A direct lightning strike will almost always cause significant medical trauma, and all victims should be given professional medical care without delay. Eighty percent of lightning strike victims survive. But twenty five percent of survivors suffer major after-effects.

5 basic ways in which a person can be injured by a lightning strike:

• Direct strike - either the victim or an object they are holding is struck directly by the bolt (i.e., umbrella, golf clubs, camera tripod, etc.).
• Side Flash - this occurs when the bolt strikes a nearby object and jumps to the victim (i.e., victim is hiding under a tree or standing outside next to a car).
• Ground current - lightning strikes the ground and spreads to the nearby victim.
• Secondary Burns - may occur from jewelry or clothing that is melted or set afire by a bolt.
• Secondary Trauma - blunt injuries or other trauma may occur from the shockwave produced by the lightning bolt or from falls produced by the strike.

• Respiratory and Cardiovascular - Cardiopulmonary arrest is the number one cause of death following a lightning strike. After a strike, ECG irregularities are common but many quickly resolve. Even after the heart has resumed beating it is not unusual for the victim to remain in respiratory arrest. A survivor may have pulseless, cold and mottled extremities. Generally this condition resolves within several hours. Other CV effects include chest pain, myocardial infarction and arrhythmias.
• Ophthalmic and Otologic - Approximately 50% of all lightning strike victims suffer some type of eye damage, usually a corneal injury; however, days to years after a strike many victims develop cataracts. Funduscopic changes associated with lightning strikes include blindness, retinal bleeding and/or detachment, optic nerve degeneration, vitreous hemorrhage, and/or hyphema. It is not uncommon for these patients to have transient pupillary changes even in the absence of a head injury. Additionally up to 50% of victims suffer ruptured tympanic membranes. Even if the TM remains intact they still may suffer from varying degrees of transient and/or permanent hearing loss as well as tinnitus.
• Musculoskeletal - potential injuries include contusions, fractures, muscle and ligament tears, and, rarely, compartment syndrome.
• Central and Peripheral Nervous Systems - Transient paralysis, amnesia and/or confusion are not uncommon. With direct strikes, coagulation of the brain, subdural hematomas, intracerebral hemorrhage are possible. Cerebral oedema is another possibility. Wide scale brain injury may be due directly to the electrical injury or to a prolonged apneic period following the strike. Long-term complications following a strike may include amnesia, dementia, alteration to reflexes, movement and gait disturbances, paraplegia and parathesias. Psychologically the victim may suffer from depression, anxiety, memory deficits and/or posttraumatic stress disorder (PTSD.)
• Dermatologic - Most lightning strike victims suffer superficial, partial or full thickness electrical burns. Occasionally victims will develop a skin discoloration that looks like a red brown feathery skin patch. This is an inflammatory reaction and generally disappears in a couple of days.

Click here for immediate first aid measures to be taken in the event of a lightning strike.

Professional medical and paramedical emergency treatment generally focuses on cardiac resuscitation and the management of cardiac arrythmias. All patients in arrest should undergo resuscitation. Statistically lightning strike victims requiring CPR have a higher than normal survival rate when compared to in-hospital cardiac arrest victims. All lightning strike victims should receive:

• Cardiac monitoring
• Two large bore IV's (normal saline or lactated ringers)
• High flow oxygen and possibly intubation and manual ventilation.
• Complete C-spine immobilization until radiographically cleared
• Laboratory assessment - baseline CBC, electrolytes, urinalysis, CPK and creatinine
• Urinary catheterization (to monitor urine output and for the presence of myoglobinuria.
• Nasogastric tube - to prevent ileus or gastric dilatation. Prompt and appropriate burn care and fluid replacement.

After-effects

Many of the aftereffects of lightning are difficult for inexperienced medical professionals to characterize. Sometimes lightning victims' symptoms are dismissed as "fakery, whining, and imagination" by responsible agencies. Sometimes valid claims for workers compensation or other insurance are denied in error.

This material was originally written for IfYouGolf.com. Background information from the US National Lightning Safety Institute (NLSI), www.lightningsafety.com