Medical Aspects of Lightning
How Big A Problem Is This? Statistics
Lightning has been the
second largest storm killer in the US for the last 40 years, exceeded
only by floods. The lightning strike results in a cardiac arrest (heart
stopping) at the time of the injury, although some 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, the U.S. averages 73 reported
lightning fatalities per year. Due to under reporting, the figures are more
realistically about 100 deaths per year. Only about 10% of people who are
struck are killed, leaving 90% with various degrees of disability.
OF BECOMING A LIGHTNING VICTIM
US 2000 Census population
of being struck by lightning in a given year
(reported deaths + injuries)
of being struck by lightning in a given year
(estimated total deaths + injuries)
of being struck in your lifetime (Est. 80 years)
you will be affected by someone being struck
(Ten people affected for every one struck)
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 their medical expenses. About
another third of injuries occur during recreational or sports activities.
The last third occurs in diverse situation, including injuries to those
How Does Lightning Injury Affect People?
Lightning tends to be a
nervous system injury and may affect any or all parts of the nervous
system: the brain, the 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. A great quote sums it
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 acutely
after the injury but changing during the next few weeks to inability to
sleep more than two or three hours at a time. A few may develop persistent
seizure-like activity several weeks to months after the injury.
Personality Changes / Self-Isolation
Many may suffer
personality changes because of frontal lobe damage and become quite
irritable and easy to anger. The person who wakes up after the injury often
does not have the ability to express what is wrong with them, may not
recognize much of it or deny it, becomes embarrassed when they cannot carry
on a conversation, work at their previous job, or do the same activities that
they used to handle. As a result, many self-isolate, 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 that 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 self-medicate with alcohol and other
drugs, particularly those who have previously sought solace with these
compounds. It is important that family and friends of the survivor 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
every task that they used to automatically do without thinking now requires
intense concentration to accomplish. Many return to work but find that they
cannot multitask and do all of the activities that are required at their
There are two kinds of
- 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 ones so that anatomic tests such as the 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.
A functional test of how
a person's brain is working that is seldom thought of by most
non-neurologists is called neurocognitive or neuropsychological testing.
These tests are administered by a qualified neuropsychologist familiar with
the literature in this area, not by a psychiatrist, and consist of a 6-8
hour battery of pen and paper tests including memory, IQ, organizational
ability, and other how the parts of the brain are working kinds of tests.
Survivors of lightning and electrical injury usually have a characteristic
pattern of deficits.
Another common, but
often delayed, problem for some survivors is pain, also a difficult problem
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 that are ordered are testing the wrong thing an electromyogram (EMG)
measures only the largest nerve fibers, 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 measures primarily 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 that has
been of tremendous help to survivors, their families, their physicians and
other professionals is Lightning Strike and Electric Shock Survivors, International
(LSESSI), a support group formed in 1989 by a gentleman who was injured in
1969 who became tired of no one recognizing or knowing what to do for those
with lightning injury. 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 as well as for
lectures from professionals who work with lightning and electrical
survivors and their families. LSESSI can be reached at 910-346-4708, Lightnin@nternet.net, http://www.lightning-strike.org/index.html,
or at P.O. Box 1156, Jacksonville, North Carolina 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:
- A supportive family /
- The person or family
becoming their own best advocate and learning as much as they can
about their disability.
- A physician (regardless of
specialty) who is 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.
courtesy Dr. Mary Ann Cooper- Associate Professor,
Departments of Emergency Medicine and Bioengineering University of Illinois