Lightning: It can burn, concuss and kill

Posted at 10:38 AM, May 07, 2015
and last updated 2015-05-11 10:15:57-04

Lightning strikes can stop the heart, concuss the brain and cook you from the inside out.

But they’re rare — and surprisingly survivable.

“It has a very wide spectrum of injury,” said surgeon Carl I. Schulman, director of the William Lehman Injury Research Center at the University of Miami Miller School of Medicine. “It can put you into a cardiac or respiratory arrest. It’s not often associated with large skin burns unless it hits something nearby like a metal object that causes a big flash.”

Lightning strikes are among the most common causes of weather-related death, though the chance of getting struck is only about 1 in 500,000, according to the Centers for Disease Control and Prevention.

“It’s hard for them to categorize how many people were stuck by lightning because it’s not always reported,” Mozingo said.

How badly a lightning strike injures depends on the strength of the bolt, where it hits and how well the victim is grounded.

Many strike injuries are indirect — a person is standing by a set of golf clubs that gets struck, for instance, and they’re hit by an indirect flash. Large skin burns are possible if the flash catches them on fire.

There can also be secondary trauma due to being thrown from the blast or falling down. That can happen to roofers or construction workers, said Doreann Dearmas, a nurse practitioner at the University of Miami Jackson Memorial Hospital Burn Center.

Most burns occur where the victim is wearing a metal object, like a necklace, rings or belt buckle. On their skin, they can experience burns that appear like the branches of a tree, called an Arborizing pattern.

“It seems like a contradiction since the energy in a lightning bolt is quite high,” Mozingo said. “But the actual current tends to go around the patient instead of going through the patient.”

The extent of electrical injury is due to how much resistance there is in the tissue — the more water content, the easier it is for the electricity to conduct and the less damage it sustains, Schulman said. Muscle and fat conduct electricity fairly well. Skin, less so.

Bones and nerve tissues are insulated and sustain the most damage from a strike.

Many patients experience neurological or psychological effects, which are common with powerful electrical injuries. That includes traumatic brain injury, concussion, weakness, or a “funny feeling” in the arms and legs called paresthesia.

The neurological effects can be due to a direct effect of the strike or oxygen deprivation from the cardiac or respiratory arrest that follows.

“They usually get better over time,” Schulman said. “But a lot of people have PTSD.”

There are stories of odd effects, like blind people gaining eyesight from a lightning strike. But that’s a myth, Schulman said, with no medical basis.

Schulman implored people not to give up on a lightning strike victim. They may appear dead, but that’s often due to a temporary paralysis from the shock.

With their breathing muscles not working, they need immediate CPR.

“If someone is struck by lightning and they become unconscious, there’s a good chance they can be resuscitated,” Schulman said. “Sometimes they’re paralyzed but not quite dead. You don’t want to write them off until you’ve done a good resuscitative effort.”

Gavin Stern is a national digital producer for the Scripps National Desk.