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Lightning Strikes at Sea!

The conversations that we always have on course but never really pay much heed to because they are so uncommon. But how much do we really know about lightning strikes and the effect that they have on the human body? And would you know what to do to provide medical care for someone who was struck by lightning?

This super fascinating blog by Dr. James Jordan gives out a lot of very useful information and whilst these things are rare, it is always worth remembering that Worse Things Happen at Sea!!

What is the risk at sea?
 
According to US insurance statistics, roughly one in every thousand boats is damaged by lightning each year. In some areas, such as the Mediterranean and Caribbean, up to 10% of all maritime insurance claims relate to lightning strikes. 
 
Advice abounds on measures to protect against catastrophic damage from lightning. The effectiveness of various methods is still debated, but it is generally agreed that protection systems involving air terminals and grounded conduction pathways can reduce the risk to the fabric of the boat. No system, however, can reliably prevent boats from being struck in the first place, and whenever this occurs there is a significant risk to the health of the crew. 
 
Lightning can bypass taller structures like masts and strike crew members directly, or it can jump sideways from other parts of the boat. The current can travel along the deck or through metal and electrical equipment, and it can arc through the air from one charged object to another, passing through anybody unlucky enough to be in the way. 
 
General advice to crews caught out in lightning storms is to shelter down below and put on dry clothing. Commercial ships usually have effective lightning protection systems which reduce the risk of lightning passing through the cabins, but crew should still try to avoid touching metal structures or wired electrical items. If crew members have to go out on deck, they should try to stay away from tall structures if possible. Some sources suggest that wearing insulating boots and gloves can improve safety, and that wet foul weather clothing worn over a dry layer can protect the wearer by routing lightning around their body, but the evidence for these measures is not strong.  


How does lightning cause harm?
 
Lightning injuries are often compared to high-voltage electric shocks from mains electricity, but the effect of lightning is actually very different. In mains electrocution, electrical current passing through the body can heat the tissues, causing significant burns. Lightning strikes involve very high voltages but are also very brief, typically lasting only one-thousandth to one-tenth of a second, and much of the electrical current flows over the outside of the victim’s body. The tissue heating effect is relatively small so major internal burns are rare. Any moisture on the skin, however, may vapourise into steam, blowing victims’ clothes and shoes off and causing superficial burns. Metal jewellery may melt and become ‘tattooed’ into the skin. 
 
Rather than causing major burns, lightning strikes tend to inflict significant neurological injury. 70% of those struck by lightning are rendered unconscious, and damage often occurs to the central and peripheral nervous systems. Survivors may have a range of neurological symptoms immediately after being struck, a common example being ‘Keraunoparalysis’ in which the lower limbs are temporarily paralysed. Injury to the autonomic nervous system - the nerves responsible for controlling body functions like heart rate and blood pressure - may also wreak physiological havoc, altering blood flow or even stopping the heart.
 
Most deaths from lightning strike are due to sudden cardiac arrest. This can be triggered by autonomic dysfunction but in most cases is thought to be caused by direct electrical disruption of the heart muscle. 
 
Lightning victims may also suffer trauma from blast injuries or flying shrapnel. They can be thrown some distance by the strike, risking secondary trauma or being lost overboard.

How should we treat people who have been struck by lightning?

 

As in all emergency scenarios, the responder should first ask themselves whether it is safe to approach the patient. Lightning can strike the same place twice, especially on a ship at sea which is likely to be the most tempting target for some distance around. Lightning strikes generally occur during periods of high wind and rough seas, so it is important to have a plan for reaching the casualty and retrieving them to a place of safety without endangering the rescuers. Contrary to popular myth, lightning victims cannot become electrically charged and do not pose any direct risk to others.

 

If there are multiple casualties, rescuers should operate a ‘reverse triage’ system, also known as ‘treat the dead.’ The rationale is that those whose hearts do not immediately stop following a lightning strike are likely to survive, whereas victims in cardiac arrest may have good outcomes if they receive immediate CPR and rapid defibrillation. Rescuers should therefore focus first on resuscitating casualties who have no signs of life, treating them according to Basic or Advanced Life Support principles.

 

Once immediate resuscitation needs have been addressed the responder should perform a careful top-to-toe survey to identify and address any injuries, which may range from major trauma to subtle skin changes. Spasm of blood vessels is very common: limbs may become cold, pale or paralysed as the blood flow is reduced or cut off. Burns may be hidden in skin folds where sweat has evaporated, and pressure waves can injure lungs and rupture eardrums in victims who appear outwardly unharmed. 

 

Most cases of lightning injury will require urgent evacuation to hospital ashore. All lightning victims should have an ECG and consideration of a period of cardiac monitoring in hospital, and those who have lost consciousness or who have neurological changes will need a CT scan to rule out intracranial bleeding. 

What are the long-term outcomes?

 

Around 90% of people who have been struck by lightning survive, but three-quarters of survivors are left with permanent disability. Long-term neurological and psychiatric dysfunction can include paralysis, memory impairment, mood changes or fatigue. Damage to the eyes or optic nerves can cause blindness, and cataracts can form within days of being struck. Chronic pain due to nerve damage is unfortunately also common. 

 

To summarise, those whose hearts keep beating after a strike will probably survive, and those who initially appear dead may respond well to CPR and rapid defibrillation. Lightning victims may have burns or trauma that require immediate stabilisation on board, but even apparently well survivors will need to be evacuated to shore-based care for investigations and monitoring. Given the wide range of injuries and likely long-term harm suffered by lightning victims, by far the best way to manage lightning strikes at sea is to take early action to protect crew by encouraging them to shelter below deck. As the US National Weather Service says, “when thunder roars, go indoors!”



by Rachel Smith 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
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At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.
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You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!
by Rachel Smith 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.
by Rachel Smith 21 Feb, 2024
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by Rachel Smith 17 Jan, 2024
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by Rachel Smith 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!
by Rachel Smith 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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