and may affect the brain, autonomic nervous system and the peripheral nervous system. When the brain is affected, the person often has difficulty with short-term memory, coding new information and accessing old information, multitasking, distractibility, irritability and personality change.

"Patients have difficulty in all areas that require them to analyze more items of information than they can handle simultaneously. They present (appear) as slow because it takes longer for smaller than normal chunks of information to be processed. They present as distractible because they do not have the spare capacity to monitor irrelevant stimuli at the same time as they are attending to the relevant stimulus. They present as forgetful because while they are concentrating on point A, they do not have the processing space to think about point B simultaneously. They present as inattentive because when the amount of information that they are given exceeds their capacities, they cannot take it all in."

Early on, survivors may complain of intense headaches, ringing in the ears, dizziness, nausea, vomiting and other post-concussion types of symptoms. Survivors may also experience difficulty sleeping, sometimes sleeping excessively at first and then only two or three hours at a time. A few may develop seizure-like activity several weeks to months after the injury.

Personality Changes / Self-Isolation

Many lightning victims may suffer personality changes because of frontal lobe damage and become quite irritable and easy to anger. People who wake up after the injury often do not have the ability to express what is wrong with them, may not recognize much, become embarrassed when they cannot carry on a conversation, work at their previous job, or do the activities that they used to handle. As a result, many isolate themselves, withdrawing from church, friends, family and other activities. Friends, family and co-workers who see the same external person, may not understand why the survivor is so different. Friends soon stop coming by or asking them to participate in activities. Families who are not committed to each other break up.

Obviously, depression becomes a big problem for people who have changed so much and lost so much. Suicide is something almost all severely injured people have thought about at one time or another. Occasionally, those who do not have access to medical care or who do not understand what is happening may resort to alcohol and other drugs, particularly those who have previously used these options. Family and friends of the survivor must remain supportive even though it may require an adjustment in their relationship with the survivor. An injury such as this affects the entire family, not just to the person hit.


Survivors often complain of becoming exhausted after only a few hours of work. This may be because tasks they used to do automatically now require intense concentration. Many return to work but find that they cannot do all of the activities required at their job.

Medical Testing

There are two kinds of medical tests:

  • Anatomic tests take a simple picture (x-ray) or measurement (blood count)
  • Functional tests show how something is working (PET, neuropsychological testing)

Sometimes function can be ascribed to the anatomic tests but often it cannot. The mental changes of a lightning survivor are functional (how the brain works) changes, not anatomic. Anatomic tests such as a CT scan and MRI are usually normal. More functional scans such as PET and SPECT may show changes but are hard to obtain due to their relative infrequency in medical centers. To use an analogy: if an electric shock were sent through a computer, the outside case would probably look OK (similar to a photo or x-rays of the person), the computer boards on the inside would probably look OK and not be fused nor melted (CT, MRI for the person), but when you boot up the computer it would have difficulty accessing files, making calculations, printing, etc. This situation is similar in a person with brain injury who has short-term memory problems, difficulty accessing and coding information, difficulty organizing output, etc.

More useful is a functional test of how a person's brain is working: a neurocognitive or neuropsychological testing. These tests are administered by a neuropsychologist, not by a psychiatrist. The tests consist of a 6-8 hour battery of tests including memory, IQ and organizational ability. Survivors of lightning and electrical injury usually have a characteristic pattern of deficits.

Delayed Problems

Another common, often delayed, problem for some survivors is pain, also difficult to quantify and manage. The pain may not be from chronic intense headaches but may be in the back (perhaps from compression and disc injury from the intense muscle contractions which may throw a person several yards at the time of the injury), or in an extremity. Some may have nerve entrapment syndromes and a small number may eventually develop Sympathetically Mediated Pain Syndrome.

Sometimes the functional tests ordered are testing the wrong thing. An electromyogram (EMG) measures only the motor fibers, which are seldom affected by lightning injury. Smaller pain carrying nerve fibers are not tested by EMG so that a normal EMG means little when ordered for someone with pain. Likewise, the standard EEG primarily measure surface readings of the brain and misses seizure activity in several deeper regions.

Decreased libido and impotence are often reported.

Help Exists - Lightning Strike and Electric Shock Survivors, International, Support Group

An organization of tremendous help to survivors, families, physicians and other professionals is Lightning Strike and Electric Shock Survivors, International (LSESSI), a support group formed in 1989 by a lightning victim. LSESSI has printed materials, offers tremendous support, networks survivors with others in their area, and provides an annual meeting where survivors come together for support and lectures from professionals who work with lightning and electrical survivors and their families. LSESSI can be reached at 910-346-4708,, or see their Website at, or at P.O. Box 1156, Jacksonville, NC 28541-1156.

Four Factors Necessary for Recovery

The four most important factors in overcoming disability from lightning injury (or from any illness or major injury for that matter) are:

  • Supportive family/friends network.
  • Becoming your own advocate and learning as much as you can about this disability.
  • A physician willing to listen, read, learn and work with the survivor and their family.
  • A sense of humor.


Far more important than treating survivors is preventing lightning injury. All of the people who helped make possible National Lightning Safety Awareness Week hope it will help you and your family learn how to avoid injury. Prevention is the KEY.

This factsheet courtesy Dr. Mary Ann Cooper- Associate Professor, Departments of Emergency Medicine and Bioengineering University of Illinois at Chicago

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