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.