# Why is a lightening strike so dangerous??



## AVPU (Mar 28, 2010)

I know it can screw up your cardio system and electrical currents, but how? Can it seriously harm you if you have no prior heart condition??

This came up in a BLS class I taught a couple weeks ago. My co-instructor, who's an electrician, answered that lightening doesn't have the amps, just the voltage (or maybe it's the other way around...). My husband (who's a cop) said it's the same reason why taser guns don't have do any lasting damage. Are they the same thing? And if so, why wouldn't tasers hurt you but lightening would? I know lightening kills, I've read about CAs and ground charges and all that. I'm confused!


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## JPINFV (Mar 28, 2010)

This might help. http://www.uic.edu/labs/lightninginjury/treatment.html


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## AVPU (Mar 28, 2010)

Thanks, I'll check it out. And I can't believe I spelled 'lightning' with an E. Who does that??


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## Foxbat (Mar 28, 2010)

AVPU said:


> I know it can screw up your cardio system and electrical currents, but how? Can it seriously harm you if you have no prior heart condition??


Yes, and it can kill you. I don't know the pathopysiology of it, I guess it somehow messes with your heart's conducting pathways.


> This came up in a BLS class I taught a couple weeks ago. My co-instructor, who's an electrician, answered that lightening doesn't have the amps, just the voltage (or maybe it's the other way around...).


Your instructor is wrong. Current and voltage in the lightning itself are very large. We're talking the orders of kilovolts and kiloamperes.
As far as the current in the body of the victim, it can vary significantly depending on body resistance (wet vs dry skin, etc), whether the lightning strikes the body directly or it strikes some object near it, etc.
And it can cause severe burns too.

One interesting thing about lightning strikes is that in the case of mass casualty incident you use reverse triage, i.e. you treat those in cardiac arrest first. With quick defibrillation, you have a pretty good chance of saving them.


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## AVPU (Mar 28, 2010)

Yeah, I read that too, about reverse triage. I missed a question on a JB practice test, nad it was in the explanation. Interesting. I've also read that contrary to popular belief, lightning can and will strike the same place twice.


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## joeshmoe (Mar 28, 2010)

Lightning has both massive voltage, like millions of volts, and massive amperage, like thousands of amps if I remember. 

The question for me is how the hell does anyone survive a lightning strike. I suspect the reason people dont suffer more damage is the length of time the current is passing through you. 

With a lightning strike its a fraction of a second, where as if you grab a live wire the current(amps) may travel through you for several seconds or longer, creating more extensive burn injuries and tissue damage. This may or may not be the reason, this is just my educated guess. The actual reasons may be more complicated.

I also think in many lightening strikes the actual bolt doesnt pass through the victim, but rather near them, so they arent taking the full brunt. Again this is me spitballing.

I think a taser on the other hand has a high amount of voltage but not much current, although still enough to do more than tickle you.


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## mycrofft (Mar 29, 2010)

*If it can blow up a tree, and it can, then it can hurt you.*

Also, many bolts don't just lance neatly into one spot in the ground. Truth is, sometimes the bolt moves up and down between the cloud and the ground...and more often it is between clouds and never grounds at all.

Some folks have been stricken more than once. PASS!


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## Melclin (Mar 29, 2010)

The idea of reverse triage seems a ridiculous blanket rule to apply considering that arrests could just as easily be from the extensive damage done by the strike rather than simply an upset electrical conduction system. 

Consider the following:

You turn up to a lightening strike which has mysteriously affected more than one person (how I'm not sure, I haven't figured that out). You find one person to be in cardiac arrest, two people with extensive burns to their arms but they are alert and screaming in pain, and the final person has burns to the face, a reduced level of consciousness and has coughed up some carbonaceous sputum. Reverse triage would have you treat the person in cardiac arrest yes?

This seems absurd to me. Firstly, in all likelihood the person has extensive internal injuries from the strike, and even if he didn't, given your response time of how ever many minutes is probably stuffed anyway. There are two people in excruciating pain and one person who is not to far away from losing his airway, that you are ignoring for a lost cause.



A quick google search has found this reverse triage to be supported in the literature by expert opinion only.

EDIT: My point is that, I get the basic idea, and I agree with the possibility that a situation might arise in which it was the best thing to do, but, like the trauma 'golden hour', its a silly blanket rule that I think is/will be applied to literally.


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## usafmedic45 (Mar 29, 2010)

> Yes, and it can kill you. I don't know the pathopysiology of it, I guess it somehow messes with your heart's conducting pathways.



It's a "cosmic cardioversion", in other words it (in severe cases) does to your heart roughly the same thing as a defibrillation shock would do.  Strikes to the head can also cause intracranial hemorrhage such as subdural hemorrhage, etc. 



> The question for me is how the hell does anyone survive a lightning strike.



Actually it's a ridiculously low mortality rate with most educated guesses placing it between 5-10%.  I did research (my first research project actually) with the physician whose site was linked earlier on the accuracy of the reporting of lightning strikes in Florida.  Believe it or not there is a serious problem in tracking lightning morbidity and mortality because of two major issues and a few minor ones:
1.  Cause of death on the death certificate may not be listed as "lightning strike" especially in cases where the patient dies days or even months after the event.
2.  Some people after being struck do not seek medical attention immediately.  Yes, you read that right.  Some surveys of self-reported survivors indicate that people do not go to the ER or call 911 after being struck and only seek medical attention after the begin to develop non-emergent symptoms (loss of hearing, balance problems, etc)

These two reasons are why- and I am not kidding about this- the National Weather Service uses media reports to track lightning strikes to people both fatal and non-fatal. 

As to why most people survive, keep in mind that not all strikes are "direct hits". Even those that are electricity, being what it is, follows the path of least resistance to the ground and that can be along the surface of the skin (not significantly affecting the heart or brain, at least in an acute sense).  This surface passage of the electricity is responsible for one of the classic signs of lightning strike which is a fern-like burn pattern called a Lichtenberg figure.  They are strangely beautiful and you should look them up.   

For the non direct hits, obviously the voltage is much reduced and the chances of survival are far better although this is the scenario through which you wind up with the mass casualty scenario that Melclin seems to have such a problem with.



> Firstly, in all likelihood the person has extensive internal injuries from the strike, and even if he didn't, given your response time of how ever many minutes is probably stuffed anyway. There are two people in excruciating pain and one person who is not to far away from losing his airway, that you are ignoring for a lost cause.



Ever seen the autopsy of a lightning strike victim?  I've seen two of them and have the reports and photos of another 40 or so.  Contrary to your contention, the "massive internal damage" is simply not there and the chances of recovery from electrically induced cardiac arrest are among some of the highest you're going to find.  This is in due to a combination of factors: people struck are usually healthy (often athletes), bystander CPR rates are quite high and AEDs are available on-site for many athletic events.  Can you point me to a case where a person has produced carbonaceous sputum after a lightning strike? Your inclusion of that in your scenario is yet another example of how little you understand about keraunopathology.  Carbonaceous sputum is a sign of the inhalation of the solid products of combustion and not internal burns or any of the other myths you may believe and repeat about lightning.   Actually you might be well served to read up on the mechanisms of inhalation injury while you are at it.  I'll forward you a couple of review articles if you're interested.


Do you understand now why "reverse triage" is recommended?  Pain is a secondary concern and the "about to lose their airway" scenario is very uncommon in lightning pathology.  The vast majority of mass casualties cases- rare as they are (hence why it's "expert opinion" guiding care, like so many other things in EMS including general cardiac arrest resuscitation itself for the most part)- have two distinct groups: Walking wounded and the apparently dead.  The "apparently dead" are simply the red tags in this scenario and the walking wounded like any other triage situation have to wait.   




> but, like the trauma 'golden hour', its a silly blanket rule that I think is/will be applied to literally.


But yet, I suppose we are supposed to broadly apply the rationalizations of a paramedic student over those of MDs and other health professionals who have looked at the survival rates of persons suffering cardiac arrest after lightning strike and found them to be very high and the mortality of those who initially survive to be complaining of pain, etc to be very low?   Actually I only know of one case where someone "talked and died" after a lightning strike and that person died of a closed head injury (including a skull fracture) after falling off a roof secondary to being struck.  Please do not spout off things that are going to hinder the delivery of appropriate and timely medical care to the only critical patients on the scene of a lightning strike.  If you only realized how much of what we do in EMS  has far less science underpinning it than what you're badmouthing here, you'd probably be quite surprised.


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## Melclin (Mar 29, 2010)

usafmedic45 said:


> For the non direct hits, obviously the voltage is much reduced and the chances of survival are far better although this is the scenario through which you wind up with the mass casualty scenario that Melclin seems to have such a problem with.
> 
> 
> 
> ...



Language like "*seems* a ridiculous *blanket rule*" and "This *seems* absurd to me" + I thought my edit cleared my position up.

I clarify in the context of you post:

1. I thought it was a silly blanket rule to say, if lightning strike --> reverse the triage order which is what I took reverse triage to mean. If for no other reason than I hate blanket rules. 

2. I presented a scenario which illustrated why it _seemed_ that way to me and yes it was an obviously flawed scenario, I didn't give the specifics a moments thought because I was looking for quick way to illustrate the idea in my head which was a concern that "could survive with intervention, but will die without" patient would die while "lost cause" pt got worked on. I see now that my concern was misplaced given the prevalence of severe internal injuries because I mistakenly generalized my understanding of high voltage burns to lightning burns and you are right to point out my mistake. 

3. I used terms like "seems" because I didn't _know_, I just mentioned the reasons it bothered me...putting it out there for someone to comment on. I wasn't writing a new guideline for practice and I don't I have to know everything about the topic to mention that it bothers me because the point of a conversation like this is voice our opinions, knowledge and wisdom; compare and contrast; and then hopefully come out the other side with the people who were mistaken (me), knowing a little more than they did. That's why I'm confused by your indignant response to my posting my initial reaction to reverse triage, despite not fully understand the evidence base for it.    

4. Given the facts about lightning injuries that you presented albeit somewhat condescendingly, the kinds of injuries that I thought might happen seem very unlikely and the idea of reverse triage makes more sense to me, so thank you.


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## mycrofft (Mar 29, 2010)

*The phenomenon of lightning is hard to generalize, too slippery.*

But I agree, electric shock is the most likely origin to yield reversible clinical death. I suspect our waterlogged clothing and wet skin with lots of nice electrolytes (sweat) offers an easier avenue for the juice to follow, like the guy who used to blow himself up with dynamite in a barrel at the fair...energy will follow the easiest route. 

I strongly believe many so-called lightning strike victims are near-misses.

Instances have been documented with multiple casualties, usually when they crowd up in a cave or other shelter. More heat effects were reported also (melted metal stuff like zippers, charred clothing).

Oh, on my earlier comment: we don't blow up because we don't have bark. Tree bark will explode off a stricken tree...and tree strikes also yield enough damage to leave permanent scars. I do not know if these are due to electrolysis of the phloem, heat damage, or both. Sincew trees don't sweat, maybe their sap is the best conductor.

Oh, and some other "knowledge" about lightning:
1. If it is so likely to strike you in water, how come after a thunderstorm the lake isn't covered with floating or dead fish? Might be safer to get out of your bolat and swim to shore. I was a boat hand and lifeguard for a summer in the San Berdoo mts and despite  multiple days ending in lightning, I never saw it strike the lake. I was very aware because I was the last one off, shooling in the toorists.
2. If it is most likely to strike the tallest tree, how come the tallest tree is still there after decades of storms?

http://www.emtlife.com/showthread.php?t=12941&highlight=lightning+stories


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## usafmedic45 (Mar 29, 2010)

> Given the facts about lightning injuries that you presented albeit somewhat condescendingly



Sorry...didn't mean to be condescending. I just have heard the same thing about mass casualty lightning strikes from others and it is kind of a pet peeve of mine.


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## Melclin (Mar 29, 2010)

usafmedic45 said:


> Sorry...didn't mean to be condescending. I just have heard the same thing about mass casualty lightning strikes from others and it is kind of a pet peeve of mine.



Yeah I can see that, sorry for stepping on you toes. I should have been more careful with my language; I am prone to hyperbole, and it was a stupid post post on my part :wacko: . 

Anyway, very enlightening thread none the less. I'll be interested to see if it comes up in my mass casualty subject next semester.


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## AVPU (Mar 30, 2010)

*There's some good knowledge out there*

Thank you all for such good and fact-filled responses. I love this forum. Very 'enlightning'....get it??!!


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## Owenscott (Apr 4, 2010)

I have not seen this answer in above text ... direct lightning strike where the bolt passes thru the pt, lets say head to toe, will cause the electrical signals in the heart to be messed up. If electricty passes between two fingers and the heart isn't in the "loop" cardiac usually wont be an issue.

 The other thing with lightning is with great amps comes great power to overcome the resistance in our bodies ... i believe causing great heat which then causes our cells to rupture by boiling. As above poster pointed to others he has studied these things and i have not .... just speaking generically.


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## Needles17 (Apr 4, 2010)

Well put.  I find it interesting that most people hit once are eventually hit again in their lifetime.


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## mycrofft (Apr 5, 2010)

*I sincerely doubt MOST folks struck once are stricken again.*

But if you are, you will make the news, documented or not.


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## MRE (Apr 5, 2010)

AVPU said:


> This came up in a BLS class I taught a couple weeks ago. My co-instructor, who's an electrician, answered that lightening doesn't have the amps, just the voltage (or maybe it's the other way around...).



To be honest, electricians generally don't know much about electricity.  They know about electrical code and installation.




Owenscott said:


> The other thing with lightning is with great amps comes great power to overcome the resistance in our bodies ... i believe causing great heat which then causes our cells to rupture by boiling. As above poster pointed to others he has studied these things and i have not .... just speaking generically.



Thats not quite true.  Very simply, Ohm's law says that Current is equal to Voltage divided by Resistance.  This means for a set resistance you need higher voltage to deliver higher current.

Where people get confused is in situations like the taser, which uses high voltage but does not end up flowing high current through a person.  What is happening there is that the entire path of current, either between surface contacts or through 40 ft of tiny wires to probes embedded in the skin, the resistance is very very high, and although you apply high voltage, the resulting current is high enough to cause involuntary muscle movement but not cardiac arrest (in most cases).  

The same goes for a 12V car battery.  With a low resistance path the battery can deliver several hundred amps, however it is safe to touch both terminals with dry skin because the even though the resistance it sees is the same as a taser with surface contacts, at only 12V the current that results is too small to feel.  Lick your fingers and touch the terminals and with the reduced resistance you will probably get enough current for a nice tingly feeling.


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## usafmedic45 (Apr 5, 2010)

> I find it interesting that most people hit once are eventually hit again in their lifetime.



Care to back that up with some credible evidence?  I'm pretty familiar with the statistics and have never heard that.


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## Scout (Apr 5, 2010)

usafmedic45 said:


> Care to back that up with some credible evidence?  I'm pretty familiar with the statistics and have never heard that.




I think it comes from if you get hit multiple times you have been hit once. But if you never get hit you wont be hit multiple times. Then just adapt that slightly.


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## KillTank (Apr 8, 2010)

AVPU said:


> I know it can screw up your cardio system and electrical currents, but how? Can it seriously harm you if you have no prior heart condition??
> 
> This came up in a BLS class I taught a couple weeks ago. My co-instructor, who's an electrician, answered that lightening doesn't have the amps, just the voltage (or maybe it's the other way around...). My husband (who's a cop) said it's the same reason why taser guns don't have do any lasting damage. Are they the same thing? And if so, why wouldn't tasers hurt you but lightening would? I know lightening kills, I've read about CAs and ground charges and all that. I'm confused!



Voltage does not kill, Amperage does.
T.A.S.E.R. has lots o volts but small amp
Lighting has both, its uncontrolled discharged electrical activtiy

here is a lesson in a electricity 101

Lets take a look at your amps, volts, and wire gauge. lets say the gauge of the wire is like a high way, the smaller the gauge the wider the freeway is. Volts is the amount of cars on the freeway and amps is the speed of the cars on the freeway. It does not matter how many cars are on the freeway if they are not going fast enough to cause harm to you. Do you see where I am getting at? You can get shocked by an electrical appliance in your house and most likely walk away with partial to full thickness burns depending on how hard you where chewing on the cord and if you where grounded properly  but if you where to ground yourself out and snag onto the power lines outside your house it could kill you.


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## Shishkabob (Apr 8, 2010)

KillTank said:


> Voltage does not kill, Amperage does.
> T.A.S.E.R. has lots o volts but small amp



Let me tell you, when being Tased, you don't give a darn about the voltage or amperage, you just wish it will stop h34r:


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## usafmedic45 (Apr 8, 2010)

+1 on that. I was a volunteer for a study on the effects of TASERs on the cardiac system.  For some reason, I was the only one to volunteer to be tased more than once.


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## LucidResq (Apr 8, 2010)

Linuss said:


> Let me tell you, when being Tased, you don't give a darn about the voltage or amperage, you just wish it will stop h34r:



Steve, your obsession with your taser experience makes me think otherwise. 

Lol... 

Sheriff's deputy shocked 30 students with Taser


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## eynonqrs (Apr 9, 2010)

It's not the voltage, it's the amperage that kills. All it takes is 1/10 of an amp to kill someone. It's all in the way it travels through the body. I was working on an old vacuum tube television, and I grabbed by accident the wire that went into the back of the picture tube. I got blown across the room. I am very lucky that the only thing that happened was a "code brown". AKA sh** one's pants. There was ample amperage there to send me into arrest.


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## firetender (Apr 9, 2010)

*Why is Lightning such a Nudge?*

You've heard the phrase, "Struck by lightning" and it's usually referring to a sudden burst of creative something. Consider this:

This guy named Paul, he was a Tax Collector. In fact, his job involved hounding what few Christians were left in the area because they were dwindling fast. About 100 years after the crucifixion, they had pretty much been hounded into the ground.

But one day, Paul, riding his horse on his way to collect tribute and cause a bit of mayhem along the way, was struck to the ground by lightning. When he arose, he literally had seen the light of Christ. Shortly after, he began preaching and, essentially became the PR man and hub for a Christianity that is practiced throughout the world over to this day.

A lot more of us would be eating Matzoh and Gefilte fish were it not for that lightning and Paul.


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## KillTank (Apr 9, 2010)

Linuss said:


> Let me tell you, when being Tased, you don't give a darn about the voltage or amperage, you just wish it will stop h34r:




I been Tased lol felt like someone kicked me in the *** really hard.


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## Tincanfireman (Apr 13, 2010)

AVPU said:


> Thanks, I'll check it out. And I can't believe I spelled 'lightning' with an E. Who does that??


 
Probably Al Gore...


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## usafmedic45 (Apr 16, 2010)

> I think it comes from if you get hit multiple times you have been hit once. But if you never get hit you wont be hit multiple times. Then just adapt that slightly.



But that does not explain the comment you actually made:



> I find it interesting that most people hit once are eventually hit again in their lifetime.


....in fact, to "adapt it slightly" is a logical absurdity since it is corrupting something that is correct into something that is patently false.  Most people who are struck once are, in fact, not struck again.  It's a myth that some people "attract" lightning strikes.  Sorry for the delay on this...I missed your response to my original comment about your misguided comment. 



> Probably Al Gore...



You mean Dan Quayle right?


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## Tincanfireman (Apr 16, 2010)

usafmedic45 said:


> You mean Dan Quayle right?


 
Just call me a dummee...  ^_^


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## usafmedic45 (Apr 16, 2010)

Tincanfireman said:


> Just call me a dummee...  ^_^


No worries....both were goofball vice presidents.  Honest enough mistake.


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## robbaN28 (Apr 21, 2010)

I can't stand lightning. 

http://en.wikipedia.org/wiki/Faraday_cage

That's why I'm in the car.


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## Robems (Apr 21, 2010)

Here is something funny i heard years ago just stick your butt in the air cause the fat will be like cushion for you. That don't sound very pleasant tho


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