On average, lightning causes more casualties annually in the U.S. than any other storm-related phenomenon except floods, according to the article. Although 90 percent of those injured survive, they often have lasting medical problems or disabilities. According to experts, many of these people are killed or injured by lightning because of misinformation and inappropriate behavior during a thunderstorm. For example, a common myth is that people struck by lightning carry a charge. This is not true, and it is safe to touch a person who has been stuck to provide medical treatment, according to the article.
"Avoiding lightning injury is an individual’s personal responsibility, which is why the public needs to be familiar with and follow lightning safety rules," said Mary Ann Cooper, MD, an emergency physician with the University of Chicago in Illinois and a co-author of the article. "While there is no guarantee these guidelines will prevent all injuries, they constitute a summary of the safest practices based on the best research and experience currently available."
Although no place is absolutely safe from the threat of lightning, some places are safer than others. According to experts, these places include:
- Large structures with plumbing and electrical wiring (eg, houses, schools, office buildings).
- Fully enclosed metal vehicles (eg, cars, buses, trucks, enclosed farm vehicles). It is important to roll up windows and avoid contact with metal or conducting surfaces outside or inside the vehicle.
Just as important, experts suggest avoiding certain locations during a thunderstorm, such as:
- Tall structures (eg, mountains, isolated trees, towers, flag poles, light poles).
- Open fields (eg, golf courses, sports fields, parks, school yards, playgrounds).
- Open structures or open vehicles (eg, gazebos, shelters, baseball dugouts, convertibles, golf carts).
- Contact with conductive materials (eg, hard-wired telephones, computers, plumbing, electrical appliances or wiring, bleachers, fences, metal window or door frames).
- Being near or in water (eg, oceans, beaches, lakes, rivers, indoor or outdoor pools).
The experts also recommend unplugging computers before a thunderstorm to avoid damage to it and to the person using it. Generic surge suppressors protect neither people nor equipment from lightning damage, they added.
"If you can hear thunder or see lightning, you are at risk," said Dr. Cooper. "Many people follow the ‘30-30’ rule. If the time delay between seeing a flash of lightning and hearing a bang of thunder is less than 30 seconds, seek a safer location immediately. However, it may be difficult to determine which flash of lightning corresponds with which bang of thunder. We suggest a simple rule often taught to children: if you see it, flee it; if you hear it, clear it."
Components of Lightning Action Plan
A lightning policy should be implemented for safety in large groups and groups with an evacuation time of more than 10 minutes, such as in sports arenas. Experts recommend group organizers develop a lightning safety plan that includes the following components:
- Train personnel to be familiar with the plan. (For large events, a team of people may be required.)
- Access up-to-date weather information. (This is available from many sites on the Internet. Monitoring weather may need to begin days or hours before a large event.)
- If detection or warning systems are used, train personnel in their use.
- Designate safer areas. (Some golf tournaments provide school buses for spectators to sit in while a storm passes.)
- Plan for routing and evacuating people.
- Display appropriate signage.
- Educate the event’s participants about the plan. (Consider placing lightning safety tips in event programs, placards near seating, or handouts.)
- Use a "warning" signal that is different from the "all clear" signal.
- Carry out regular Lightning Action Plan drills.
- Review and modify the Lightning Action Plan as needed.
Medical Recommendations for Lightning Victims
Most people struck by lightning survive, especially with timely medical treatment, according to the article. Those people who do not survive often experience cardiac arrest.
- If the person is not breathing or has no pulse, it may be necessary to begin advanced cardiac life support (ACLS) protocols.
- If you decide to move a victim, a few quick breaths should be administered before the person is moved.
- If the victim is cold or wet put a protective layer between the victim and the ground to decrease chances of hypothermia.
Another article in this issue of the Annals of Emergency Medicine describes the largest, multiple-casualty lightning event involving children who suffered severe injuries from a single lightning strike. The report raises concerns about lightning injury prevention during camping.
The event, which occurred in South Africa in 1994, included 26 girls, ages 10 and 11 years, two adults, and seven dogs, which were all sleeping in a large tent, located in an open grassy field, when it was struck by lightning at 2:30 a.m. Four children who slept closest to a metal tent pole were fatally injured. Four of the seven dogs were also killed. The two adults and a small dog sleeping near the entrance of the tent were uninjured. Three children also had no visible injuries. Many of the other children experienced burns that ranged from mild to burns that were described as "hot poker or skewer" burns. Two other victims experienced fractured skulls, and cataracts developed in eight of 24 survivors.
"To prevent these type of tragedies, people need to be informed about the risks associated with lightning," added Dr. Cooper. "Many lightning deaths and injuries, such as the ones to the children camping in South Africa, could have been avoided if the adults had taken precautions."
Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical organization with nearly 23,000 members. ACEP is committed to improving the quality of emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia, and a Government Services Chapter representing emergency physicians employed by military branches and other government agencies.
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Annals of Emergency Medicine