There are still plenty of superstitions and misunderstandings in this area. For example, some people believe that when a person is struck by lightning, he or she retains an electrical charge and it is dangerous to touch them. This is not true.
Dr Chris Davis
New practice guidelines issued by the Wilderness Medical Society aim to reduce the risk of being killed or injured by lightning, and could result in more effective medical treatments following strikes. Lightning-related deaths in the United States have declined over the last 50 years to an annual figure of approximately 40. The new prevention and treatment strategies published in the September issue of the journal Wilderness & Environmental Medicine
, aim to further reduce this number.
A team of lightning experts from the United States employed an evidence-based approach to formulate the new guidelines. Scientists used the American College of Chest Physicians classification scheme to ensure the highest possible quality of their recommendations, which include taking shelter and avoiding bodies of water during electrical storms. In addition to prevention strategies, the team also recommended medical procedures to more effectively treat victims of lightning strikes.
Chris Davis, MD, Wilderness Fellow and Clinical Instructor at the University of Colorado Hospital’s Department of Emergency Medicine, is a member of the panel that formulated the new practice guidelines. I had the chance to question Dr Davis about what to do when lightning strikes…
Could you outline the evidence-based approach that you and your colleagues adopted whilst formulating the new practice guidelines?
We used a general grading guideline. When taking an evidence-based approach to a question or problem, you must obviously begin by gathering the available evidence. We tried to move beyond the usual libraries of data that are used in medically-related research and look into the meteorological literature as well.. Once we had gathered the relevant articles, we had to grade them. We used grading criteria that look at how well designed particular studies are and how comparable they are with other studies. When it comes to lightning, the majority of related articles are fairly weak. This is because, by its very nature, the evidence is retrospective. We cannot take two groups of people into the wilderness and try a prevention strategy with one group but withhold it from the other. We cannot send people to the top of a mountain, have them struck by lightning and then try to revive them. It’s just not ethical.
In light of this, our data is predominantly retrospective, making it weaker. On the flipside, most of the prevention and medical strategies that we are proposing pose little risk to strike victims. This is not the case with many of today’s medical interventions. Even though our data is weak, therefore, the negligible risk associated with our proposals enables us to strongly recommend these strategies.
Do you intend to look back at any point, to see whether or not your guidelines have had an impact upon those struck by lightning?
We will certainly revisit the recommendations in another eight to 10 years. I don’t think that we will be able to say with certainly whether or not our guidelines have been responsible for any patterns that we might identify. There will be too much other noise; too many demographic trends that could account for changes in either direction.
Could you outline some of the ways in which people can reduce their risk of being injured or killed by lightning?
Adopting the lightning position - This is a strategy of last resort as it is a difficult position to maintain for a long period of time
We need to educate people about prevention strategies and we must try to dispel some of the myths that surround lightning. There are still plenty of superstitions and misunderstandings in this area. For example, some people believe that when a person is struck by lightning, he or she retains an electrical charge and it is dangerous to touch them. This is not true. People should also be aware of the fact that both the leading and trailing edges of a storm are the most dangerous. These are where most of the electrical activity occurs. For this reason, we would encourage people to seek shelter as soon as possible, either in cars or in buildings with plumbing. Such structures mimic Faraday cages. The lightning is directed around
the building or car and gets absorbed by the earth. Even if a storm seems to be far away, seek shelter immediately. It is the edge of the storm that poses the greatest danger.
This may also be a myth, but then I have never before had the opportunity to speak with a lightning expert. Is it dangerous to take shelter under a tree during an electrical storm?
It depends. Choosing to take shelter under the tallest tree is a potentially dangerous decision. On the other hand, it might be a reasonable strategy to take shelter in a copse where the trees of similar heights. You might even want to choose a tree that is shorter than the others.
How can the medical procedures employed to treat the victims of lightning strikes be improved?
I would offer two responses to that question. Firstly, laypeople and lay-rescuers must realise that most lightning-related deaths are the result of cardiac arrests. Victims simply stop breathing. If you target somebody’s breathing immediately after a lightning strike, you will probably be able to effect a change in mortality. In our paper, we discuss the concept of ‘reverse triage’. If several people are struck by lightning and you are the only person available to treat them, it is best to concentrate on those who appear to be dead. Whilst it might be tempting to focus your attentions on the ones showing signs of life, if somebody survives the initial strike, they are likely to survive no matter what. It is rare for victims to die later in the hospital. It is therefore important to try to support those who are struggling to breathe. You need to give the heart a chance to restart.
Secondly, it is important for us to appreciate that significant disability – both neurological and psychological – can result from a lightning strike. A universal support process for those struck by lightning would facilitate the gathering of raw data, and would improve follow-up treatment for such patients. Does cognitive behavioural therapy (CBT) combat the long-term depression and post-traumatic stress that can result from a lightning strike? At present, we just don’t have a way of teasing out what works and what doesn’t in terms of treating long-term, lightning-related disability.
Click here to view the full paper: Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries