Lightning Injury Research Articles

Lightning Casualties of Vulnerable Caterpillar Fungus Collectors on the Qinghai–Tibetan Plateau

Abstract Lightning has killed and injured many people in recent years in the Qinghai–Tibetan Plateau area of China when they were collecting a rare product used for medical applications. The fungus that grows on dead caterpillars at high altitudes in this region demands a high price when sold, so it attracts collectors that unfortunately become at risk from lightning during this process. A total of 12 lightning-related events during 2004–22 resulted in 29 deaths and 53 injuries. All cases occurred at high elevations in rugged terrain with no available lightning-safe structures or vehicles. The fungus collection occurred during the daytime hours in late spring and early summer, which is also when lightning is frequent. Maps of lightning for the cases and information gained from the Chinese-language reports are summarized. It is apparent that this is a unique high-risk, high-reward occupation that is similar in terms of exposure to other situations around the world that result in lightning deaths and injuries. Significance Statement Lightning deaths and injuries often occur when people push the limits of safety due to occupational or recreational demands. Most of these decisions are on short time scales such as while tending agricultural fields, working on roofs, running a competitive race, or walking home from school when a thunderstorm is approaching. In the scenario presented here, groups of people with few income alternatives spend weeks or months in mountainous regions where lightning is common, but safety is elusive. This situation is an unusual version of high lightning risk occurring while pursuing a high reward.

Lightning Injury: Case of a 7-Year-Old Child Struck by Lightning in Region 8 Guyana

Background: It is estimated that lightning occurrence frequency worldwide is 50 occurrences per second with 20% of those resulting in ground strikes. It is estimated that approximately 24,000 fatalities occur worldwide due to lightning strikes and in the US 25-50 patients die each year. The mechanisms of injury due to lightning strike are numerous which includes the effects of the electrical current passing through body tissue, burns and mechanical trauma. Cardiac and respiratory arrest are more common with direct lightning strikes and may lead to sudden death. Case Presentation: Here we present a case of child who was struck by lightning in a hinterland region. The child was found in an unconscious state by a passerby. He was then taken to a local health post where he regained consciousness. Initial vitals were stable, and child appeared to have suffered burns about the body. Arrangements were made and he was air dashed to GPHC. He was alert with stable vitals when he arrived, appeared to have suffered minor burns about the body. His ECG, X rays and CT head were all normal. He had an elevated CPK level which caused concern for Rhabdomyolysis. He was admitted to the paediatric ward. Outcome: The child spent 3 days on the ward, where he was monitored closely for any delayed complications related to lightning injuries. His CPK had normalized, he received dressings for his burns and was subsequently discharged home. Keywords: Lightning Strike, Lightening Injuries

Clinical case of lightning injury

Atmospheric electricity damage as a result of lightning strike is a relatively rare condition in intensive care medicine, however it can be accompanied by high mortality and serious complications in the majority of survived patients.The objective was to demonstrate a clinical case of lightning injury and discussion of diagnostic and treatment aspects in this condition.Materials and Methods. 18-yr old patient was delivered to hospital after lightning strike. She lost consciousness, there was no breathing for a short time, and the witnesses provided artificial respiration and external cardiac compressions. On admission, the signs of shock were present in parallel with dopamine infusion, the skin was pale-grey and cold, with traces of thermal damage according to the type of contact with metal of various localization on the neck, scalp, front surface of the chest and abdominal wall, in the groin, on the left foot. The patient was hospitalized to ICU, therapeutic and diagnostic measures were started. We revealed decompensated lactic acidosis, biochemical signs of myocardial and muscle damage. The infusion therapy, analgesics, antibiotics, proton pump inhibitors, anticoagulants were administered. During the therapy in the first 6 hours, the signs of shock were attenuated, in 4 days, the patient was transferred to traumatological department in a stable state. After the transfer from the ICU, hearing decline as well as pain and sensory disturbances in the left foot are persisting.Conclusion. An integrated approach is required in the diagnosis, treatment, and rehabilitation of patients with lightning injury.

Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience

IntroductionElectrical injuries can be devastating, and data is lacking in low-resource settings. We aimed to identify predictors of mortality following electrical and lightning injuries (ELI) in Malawi. MethodsWe performed a retrospective observational study of patients presenting with ELI and burn injuries at a tertiary hospital in Malawi from 2011 to 2020. Outcomes were compared and predictors of mortality were modeled. ResultsA total of 382 ELI and 6371 burn patients were included. The mean ages for ELI and burn groups were 24 ± 14 and 11 ± 14 years, respectively (p < 0.01). Most patients were injured at home (91% in the burn group versus 51% in the ELI group, p < 0.01). The crude mortality rate in the ELI group was 28%, compared to 12% in the burn group (p < 0.01). On multivariate logistic regression, predictors of mortality included ELI (odds ratio [OR] 13.3, 95% confidence interval [CI] 7.2–24.5) and total body surface area burned (OR 1.1, 95% CI 1.1–1.1). Predicted mortality for ELI has increased over time (p = 0.05). ConclusionsELI confers more than 13 times higher odds of mortality than burn injuries in Malawi, with mortality risk increasing over time. More efforts are needed to prevent electrical hazards and implement timely interventions for patients with ELI.

Clinical characteristics and analysis of risk factors for heart injuries in 55 patients with lightning injury on plateau in Tibet Autonomous Region

Objective: To explore the clinical characteristics and treatment outcomes of patients with lightning injury on plateau in Tibet Autonomous Region, and to analyze the risk factors for heart injuries in these patients. Methods: A retrospective case series study was conducted. From January 2008 to July 2023, 55 patients with lightning injury who met the inclusion criteria were admitted to the General Hospital of PLA Tibet Military Area Command. The gender, age, ethnicity, time of injury, location of injury (average altitude), activity at the time of injury, the occurrence of thermal burns on the body surface, the occurrence of complication, the occurrence of combined injury, underlying disease or physiological process before injury, length of hospital stay, treatment outcome, and effective rate of treatment were recorded. The patients were divided into juvenile group (11 cases), young group (28 cases), middle-aged group (14 cases), and elderly group (2 cases) according to age bracket, then the gender and ethnicity distribution of patients in the 4 groups were compared. According to the occurrence of heart injuries at admission, the patients were divided into heart injury group (44 cases) and non-heart injury group (11 cases), then the gender, age, ethnicity, average altitude of location of injury, length of hospital stay, the occurrence of complication, the occurrence of combined injury, site of thermal burns on the body surface, and area of thermal burns on the body surface in patients were compared between the two groups. Data were statistically analyzed with Mann-Whitney U test, chi-square test, or Fisher's exact probability test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for heart injury in patients with lightning injury. Results: Among the 55 patients aged 10-68 years, 39 were male and 16 were female, including 47 Tibetans and 8 Hans. There were no statistically significant differences in gender or ethnicity distribution of patients among the 4 groups with different age brackets (P>0.05). Lightning injuries occurred from May to September, which mostly occurred in June and July. The incidence of lightning injury was higher in Chengguan District of Lhasa City (average altitude of 3 650 m) and Baqing County of Naqu City (average altitude of 4 500 m), being 20.0% (11/55) and 16.4% (9/55), respectively. A total of 96.4% (53/55) of the patients were engaged in outdoor activities when injured, such as grazing, digging Cordyceps, and harvesting highland barley. Among the 55 patients, 46 (83.6%) cases had thermal burns on the body surface, with burn area mainly being not more than 10% total body surface area and burn depth mainly being deep partial-thickness. Fifty-two (94.5%) patients had complications, with heart injury being the most common complication (44 cases, 80.0%). Twenty-two (40.0%) patients had 11 combined injuries, and traumatic brain injury was the most common combined injury. Seventeen (30.9%) patients had 11 underlying diseases or physiological processes before injury. The length of hospital stay of patients was 9 (5, 17) d. Among the 55 patients, 14 cases were cured and discharged, 40 cases were improved, and 1 case died, with effective rate of treatment of 98.2%. Compared with those in non-heart injury group, the proportion of complication occurrence (χ2=12.28), the proportion of trunk burns (χ2=5.15), and the average altitude of location of injury (Z=-2.38) of patients in heart injury group were increased significantly (P<0.05), while there were no significant changes in the other indicators (P>0.05). Multivariate logistic regression analysis showed that the average altitude at the location of injury was the independent risk factor for heart injury in patients with lightning injury (with odds ratio of 3.28, 95% confidence interval of 1.35-7.99, P<0.05). Conclusions: Lightning injuries on plateau in Tibet Autonomous Region mainly occur from May to September, with an average altitude of 4 500 m at the location of injury. Patients with lightning injury are injured when participating outdoor activities, and the affected patients are mainly mainly young male Tibetans. Most of the injuries are mild burns. Lightning injuries are complex and have many complications, with heart injury being the most common one. The average altitude at the location of injury is the independent risk factor for heart injury in patients with lightning injury.

Retinal detachment following lightning injury mimicking acute retinal necrosis: A case report

A 16-year-old male presented with a diminution of vision after 1 month of lightning injury. Fundus examination showed inferior retinal detachment with multiple sieve-like breaks. After pars plana vitrectomy, he developed mutton fat keratic precipitates and anterior segment inflammation. Sieve-like breaks and mutton-fat keratic precipitates (MF-KPs) led to the diagnostic dilemma of viral etiology. The patient responded well to treatment with steroids and antivirals, showing good visual recovery after silicone oil removal. Lightning strike injury–related retinal detachment can rarely mimic an acute retinal necrosis (ARN)-related retinal detachment (RD).

Major Burns After Lightning Strikes at Field: Case Report

Lightning injuries can cause multi-organ damage such as burns, ear damage, and nervous system damage. The type of Burns in this trauma consists of linear or flash burns, punctate burns, thermal injuries, Lichtenburg figures, and combination wounds which are generally superficial and heal faster. Lightning strikes also cause ear damage in the form of perforation of the tympanic membrane, bleeding, and micro fractures in the cochlea. The sequelae in lightning injury survivors consist of permanent brain injury, chronic pain syndrome, peripheral neuropathy, and blindness. This case is a man, 20 years old, working as a farmer, referred to the hospital because he was struck by lightning while working in the middle of the rice fields during heavy rain. There were complaints of pain, heat throughout the body, and decreased hearing in both ears in the anamnesis. Physical examination showed a general condition within normal limits. Local status examination found burns as large as 31.5% of the body area, with 2a degree burns (partial thickness) on the chest, back, upper and lower limbs. Examination of the outer and middle ear revealed no abnormalities. The principle of the treatment refers to the electric burns treatment with initial therapy in fluid resuscitation, evaluation of ECG, adequate analgesia, and wound care. The advanced phase of the treatment focuses on treating the burns and evaluating the hearing loss. Adequate care for nine days showed that the wound was epithelialized by 60% of the total wound area and without any other complaints. This case is essential to be studied considering that Indonesia's natural conditions allow for lightning strikes, especially during the rainy season, so lightning is a threat to farmers as a part of the agro-industrial community.&#x0D; Keywords: Lightning injuries, burns, agroindustrial

Defining lightning-safe structures for all socio-economic communities

Four levels of lightning-safe structures are defined based on the protection expected from various lightning injury mechanisms under thunderstorm conditions. This work, therefore, provides clarification for the long-standing issue of determining the most suitable recommendation for lightning safety in various socio-economic layers of society, especially in underprivileged communities. These globally uniform and consistent guidelines will help standard development committees, lightning safety seekers and donors of protection systems, state policy developers on disaster management, the insurance sector and industries that provide lightning protection, in determining the most appropriate lightning safety measures for a given target, based on the safety requirements, societal behaviour and affordability. Significance: Lightning safety module developers could confidently adopt the definition of safe structures provided here in their guidelines. The ambiguity on both indigenous and commercial lightning safe structures (purpose made) is cleared. Standards could specify the essential features of a structure that can be considered lightning safe.

Two Cases of Lightning Injuries That Were Injured at the Same Time

Two Cases of Lightning Injuries That Were Injured at the Same Time

İSTANBUL’DA 2007-2012 YILLARI ARASINDA YILDIRIM ÇARPMASINA BAĞLI ÖLÜMLER

Objective: Lightning injuries can cause a variety of injuries including “integumentary system, cardiac system, central nervous system, eyes and ears, and blunt trauma”, in which some of them may cause death. In this study, it was aimed to evaluate crime scene findings, autopsy findings and histopathological findings by presenting 9 cases that died due to lightning strike. Material and Methods: The 9 cases (0.3%) included this study were obtained from the screening of a total 24.755 cases that were performed autopsy at the Council of Forensic Medicine, Istanbul between 2007 – 2012. All cases’ age, gender, crime scene, circumstances during the event, witness statement, skin lession, autopsy findings, histopathological findings were evaluated. Results: Three (33.3%) cases were female and six (66.7%)cases were male, and the mean age was 39,66±13,36 (min:18, max:56). Fatal lightning strike occurred between April and September, but mostly in May. At autopsy, an external examination was revealed an electrical exit wound in 4 cases, burn areas on the skin in 5 cases, a Lichtenberg figure on the skin in 2 cases, and a burn in the hair surface in 4 cases. Conclusion: As a result, nonspecific findings are frequently detected in autopsies performed due to lightning strikes. However, crime scene investigation and the testimony of the witness may be the crucial indicative evidence for forensic investigators in getting an accurate diagnosis in cases of suspected lightning strikes. In addition, examining the clothes worn by victims provides important clues in diagnosis.

Retrospective study of lightning fatalities in Raigarh, Chhattisgarh

is a massive electrostatic discharge caused by the circulation of warm moisture-filled air through unbalanced electric field in the atmosphere, accompanied by the loud sound of thunder.: The present study was conducted to ascertain the pattern of lightning cases along with distribution of cases based on age, sex, season, location, activity of the victim and injury pattern in the corpse.: The present cross sectional retrospective study was carried out in the department of Forensic Medicine at Govt. Medical College, Raigarh, CG. All autopsy cases of lightning deaths from 2018 to 2019 (two years) were considered for the study.: Most of the deceased were in the age group of 31-40 years. All incidents happened in open field. High incidence of lightning deaths occurred during monsoon season and peak incidence in evening hours. In most cases arborescent mark was found as pathognomonic finding.: Lightning incidents are always accidental in nature. They are fatal and need prompt resuscitative measures. Lightning injuries have bizarre presentation in the body, therefore the autopsy surgeon needs meticulous and detailed methodical approach during autopsy.

Lightning injuries of the posterior segment of the eye

Lightning causes serious injuries and deaths worldwide every year. Ophthalmic injuries due to lightning are due to direct or indirect transmission of electric current, resistance-induced heat, and heat-induced shock wave. PubMed search of articles related to posterior segment injuries caused by lightning using keywords (lightning injury, ophthalmic manifestations, ocular injuries, and posterior segment) was conducted, and 19 case reports in 17 articles including 29 eyes with lightning injury to the posterior segment of the eye from 1984 to 2019 were reviewed. The majority of case reports (n = 10, 53%) were from North America. Eleven patients (58%) were in the age group of 10–30 years. Most patients (n = 10, 53%) had bilateral injury. The macula was the most common site of involvement with retinal pigment epithelial changes (n = 14, 48%) being the most common manifestation. A variety of other retinal, vitreous, and electrophysiological abnormalities have also been reported. We conclude that although lightning injuries are usually mild injuries, with vision remaining, either stable or showing some improvement in the majority of cases, severe visual loss due to optic atrophy and maculopathy may occur in long term.

Keraunoparalysis and burning thatch: A proposed explanation for severe lightning injuries reported in developing countries

It is well known that lightning strikes produce direct and indirect consequences in power utilities and systems, which have been addressed by implementing lightning protection systems. However, dealing with the effects of lightning on people is different due to the complexity of the human body and the multiple mechanisms by which a person can be injured by lightning. While lightning injuries in developed countries seldom show significant burns, those killed by lightning in developing countries are often characterized as ‘charred’ or ‘burned beyond recognition’. Keraunoparalysis, an immediate but temporary paralysis of one or more limbs after lightning injury, occurs in many victims and may be the reason that even healthy individuals cannot escape from burning thatched buildings, explaining these descriptions in news reports. Keraunoparalysis and burning thatch make a deadly recipe.

Lightning Fatalities and Injuries in Nepal

AbstractLightning is one of the most devastating hazards in Nepal because of a large amount of atmospheric water vapor coming from the Indian Ocean and a large orographic lifting of this moist air. In 2019, a total of 2884 people were affected, with loss of USD 110,982, and the fatality number was the highest (94) in reported lightning events since 1971. The long-term analysis of this hazard is very scanty in Nepal. Therefore, this study analyzes lightning fatality events, fatality rates, and economic loss from 1971 to 2019 collected from the DesInventar dataset and the Disaster Risk Reduction portal of the government of Nepal using Statistical Package for Social Sciences (SPSS) and geographic information system (ArcGIS) tools. The analysis shows that the overall countrywide lightning fatality rate of the entire period is 1.77 per million per year. District lightning fatality rates range from 0.10 to 4.83 per million people per year, and the Bhaktapur district has the highest fatality density (0.067). Furthermore, there were a total of 2501 lightning fatality events in which 1927 people lost their lives and 20 569 people were affected. The increase in lightning fatality events in recent years is due to internet penetration and other measures of information gathering that result in lightning fatality reports reaching agencies collecting information. The high and low concentrations of loss and damage are mainly due to geographic distribution, population density, and economic activities. This study recommends the establishment of lightning early warning systems in the Nepal Himalayas to save life and property.

Bilateral lightning injury of the eye: case report and review of the literature

Bilateral lightning injury of the eye: case report and review of the literature

Lightning Injury Caused by a Side Flash

A 29-year-old male soldier, who was taking part in a military field training exercise during summer, lost consciousness and fell backwards while sheltering at the foot of a tree that was struck by lightning during a thunderstorm. Upon arrival, his vital signs were stable. He had a linear burn at the right brachium with headache. Electrocardiography, cardiac ultrasound and whole body computed tomography revealed no specific findings. Blood biochemistry revealed rhabdomyolysis. The post-admission course was uneventful. This is a rare report of a patient who received a side flash from a tree during a lightning strike. Service members who routinely train and work outdoors should be vigilant in relation to the dangers of lightning.

Lightning Maculopathy: A Case Report

Lightning induced maculopathy is a very rare condition and there are barely any published reports on lightning induced maculopathy in our country. Here we present a case of twenty three years female who presented with lightning induced burns on the neck, chest and abdomen. She had unconsciousness for 3 days after lightening injury for which she was treated in intensive care unit. She presented with complain of diminution of vision in both eyes after 2 weeks. Optical Coherence tomography revealed cystic changes in fovea in right eye and a macular hole in left eye. Lightning injury is a life threatening condition. Lightning maculopathy should always be ruled out which can be best detected on optical coherence tomography.&#x0D; Keywords: foveal cyst; lightning injury; maculopathy; optical coherence tomography.

Lightning and Electrical Injury

There are multiple types of electrical injuries, which vary according to the type of electricity (alternating current or direct current) and the mechanism of contact. Electrical injuries caused by contact with alternating current are more commonly encountered in the household setting, while direct current is found in industrial accidents. Lightning injuries are rare in the United States but are much more common in developing countries due to a lack of access to infrastructure and more agrarian economies. This review includes an overview, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for each of these types of injury. This review contains 2 figures, 18 tables, and 68 references. Keywords: Lightning, electrical injury, burn, voltage, alternating current, direct current, conducted electrical weapon, TASER, arrhythmia, cardiac arrest, myonecrosis, rhabdomyolysis

Characteristics of a multi-stroke “bolt from the blue” lightning-type that caused a fatal disaster

Observational data from the low-frequency electric-field detection array (LFEDA) and radar were used to study the precise location of a fatal accident caused by a lightning in Conghua, Guangzhou, China, 2017. Based on a comprehensive analysis, the lightning was concluded to be a negative “bolt from the blue” ground flash with seven return strokes. The first return stroke was on June 3 at 16:36:49.219 with a peak current intensity of −30.9 kA. The LFEDA system mapped the development of the lightning channel. The horizontal distance from the edge of the cloud anvil area (0 dBz) to the return stroke point was about 0.3 km, the horizontal distance from the edge of the precipitation area (18 dBz) to the return stroke point was about 1.8 km, and the return stroke channel extended as far as 3 km out of the cloud. There was no cloud cover above the head of the victim. The electric field waveform of the return strokes detected by the LFEDA system showed multi-peak characteristics, and all seven return strokes were multiple-termination strokes. The most probable mechanism for the lightning injuries was the side flash.

Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018.Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas.Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue.Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents.Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings.Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.