Lightning/Lightning Strike Injury
Patient Safety Considerations
- Recognize that repeat strike is a risk. Patient and rescuer safety is paramount
- Victims do not carry or discharge a current, so the patient is safe to touch and treat
Notes/Educational Pearls
Key Considerations
- Lightning strike cardiopulmonary arrest patients have a high rate of successful resuscitation, if initiated early, in contrast to general cardiac arrest statistics
- There may be multiple victims
- If multiple victims, cardiac arrest patients whose injury was witnessed or thought to be recent should be treated first and aggressively (reverse from traditional triage practices)
- Patients suffering cardiac arrest from lightning strike initially suffer a combined cardiac and respiratory arrest
- Return of spontaneous circulation may precede resolution of respiratory arrest
- Patients may be successfully resuscitated if provided proper cardiac and respiratory support, highlighting the value of “reverse triage”
- It may not be immediately apparent that the patient is a lightning strike victim
- Injury pattern and secondary physical exam findings may be key in identifying patient as a victim of lightning strike
- Lightning strike is a result of very high voltage, very short duration DC current exposure
Pertinent Assessment Findings
- Presence of thermal or non-thermal burns
- Evidence of trauma
- Evidence of focal neurologic deficits
Quality Improvement
Associated NEMSIS Protocol(s) (eProtocol.01)
- 9914209 – Injury-Lightning/Lightning Strike
Key Documentation Elements
- Initial airway status
- Initial cardiac rhythm
- Neurologic exam (initial and repeat)
- Associated/secondary injuries
- Pain scale documentation/pain management
Performance Measures
- Cardiopulmonary issues addressed early and documented appropriately
- Patient transported to closest appropriate facility
- Pain scale documented and treated per guidelines (when appropriate)
- EMS Compass® Measures (for additional information, see http://www.emscompass.org)
- Trauma-01: Pain assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
- Trauma-02: Pain re-assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
- Trauma-04: Trauma patients transported to trauma center. Trauma patients meeting Step 1 or 2* or 3** of the CDC Guidelines for Field Triage of Injured Patients are transported to a trauma center
- * Any value documented in NEMSIS eInjury.03 – Trauma Center Criteria
- ** 8 of 14 values under eInjury.04 – Vehicular, Pedestrian, or Other Injury Risk Factor match Step 3, the remaining 6 value options match Step 4
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