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Lightning Injuries Treatment & Management

  • Author: Mary Ann Cooper, MD; Chief Editor: Joe Alcock, MD, MS  more...
Updated: Jun 06, 2016

Approach Considerations

Do not assume that lightning injuries are like high-voltage injuries or treat them as such in the absence of deep burns. Only the rare lightning patient requires aggressive fluid resuscitation, alkalinization of the urine, or transfer to a burn unit.

Anecdotal reports of survival with prolonged CPR started in the field have been received, but the overall prognosis remains extremely poor in these situations.[106] If resuscitation is successful, rare cases of reasonable recovery have been reported but only after extensive critical and rehabilitative care.

Resuscitation dosages and administration schedules for cardiac medications are the same as for persons with cardiac arrest from other causes. Initial treatment should begin with assessment and stabilization of the airway, breathing, and circulation. Persons who have been struck by lightning should be treated as trauma patients, with close attention to spinal immobilization. If lightning causes asystole, a sinus rhythm may be spontaneously reestablished in some cases. Respiratory support should be provided if the patient's efforts are inadequate to prevent deterioration to cardiac arrest or ventricular fibrillation. Automated external defibrillators (AEDs) have been reported to be used successfully in several cases.[107]

Emergency department care

Routine care should be performed for any complications such as seizures, chest pain, and other symptoms. Reasonable reassurance and referral for continuing problems/sequelae is indicated. The vast majority of lightning survivors do not need to be admitted.

Referral to a support group (eg, Lightning Strike and Electric Shock Survivors International) can be made. Much more information is available on the Internet about lightning injuries than in the past.

Surgical therapy

No surgical therapy is indicated initially in cases of lightning injuries. Rarely, persons with severe lightning injuries may require fasciotomies for extremity compartment syndromes or escharotomies for severe burns.

Patients requiring surgery for any reason after a lightning injury should have adequate intravenous (IV) access and cardiac monitoring throughout the procedure.


Consultations are based on physical findings and may include referral to a neurologist, cardiologist, ophthalmologist, otolaryngologist, or, rarely, a burn surgeon. Later consultations may include referral to a neuropsychologist, pain specialist, or psychiatrist.


Transfer the patient as appropriate for patient status and stability, as well as for the capabilities of the treating facility. The vast majority of lightning survivors do not need admission, much less transfer.


If the patient continues to experience pain, dysesthesias, or other neurologic symptoms, referral to a neurologist or a pain specialist is appropriate.

A neuropsychological battery may be helpful for patients who develop neurocognitive (eg, memory, processing, endurance, sleep disorders) problems.


Effect of lightning injury in pregnancy varies. Of 11 pregnant women struck by lightning, approximately half of the pregnancies resulted in full-term live births without evidence of birth defects. One fourth of the pregnancies resulted in neonatal deaths and one fourth in stillbirths or deaths in utero.[27, 108]


Prehospital Care

Typically, all lightning strike victims who do not experience cardiac or respiratory arrest survive; therefore, normal triage priorities do not pertain to these individuals. Immediate attention should be directed to the resuscitation of those patients in respiratory or cardiac arrest.[14]

Patients with dysrhythmia who traditionally have a poor prognosis (eg, those with asystole) may occasionally recover. It is reasonable to end resuscitative efforts if there has been no response after 20, or at most 30 minutes, of aggressive and persistent resuscitation.

Remember that no place outside is safe when thunderstorms are in the area and rescuers may be at significant risk. National lightning safety guidelines indicate that significant risk continues for 30 minutes after the last lightning is seen or thunder is heard. If it is judged that there is no risk of continuing danger of lightning injury to emergency medical services (EMS) personnel, resuscitation can occur in the field. Otherwise, safe evacuation to the unit or a substantial building is indicated. Immobilization should be considered because of risk of blunt trauma from the lightning concussion or from being thrown by involuntary muscle contraction. (Obviously, a sober, alert, minimally injured patient can help to decide if this is necessary.) Resuscitation or supportive care, including advanced cardiac life support (ACLS) and AED use, can then proceed as indicated based on clinical status.

Fluid loading and alkalinization of the urine is not warranted in the vast majority of cases.

Immediate resuscitation

Immediate resuscitation of the person struck by lightning greatly influences prognosis. If a witness to the accident is present, he or she should initiate resuscitation at the scene. The rescuer first should check the person's responsiveness. If a spinal cord injury is suspected, stabilize the person's head during assessment of the level of consciousness. Keraunoparalysis or evidence of head injury or tenderness or hematomas of the neck or back should alert the rescuer to the possibility of an injury to the spinal cord. In such cases, stabilize the head until the person is secured to a long backboard by emergency medical technicians.

If a group of persons is struck by lightning, attention should be directed to those with no signs of life, because the others will probably recover although they may have burns or injuries that need treatment. Immediate cardiopulmonary resuscitation and prevention of anoxic death are essential, but the majority of these patients die despite these resuscitative efforts.

Altered level of consciousness

If the person has an altered level of consciousness or is unresponsive, the rescuer should assess ventilatory impairment. Kneeling at the person's side, the rescuer places his or her cheek close to the person's mouth. While listening and feeling for breathing, the rescuer should watch the movement of the bared chest. Movement of the chest wall should be synchronous and symmetrical with each ventilation. Satisfactory air exchange is evidence of adequate ventilation.

Inadequate ventilation

The most common cause of inadequate ventilation in the unconscious victim is blockage of the pharynx by the relaxed tongue. This airway obstruction is relieved by the modified jaw thrust maneuver that moves the jaw forward and lifts the tongue from the posterior pharyngeal wall with minimal movement of the spinal cord. Ideally, emergency medical technicians should continue monitoring throughout transport to the advanced life-support facility.

Electrocardiographic changes

Electrocardiographic changes observed following lightning accidents probably stem from vascular spasm or arrhythmia without coronary artery occlusion.[25] Occasionally, there is direct damage to the myocardium. Autopsy studies of victims of lightning injuries have demonstrated epicardial hemorrhages and a peculiar spiral malformation of the myocardial fibers.

Electrocardiographic evidence for direct myocardial damage includes ST segment elevation, T-wave inversion, and prolongation of the QT interval. Fortunately, these electrocardiographic changes usually resolve without serious cardiac complications, although occasionally more serious sequelae develop. Usually, no evidence of cardiac dysfunction is seen at several months after injury, and the patient's exercise tolerance returns to normal.

Vasomotor spasm

Keraunoparalysis with vasomotor spasm is the local response of the vasculature to electrical current from direct sympathetic stimulation. Vasoconstriction may be so prolonged and intense that it causes early and severe loss of pulses and mottled, cool extremities. This vasoconstriction is usually self-limited and resolves within hours.

Transient hypertension

Transient hypertension may occur and usually requires no short-term therapy. However, hypertension that persists 12-72 hours after the lightning strike responds to beta-blockers.


Pharmacologic Therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs), as well as narcotics, are often used for the acute pain. Chronic pain management may include acetaminophen, tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs), medications for adult attention deficit, neuroleptics, narcotics, sympathetic blockade, and other pain control measures, as indicated by the patient's symptoms.

Burn surgeons administer NSAIDs, vitamin C 1 g/day, and vitamin E 400 U/day to decrease scarring from electrical injuries. Vitamin C and vitamin E are hypothesized, but not proven, to be effective against other injuries as well, such as nerve damage. Whether they are effective for lightning survivors is not known.


Treatment of Lightning-Damaged Ears

Immediate treatment of lightning-damaged ears includes cleaning blood and debris from the external auditory canal and aural hygiene. Otic drops can be used unless the patient has cerebrospinal fluid otorrhea.

Prudence dictates delaying surgery on unresolved tympanic membrane perforations for at least 6 months for several reasons. Edema, burning, and charring of the ear canal may interfere with tympanoplasty. Spontaneous healing often occurs. A delay may also reveal partial ossicular necrosis and discontinuity, which can be corrected at the time of tympanoplasty.

Following tympanoplasty or spontaneous healing of the tympanic membrane, prolonged observation for a blast-induced cholesteatoma is advised. Implants of squamous epithelium from the drum may be blown into the promontory, where they proliferate and cause cholesteatoma.

Management of peripheral facial nerve palsy involves frequent stimulation to see if the nerve is injured and if surgical decompression or repair is necessary.

Even after repair of the ear, the patient may report continuing and irritating tinnitus from eighth nerve damage, as well as problems with balance and dizziness.


Inpatient Care

The vast majority of patients do not need inpatient admission and few need cardiac monitoring. Routine and supportive care is administered to patients as indicated by physical findings. Sometimes, however, chronic pain syndromes, neuromuscular injury, and neurocognitive deficits, which are significant and life changing, become apparent in patients who initially seemed to be only minimally injured.

Obviously, persons who have been severely injured by lightning require hospital admission, often to an intensive care unit. There is nothing special or specific regarding the care of such patients; care is routine, being carried out as indicated by the injuries. Rehabilitation may be prolonged and extensive for the more seriously injured patient.

If a patient has evidence of cardiac dysrhythmias or myocardial injury or has been revived from cardiorespiratory arrest, he or she should be admitted to the appropriate monitored setting. A patient who has suffered significant blunt trauma as a result of the lightning strike should be admitted to the appropriate trauma service and setting for further management.



Predicting the possibility or severity of any given lightning strike is impossible. Altering the course of injury, once set in motion, is also difficult. Therefore, preventive measures and education for individuals at risk are the most effective methods of minimizing lightning-related mortality and morbidity.[14, 71]

Guidelines by the Lightning Safety Group (LSG) have been published in the Annals of Emergency Medicine.[71] In 2000, some of the LSG authors were invited by the National Oceanic and Atmospheric Administration (NOAA) to become founding members of National Lightning Safety Awareness Week (LSW). The LSW Web site is now the premier reference for lightning safety in the world. It includes links to media and teacher sections, science sections with animations, the LSESSI support group, children’s games and curricula, free downloadable educational and safety materials, statistics and individual injury reports for the last several years, and multiple links to other related lightning sites.

Over the last decade, committee members have given thousands of interviews to the media, educating broadcasters and the public in lightning injury prevention. Lightning safety guidelines now appear in almost every sports, scouting, coaching, and public venue in the United States.[43, 58, 109, 110] Several individuals from other countries have worked with committee members to modify Web site source materials with pictures, language, and safety rules appropriate to their settings.

The US National Collegiate Athletic Association (NCAA) has been an active partner in this, with guidelines for their coaches since 1997.[43] Multiple professional and college-level games, including those being televised, have been delayed or called for lightning risk in the last decade. High schools have adopted similar guidelines for lightning stoppage. There are now lightning safety toolkits for stadia, beaches, and other mass gatherings to help managers plan appropriate response to bad weather and thunderstorms that are also available on the NOAA Web site.[110]

Hurricanes and, often, floods can be predicted days ahead of time, and tornadoes can be predicted minutes to hours in advance, allowing time for people to prepare, evacuate, or seek appropriate shelter. Small thunderstorm cells arise and disappear and lightning occurs far too often and unpredictably for the government to issue warnings for every event. The National Weather Service (NWS) issues severe storm or thunderstorm warnings upon danger of (1) straight-line winds exceeding 60 miles per hour, (2) hail three fourths of an inch or larger in diameter, or (3) tornadolike gusts.

In the last decade, largely in response to LSW team efforts, many offices now report the possibility of "dangerous lightning" as well. However, lightning safety continues to be primarily an individual responsibility, requiring individual decisions for prevention. With improved nowcasting, nearly real-time warnings can be issued and there are subscription services for this type of information that are available to scouting, entertainment, sporting, and other outdoor enthusiasts.

One exception to the individual responsibility caveat is if an adult, such as a parent or coach, or an organization, such as a pool, school, park, or scouting organization, is responsible for children. In those cases, the adult or organization is accountable and responsible for being aware of lightning safety rules, exercising prudent judgment, having an evacuation plan, and exercising that plan when appropriate to protect the children from harm and injury. The NCAA handbook’s section on lightning injury prevention policy is particularly useful for parents, who can present a copy to their children's team managers to spur lightning safety planning. The NOAA LSW Web site has many resources for teaching lightning safety. Coaches, who used to be resistant to cancelling practices and games, are now among the most proactive when it comes to lightning safety.

Event planners should be proactive and may need to monitor the weather hours to days in advance of an event. A number of online, real-time services may be accessed or subscriptions purchased. Some will warn via cell phones or other electronic devices, which is particularly handy for camps and large, outdoor sports venues. Users of these services should ensure they are using real-time data, not reports that have been delayed 10-30 minutes by some services. Lightning safety plans should include safer areas for shelter, appropriate signage and written material in event programs, and clear warning signals with different "seek shelter" and "all clear" signals.

Lightning protection for stadia and other outdoor venues can be done surprisingly inexpensively, particularly if planned in the initial construction. More stadia and large venues are establishing lightning safety plans, warnings, signage, and other appropriate means of preventing lightning injuries. Look for this material in programs or brochures. If it is not present in lightning-prone areas, ask management about it so that those who run the venue are spurred to carry out appropriate planning.

Monitoring of a radius around a park district, municipality, or sporting event to warn people of approaching thunderstorms can potentially decrease the number of lightning injuries.

Individual preparation

No place outside is safe when thunderstorms are in the area. Do not resume outside activity for 30 minutes after thunder is last heard or lightning is last seen.

Be aware of weather forecasts before beginning outdoor activities. Make appropriate evacuation plans, identify safer locations beforehand, and include the time to reach them in preplanning of activities. Also be aware of local thunderstorm patterns. For instance, 1-5 pm is a common time for thunderstorms to occur on some mountain slopes but may be different on others; ascent and descent should be done before lightning risk is likely.

Although it is now "duty to warn" on US golf courses and lightning safety and injury prevention information is widespread in sports literature, park management and coach's materials, ultimately, individuals are responsible for their own safety and the safety of any children in their care.


When lightning is seen or thunder is heard, danger is present. A simple safety-teaching tool is, "When thunder roars, go indoors."[47] Lightning may travel as far as 10-12 miles anywhere around a thunderstorm; clouds need not be overhead and rain need not be present for a lightning strike to occur.

Safer areas

Common safety precautions during thunderstorms include remaining inside a metal-topped and enclosed vehicle or a steel-framed building or other substantial habitable building because these have plumbing and wiring that act as a Faraday cage, diverting lightning from the inhabitants. Rented school buses distributed around a large outdoor venue make excellent shelters during activities such as golf tournaments, concerts, and marathons.[71]

Stay away from trees, bleachers (whether wood, plastic, or metal), fences, towers, other structures that transmit current, and any small or open structure that has the word shelter in it; get out of water, pools, and other wet areas such as beaches; and stay off of high areas, such as ridges and mountains, when thunderstorms are likely.

The lightning crouch has been shown to be less effective than standing with the feet close together to minimize the “footprint” for ground current effect.[111] For most people, it is also difficult to get into or maintain the lightning crouch for more than a short time. Sheltering inside shallow caves or overhangs can actually increase the person's risk of injury. Lightning can travel through water; thus, swimming, boating, and bathing should be avoided during a thunderstorm.

Avoid the use of landline telephones, hard-wired electronic equipment, or any contact with conductive surfaces inside a structure (eg, plumbing, sinks, devices connected to electrical wiring) during a thunderstorm. Side flashes from landline telephones, plumbing fixtures, and appliances connected to the outside by metal conductors have injured people inside buildings.

Avoid metal door and window frames, as they can build up a substantial static charge. While this may not technically be a lightning injury, it is still precipitated by the lightning event. Approaching and touching a vehicle after a thunderstorm can sometimes result in the discharge of a static electrical charge that has built up on the vehicle. This is similar to static discharge from winter carpet conditions. Technically, it is not a lightning injury but anyone presenting with this history should still be evaluated and then reassured if nothing is found on examination.

Activities should not be resumed until 30 minutes after the last lightning is seen or thunder is heard.[10, 47] The phrase "Half an hour since thunder roars, now it’s safe to go outdoors!" can be used to teach when it is safe to resume activities. This strategy provides about a 90-95% confidence interval.

Home protection systems

Lightning rods do not divert or prevent lightning strikes but serve as the contact point for lightning protection systems that provide a path along which lightning can travel with less damage to the structure.

Each year, thousands of homes and other properties are damaged and destroyed by lightning. Home lightning damage accounts for more than a quarter of a billion dollars’ worth of damage in the United States alone.[55] State and local building codes include requirements for those structures that require protection. Damage to electronics and the cost and time of replacing data on hard drives has become the major cost to most home and business owners affected by lightning. Damage can only reliably be averted by unplugging electronics from wall units prior to the storm. Common surge protectors and power strips are almost always inadequate for protection from lightning surges, despite claims on the packaging material.

Contributor Information and Disclosures

Mary Ann Cooper, MD Professor Emerita, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine; Founding Director, African Centres for Lightning and Electromagnetics

Mary Ann Cooper, MD is a member of the following medical societies: American Meteorological Society

Disclosure: Nothing to disclose.


Richard F Edlich, MD, PhD, FACS, FACEP FASPS, Distinguished Professor Emeritus of Plastic Surgery, Biomedical Engineering and Emergency Medicine, University of Virginia Health Care System

Richard F Edlich, MD, PhD, FACS, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Burn Association, American College of Emergency Physicians, American College of Surgeons, American Society of Plastic Surgeons, American Spinal Injury Association, Plastic Surgery Research Council, Society of University Surgeons, Surgical Infection Society, American Surgical Association, American Trauma Society

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.


Marc D Basson, MD, PhD, MBA Professor, Chair, Department of Surgery, Michigan State University

Marc D Basson, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

H Scott Bjerke, MD, FACS Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine

H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, andWilderness Medical Society

Disclosure: Nothing to disclose.

David B Drake, MD, FACS Associate Professor, Department of Plastic Surgery, Medical Director, DeCamp Burn and Wound Center, Program Director, Hand Fellowship, University of Virginia School of Medicine

David B Drake, MD, FACS is a member of the following medical societies: American Association for Hand Surgery, American Burn Association, American College of Surgeons, American Society for Reconstructive Microsurgery, American Society of Plastic and Reconstructive Surgery, Association for Surgical Education, Southeastern Society of Plastic and Reconstructive Surgeons, and Southern Medical Association

Disclosure: Nothing to disclose.

John Geibel, MD, DSc, MA Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Other

Edmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

William B Long III, MD, FACS, FASTS President, Trauma Specialists, LLP; Legacy Emanuel Trauma Center, Legacy Emanuel Hospital, Portland, Oregon

William B Long III, MD, FACS, FASTS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Thoracic Society, American Trauma Society, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Dennis P Orgill, MD, PhD Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital

Dennis P Orgill, MD, PhD is a member of the following medical societies: American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council

Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Brigham and Women's Hospital Royalty None; Kinetic Concepts, Inc. Expert Witness None

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons

Disclosure: Nothing to disclose.

Wayne Karl Stadelmann, MD Stadelmann Plastic Surgery, PC

Wayne Karl Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Plastic Surgeons, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Lars M Vistnes, MD, FRCSC, FACS Professor of Surgery, Emeritus, Stanford University Medical Center

Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

James Steven Walker, DO, MS Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

  1. Centers for Disease Control and Prevention. Lightning-associated deaths-United States, 1980-1995. Morbidity Mortality Weekly Reports. 391-394. 1998.

  2. Jensenius JS. A detailed analysis of recent lightning deaths in the United States. 23rd International Lightning Detection Conference; 2014. Available at Accessed: June 18, 2014.

  3. Roeder WP. Lightning has fallen to third leading source of US storm deaths. National Weather Association Annual Meeting; 2012. Available at Accessed: June 18, 2014.

  4. Holle RL, López RE, Howard KW, Vavrek J, Allsopp J. Safety in the presence of lightning. Semin Neurol. 1995 Dec. 15(4):375-80. [Medline].

  5. Trengove E, Jandrell IR. Strategies for understanding lightning myths and beliefs. Preprints, 30th International Conference on Lightning Protection. Cagliari, Italy. September 13-17, 2010.

  6. Trengove E, Jandrell IR. Leveraging a mobile culture for lightning awareness: the African context. Preprints, International Conference on Lightning Protection. Vienna, Austria. September 2-7, 2012.

  7. Mulder MB, Msalu L, Caro T, Salerno J. Remarkable rates of lightning strike mortality in Malawi. PLoS One. 2012. 7(1):e29281. [Medline].

  8. Krider EP, Uman MA. Cloud-to-ground lightning: mechanisms of damage and methods of protection. Semin Neurol. 1995 Sep. 15(3):227-32. [Medline].

  9. MacGorman BR, Maier MW, Rust WD. Lightning strike density for the contiguous United States from thunder storm duration records Washington DC. Washington D.C: US Nuclear Regulatory Commission. 1984.

  10. Cooper MA, Andrews CJ, Holle RL. Lightning injury. Auerbach. Wilderness Emergencies. CV Mosby; 2006. chap3. [Full Text].

  11. Andrews CJ, Cooper MA, Darveniza M. Lightning Injuries: Electrical Medical, and Legal Aspects. 1992.

  12. Andrews CJ, Darveniza M. Telephone-mediated lightning injury: an Australian survey. J Trauma. 1989 May. 29(5):665-71. [Medline].

  13. Tushemereirwe R, Tuhebwe D, Cooper MA, D’ujanga FM. The Most Effective Methods for Delivering Severe Weather Early Warnings to Fishermen on Lake Victoria. 6th International Lightning Meteorology Conference. 2016; Accessed: May 20, 2016.

  14. Edlich RF, Farinholt HM, Winters KL, Britt LD, Long WB 3rd. Modern concepts of treatment and prevention of lightning injuries. J Long Term Eff Med Implants. 2005. 15(2):185-96. [Medline].

  15. Lifschultz BD, Donoghue ER. Deaths caused by lightning. J Forensic Sci. 1993 Mar. 38(2):353-8. [Medline].

  16. Cooper MA. Emergent care of lightning and electrical injuries. Semin Neurol. 1995 Sep. 15(3):268-78. [Medline]. [Full Text].

  17. Cooper MA, Holle R, Andrews C. Field J, ed. Electrical Current and Lightning Injury, The Textbook of Emergency Cardiovascular Care and CPR. Lippincott, Williams & Wilkins; ACLS for the Experienced Provider, AHA/ACEP; 2009. 498-511.

  18. Cooper MA, Johnson SA. Cardiopulmonary resuscitation and early management of the lightning strike victim. Ornato JP, Peberdy MA. Cardiopulmonary Resuscitation. Humana Press; 2005.

  19. Cooper, MA. Lightning Injury Homepage. Lightning Injury. Available at or several articles in PDF as well as complete world bibliography on lightning injury. [Full Text].

  20. Cooper MA, Holle RL. Mechanisms of lightning injury should affect lightning safety messages. 3rd International Lightning Meteorology Conference, Orlando, Florida; 2010: [Full Text].

  21. Blumenthal R, Jandrell IR, West NJ. Does a Sixth Mechanism Exist to Explain Lightning Injuries?: Investigating a Possible New Injury Mechanism to Determine the Cause of Injuries Related to Close Lightning Flashes. Am J Forensic Med Pathol. 2011 Sep 26. [Medline].

  22. Cooper MA. Whether the medical aspects of lightning injury are different in developing countries. Preprints, International Conference on Lightning Protection. Vienna, Austria. September 2-7, 2012.

  23. Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med. 1980 Mar. 9(3):134-8. [Medline].

  24. Blumenthal R. Secondary missile injury from lightning strike. Am J Forensic Med Pathol. 2012 Mar. 33(1):83-5. [Medline].

  25. Lichtenberg R, Dries D, Ward K, Marshall W, Scanlon P. Cardiovascular effects of lightning strikes. J Am Coll Cardiol. 1993 Feb. 21(2):531-6. [Medline].

  26. Whitcomb D, Martinez JA, Daberkow D. Lightning injuries. South Med J. 2002 Nov. 95(11):1331-4. [Medline].

  27. Fish RM. Electric injury, part III: cardiac monitoring indications, the pregnant patient, and lightning. J Emerg Med. 2000 Feb. 18(2):181-7. [Medline].

  28. Offiah C, Heran M, Graeb D. Lightning strike: a rare cause of bilateral ossicular disruption. AJNR Am J Neuroradiol. 2007 May. 28(5):974-5. [Medline]. [Full Text].

  29. Miller SF. The long-term consequences of lightning injuries. Muehlberger T, Vogt PM, Munster AM, (Burns 2001;27:829-33). Burns. 2003 Feb. 29(1):97. [Medline].

  30. Norman ME, Albertson D, Younge BR. Ophthalmic manifestations of lightning strike. Surv Ophthalmol. 2001 Jul-Aug. 46(1):19-24. [Medline].

  31. Janus TJ, Barrash J. Neurologic and neurobehavioral effects of electric and lightning injuries. J Burn Care Rehabil. 1996 Sep-Oct. 17(5):409-15. [Medline].

  32. Cherington M. Neurologic manifestations of lightning strikes. Neurology. 2003 Jan 28. 60(2):182-5. [Medline].

  33. Kilbas Z, Akin M, Gorgulu S, Mentes O, Ozturk E, Kozak O, et al. Lightning strike: an unusual etiology of gastric perforation. Am J Emerg Med. 2008 Oct. 26(8):966.e5-7. [Medline].

  34. Montalto M, Ancarani F, Manna R, Gasbarrini G. Globus pharyngis: was it a stroke of lightning?. Am J Gastroenterol. 2003 Apr. 98(4):938-9. [Medline].

  35. Aslan S, Aydinli B, Ocak T, Akcay M. Lightning: an unusual etiology of gastrointestinal perforation. Burns. 2005 Mar. 31(2):237-9. [Medline].

  36. Abrahamson J, Dinniss J. Ball lightning caused by oxidation of nanoparticle networks from normal lightning strikes on soil. Nature. 2000 Feb 3. 403(6769):519-21. [Medline].

  37. Sinha AK. Lightning-induced myocardial injury. A case report with management. Angiology. 1985 May. 36(5):327-31. [Medline].

  38. Blount BW. Lightning injuries. Am Fam Physician. 1990 Aug. 42(2):405-15. [Medline].

  39. Ohashi M, Kitagawa N, Ishikawa T. Lightning injury caused by discharges accompanying flashovers--a clinical and experimental study of death and survival. Burns Incl Therm Inj. 1986 Oct. 12(7):496-501. [Medline].

  40. Bier M, Chen W, Bodnar E, Lee RC. Biophysical injury mechanisms associated with lightning injury. NeuroRehabilitation. 2005. 20(1):53-62. [Medline].

  41. Cooper MA. A fifth mechanism of lightning injury. Acad Emerg Med. 2002 Feb. 9(2):172-4. [Medline].

  42. Cankaya H, Egeli E, Evliyaoglu Z. Hearing loss caused by lightning strike: case report and review of the literature. J Otolaryngol. 2002 Jun. 31(3):181-3. [Medline].

  43. National Collegiate Athletic Association. NCAA Sports Medicine Handbook 2008-09. National Collegiate Athletic Association. Available at Accessed: November 14, 2011.

  44. Holle RL, Lopez RE, Zimmermann C. Updated recommendations for lightning safety. Bulletin of the American Meteorological Society. 1999. 80:2035-41.

  45. Mary AK, Gomes C. Lightning accidents in Uganda. International Conference on Lightning Protection, September 2-7, Vienna, Austria. Available at Accessed: June 18, 2014.

  46. Blumenthal R. Lightning fatalities on the South African Highveld: a retrospective descriptive study for the period 1997 to 2000. Am J Forensic Med Pathol. 2005 Mar. 26(1):66-9. [Medline].

  47. Lightning Safety. NWS Lightning Safety. Available at http://Available at Accessed: April 16, 2009.

  48. Utley M. StruckbyLightning. Available at http://Available at Accessed April 16, 2009.

  49. Agoris D, Pyrgioti E, Vasileiou D, Dragoumis S. Analysis of lightning death statistics in Greece. International Conference on Lightning Protection ICLP 2002: Conference Proceedings, 2nd - 6th September26th. Cracow, Poland: Association of Polish Electrical Engineers; 2002. Vol 1: 654-657.

  50. Kadir MZA, Misbah NR, Gomes C et al. Recent statistics on lightning fatalities in Malaysia. 2012 International Conference on Lightning Protection (ICLP), Vienna, Austria. Available at Accessed: June 18, 2014.

  51. Zhang Y, Zhang W, Meng Q. Lightning casualties and damages in China from 1997 to 2010. Preprints, International Conference on Lightning Protection. Vienna, Austria. September 2-7, 2012.

  52. Cardoso I, Pinto Jr O, Pinto IRCA, Holle R. A new approach to estimate the annual number of global lightning fatalities. 14th International Conference on Atmospheric Electricity. Rio de Janeiro, Brazil. August 8-12, 2011.

  53. Holle RL, Lopez RE. A comparison of current lightning death rates in the U.S. with other locations and times. Preprints, International Conf on Lightning and Static Electricity. Sept 16-18, B. 2003. paper 103-34.

  54. Navarrete-Aldana N, Cooper MA, Holle RL. Lightning fatalities in Colombia from 2000 to 2009. Natural Hazards. May 2014. doi 101007/s11069-014-1254-9:

  55. Holle RL. Lightning–caused deaths and injuries in and near dwellings and other buildings. 4th Conference on the Meteorological Applications of Lightning Data; Phoenix, Arizona: American Meteorological Society; 2009.

  56. National Oceanic and Atmospheric Administration. Lightning Safety Awareness Week. Available at Accessed: November 14, 2011.

  57. Cooper, MA. A brief history of lightning safety efforts in the United States. Preprints, 4th International Lightning Meteorology Conference. Broomfield, Colorado. April 4-5, 2012.

  58. Hodanish S, Torgerson K, Jensenius J, Cooper MA, Utley M, Roeder WP. Leon the lightning safety lion says: "When thunder roars – go indoors:" – NOAA’s efforts regarding children’s lightning safety. Preprints, 3rd Conference on Meteorological Applications of Lightning Data. American Meteorological Society. New Orleans, Louisiana. January 20-24, 2008.

  59. Jensenius JS, Franklin D. A review of NOAA’s lightning safety awareness campaign and its impact across the United States. Preprints, 4th International Lightning Meteorology Conference. Broomfield, Colorado. April 4-5, 2012.

  60. Lengyel MM, Cooper MA, Holle R, Brooks H. The role of multidisciplinary teams and public education in decreasing lightning casualties worldwide. Preprints, 30th International Conference on Lightning Protection. Cagliari, Italy. September 13-17, 2010.

  61. Holle RL. Annual rates of lightning fatalities by country. 20th International Lightning Detection Conference; 2008. Available at Accessed: November 14, 2011.

  62. Blumenthal R. A retrospective descriptive study on the pathology of trauma of lightning fatality cases in Gauteng 2001-2004. International Conference on Lightning and Static Electricity. Paris, France. August 28-31, 2007. paper IC07/PPRKM10.

  63. Blumenthal R, Trengove E, Jandrell IR, Saayman G. Lightning medicine in South Africa. S Afr Med J. 2012 Jun 6. 102(7):625-6. [Medline].

  64. Cardoso I, Pinto Jr O, Pinto IRCA, Holle R. Lightning casualty demographics in Brazil and their implications for safety rules. Atmospheric Research. January 2014. 135-136:374-379. [Full Text].

  65. Dlamini WM. Lightning fatalities in Swaziland. Natural Hazards. doi:10.1007/s11069-008-9331-6.

  66. Murty OP, Kian CK, Ari Husin MH, Nanta Kumar RK, Mohammed Yusuf WY. Fatal lightning strikes in Malaysia. Am J Forensic Med Pathol. 2009 Sep. 30(3):246-51. [Medline].

  67. Pinto IRCA, Cardoso I, Pinto Jr O, Geier N. 2010: Lightning fatalities in Brazil in the last decade. Preprints, International Lightning Meteorology Conference, Orlando, Florida. Vaisala. April 21-22.

  68. Holle RL. Lightning fatalities in tropical and subtropical regions. Preprints, 29th Conf on Hurricanes and Tropical Meteorology. American Meteorological Society. Tucson, Arizona. May 10-14, 2010.

  69. Roeder WP, Cummins BH, Ashley WS, Holle RL, Cummins KL. Mapping lightning fatality risk. Preprints, 5th International Lightning Meteorology Conference, Tucson, Arizona, Vaisala. March 20-21, 2014.

  70. Holle RL, Murphy MJ, Lopez RE. Distances and times between cloud-to-ground flashes in a storm. Preprints, Intl Conf on Lightning and Static Electricity, Blackpool, UK, Royal A. 2003.

  71. [Guideline] Zimmermann C, Cooper MA, Holle RL. Lightning safety guidelines. Ann Emerg Med. 2002 Jun. 39(6):660-4. [Medline]. [Full Text].

  72. Adekoya N, Nolte KB. Struck-by-lightning deaths in the United States. J Environ Health. 2005 May. 67(9):45-50, 58. [Medline].

  73. Cherington M, et al. Closing the gap on the actual numbers of lightning casualties and deaths. 11th Conference on Applied Climatology, Dallas, January 10-15, 1999: American Meteorological Society;

  74. Ashley W, Gilson C. A reassessment of U.S. lightning mortality. Bulletin of the American Meteorological Society. 2009.

  75. Lopez RE, Holle RL, Heitkamp TA. Lightning casualties and property damage in Colorado from 1950 to 1991 based on storm data. Weather and Forecasting. 10:114-126.

  76. Chao TC, Pakiam JE, Chia J. A study of lightning deaths in Singapore. Singapore Med J. 1981 Jun. 22(3):150-7. [Medline].

  77. Coates L, Blong R, Siciliano F. Lightning fatalities in Australia, 1824-1993. Natural Hazards. 1993. 8(3):217-233.

  78. Nizamuddin S. 1992: Deaths caused by lightning in India. Weather. 47:366-7.

  79. Elsom DM. Deaths and injuries caused by lightning in the United Kingdom: analyses of two databases. Atmos Res. January 2001. 56:325-34.

  80. Cooper MA, Kadir MZA. Lightning Injury Continues to be a Public Health Threat Internationally. 3rd International Lightning Meteorology Conference; 2010. Available at,%20Zainal.pdf. Accessed: November 14, 2011.

  81. Cooper MA, Silva LM, Blumenthal R, Pliskin N. A follow-up study of a large group of children struck by lightning. International Conference on Lightning Protection. Shanghai. October 2014.

  82. Cherington M, Krider EP, Yarnell PR, Breed DW. A bolt from the blue: lightning strike to the head. Neurology. 1997 Mar. 48(3):683-6. [Medline].

  83. Blumenthal R. When thunder roars -- go indoors!. S Afr Med J. 2006 Jan. 96(1):38-9. [Medline].

  84. Cherington M, Kurtzman R, Krider EP, Yarnell PR. Mountain medical mystery. Unwitnessed death of a healthy young man, caused by lightning. Am J Forensic Med Pathol. 2001 Sep. 22(3):296-8. [Medline].

  85. Gluncic I, Roje Z, Gluncic V, Poljak K. Ear injuries caused by lightning: report of 18 cases. J Laryngol Otol. 2001 Jan. 115(1):4-8. [Medline].

  86. Ramati A, Pliskin NH, Keedy S, et al. Alteration in functional brain systems after electrical injury. J Neurotrauma. 2009 Oct. 26(10):1815-22. [Medline].

  87. Ramati A, Rubin LH, Wicklund A, et al. Psychiatric morbidity following electrical injury and its effects on cognitive functioning. Gen Hosp Psychiatry. 2009 Jul-Aug. 31(4):360-6. [Medline].

  88. Cherington M. Spectrum of neurologic complications of lightning injuries. NeuroRehabilitation. 2005. 20(1):3-8. [Medline].

  89. Cooper MA, Kotsos T, Gandhi MV. Acute Autonomic and Cardiac Effects of Simulated Lightning Strike in Rodents. Society for Academic Emergency Medicine. Atlanta, Ga: 2001.

  90. Cooper MA, Marshburn S. Lightning Strike and Electric Shock Survivors, International. NeuroRehabilitation. 2005. 20(1):43-7. [Medline].

  91. Jost WH, Schonrock LM, Cherington M. Autonomic nervous system dysfunction in lightning and electrical injuries. NeuroRehabilitation. 2005. 20(1):19-23. [Medline].

  92. Marshburn S. Lightning strike and electric shock survivors, international. LSESSI. Available at Accessed: April 1, 2009.

  93. Primeau M, Engelstatter GH, Bares KK. Behavioral consequences of lightning and electrical injury. Semin Neurol. 1995 Sep. 15(3):279-85. [Medline].

  94. Yarnell PR. Neurorehabilitation of cerebral disorders following lightning and electrical trauma. NeuroRehabilitation. 2005. 20(1):15-8. [Medline].

  95. Lammertse DP. Neurorehabilitation of spinal cord injuries following lightning and electrical trauma. NeuroRehabilitation. 2005. 20(1):9-14. [Medline].

  96. Cherington M, McDonough G, Olson S, Russon R, Yarnell PR. Lichtenberg figures and lightning: case reports and review of the literature. Cutis. 2007 Aug. 80(2):141-3. [Medline].

  97. Primeau M. Neurorehabilitation of behavioral disorders following lightning and electrical trauma. NeuroRehabilitation. 2005. 20(1):25-33. [Medline].

  98. Selvaggi G, Monstrey S, Van Landuyt K, Hamdi M, Blondeel P. Rehabilitation of burn injured patients following lightning and electrical trauma. NeuroRehabilitation. 2005. 20(1):35-42. [Medline].

  99. Bartholome CW, Jacoby WD, Ramchand SC. Cutaneous manifestations of lightning injury. Arch Dermatol. 1975 Nov. 111(11):1466-8. [Medline].

  100. Cooper MA. Medical Aspects of Lightning Injury in the Developing World: Keynote address. International Conference on Lightning Protection, Kathmandu, Nepal Oct 12-14, 2011:

  101. ten Duis HJ, Klasen HJ, Nijsten MW, Pietronero L. Superficial lightning injuries--their "fractal" shape and origin. Burns Incl Therm Inj. 1987 Apr. 13(2):141-6. [Medline].

  102. Navarrete N. Severe rhabdomyolysis without renal injury associated with lightning strike. J Burn Care Res. 2013 May-Jun. 34(3):e209-12. [Medline].

  103. Noel LP, Clarke WN, Addison D. Ocular complications of lightning. J Pediatr Ophthalmol Strabismus. 1980 Jul-Aug. 17(4):245-6. [Medline].

  104. Shapiro MB. Lightning cataracts. Wis Med J. 1984 Dec. 83(12):23-4. [Medline].

  105. Freeman CB, Goyal M, Bourque PR. MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol. 2004 May. 25(5):851-3. [Medline]. [Full Text].

  106. Marcus MA, Thijs N, Meulemans AI. A prolonged but successful resuscitation of a patient struck by lightning. Eur J Emerg Med. 1994 Dec. 1(4):199-202. [Medline].

  107. Nelson KL, Mills W Jr, Umbel S, Crosson JE, Shaffner DH, Hunt EA. Lightning, sudden cardiac death, simulation and an automated external defibrillator: the perfect storm. Resuscitation. 2007 Sep. 74(3):567-71. [Medline].

  108. Fatovich DM. Electric shock in pregnancy. J Emerg Med. 1993 Mar-Apr. 11(2):175-7. [Medline].

  109. Walsh KM, Cooper MA, Holle R, Rakov VA, Roeder WP, Ryan M. National Athletic Trainers' Association position statement: lightning safety for athletics and recreation. J Athl Train. 2013 Mar-Apr. 48(2):258-70. [Medline]. [Full Text].

  110. Woodrum CC, Franklin D. Using a lightning safety toolkit for outdoor venues. Preprints, 4th International Lightning Meteorology Conference. Broomfield, Colorado. April 4-5, 2012.

  111. Roeder WP. Backcountry lightning risk reduction—Lightning crouch versus standing with feet together. Preprints, International Lightning Meteorology Conference. Tucson, Arizona. March 20-21, 2014.

  112. Cooper MA, Holle RL, Andrews C. Distributions of lightning injury mechanisms. Preprints, International Lightning Detection Conference. Tucson, Arizona: Vaisala. April 21-23, 2008.

  113. Kadir MZA, Cooper MA, Gomes C. An overview of the global statistics of lightning fatalities. Preprints, 30th International Conference on Lightning Protection. Cagliari, Italy. September 13-17, 2010.

  114. Lubasi FC, Ab Kadir MZA, Gomes C, Cooper MA. Case studies of lightning related injuries and property damage in Zambia. Preprints, International Conference on Lightning Protection. Vienna, Austria. September 2-7, 2012.

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