Medical Aspects of Lightning
How Big A Problem Is This? Statistics
Lightning is a major cause of storm related
deaths in the
U.S., out pacing hurricanes and tornados in most years.
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 62 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. Population - 300,000,000
ODDS OF BECOMING A LIGHTNING
VICTIM |
U.S. 2000 Census population as of 2008 |
300,000,000 |
Number of Deaths Actually Reported |
60 |
Number of Injuries Reported |
340 |
400 |
Estimated number of actual U.S. Deaths |
60 |
Estimated number of actual Injuries |
540 |
600 |
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.
Fatigue
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,
info@lightning-strike.org,
or see their Website at http://www.lightning-strike.org/,
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.
Prevention
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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