© Sports Medicine Concepts, Inc. All Rights Reserved.
Contributed by Pete McCabe, MS, ATC
Injuries sustained from lightning have been well documented in recent literature. It is important to note that if lightning safety procedures are not reviewed and implemented, lightning occurrences can result in fatal outcomes in the athletic setting. According to the National Weather Service, 210 fatalities were reported from 2006-2011. Of the 210 fatalities reported, 51% were engaging in some form of recreational activity. Peak seasons for thunderstorms seem to correlate with the data placing the physically active population in more danger. Late spring to early fall historically have seen increases in thunderstorm activity with a high prevalence of thunderstorm activity from afternoon to early evening. 4,5,7 The previously mentioned timing of seasonal thunderstorms makes them a substantial risk for most outdoor practices and competitions in certain areas. On average, 25 million lightning strikes hit the ground in the United States. 3,8 While certain areas of the United States are more exposed to lightning activity, no location is safe from the potential risk of lightning exposure. Institutions need to ensure proper lightning procedures are in place, along with educational opportunities for administrators, coaches, players and referees.
Lightning is defined as a transient, high-current electric discharge in the air.1 These high-current discharges’ peak temperatures have been documented to be about 5 times greater than the temperature on the sun.16 Lightning often result in visible flashes that are the result of conduction of electricity between gradient potentials created within positively and negatively charged areas of a cloud. There are two primary types of lightning, cloud-to-ground and cloud-to-cloud strikes.1 As these gradient potentials increase within a cloud, the negatively charged region of the cloud begins to create a stepped leader that moves toward the ground. On average, more than 90% of global cloud-to-ground lightning is negative.1
When thunder is heard or a lightning bold is seen, the leading edge of the thunderstorm is close enough to strike the current location with lightning. It is important for athletic trainers, administrators and coaches to understand the mechanisms of a lightning injury. Lightning can cause injury or death through 6 potential mechanisms: direct strike, contact injury, side flash, step voltage, upward leader and concussive. 7,15, 17
- Direct Strike is the least common mechanism of a lightning strike. A direct strike mechanism occurs when an individual is struck directly.
- Contact Injury occurs when an individual is touching an object that is in the direct path of the lightning current. Objects such as wired telephones, poles, trees and wired computers are documented as causing contact lightning injuries.
- Side Flash injuries occur when an object is struck by lightning and an individual is close enough for a portion of the lightning’s energy to “jump” toward them. This mechanism is accounts for approximately 30-35% of lightning injuries.18
- Step Voltage is documented as being the most common mechanism of a lightning strike, attributed to nearly half of all lightning injuries and deaths.18 This mechanism occurs when an individual near the strike disrupts the path of the lightning’s energy path. Often in this mechanism, the voltage from the strike will travel through the victim’s body via a limb and exit a separate limb in contact, or enroute of, the lightning’s path to the ground. This mechanism is more prevalent when groups of people are in one area, sometimes resulting in mass injuries or casualties.1
- Upward Leader mechanisms are lightning strikes that develop from the earth toward a cloud. Upward leaders are responsible for approximately 10-15% of all lightning encounters.17, 18 Upward leaders that remain disconnected from downward leaders can transfer sufficient energy to injure or kill. 1
- Concussive mechanisms of injury can cause violent muscular contractions and can sometimes throw victims away from the site of the lightning strike. Sometimes termed, “explosive forces,” concussive mechanisms result from rapid heating and cooling of the lightning current.1 Injuries to the eyes and ears are commonly reported as a result of explosive force lightning strikes.
Injuries sustained by a lightning strike can have long-term effects on the human body. Research has documented short-term memory problems, attention deficit, difficulty processing new information, and severe headaches resulting from lightning strikes.20,21 Additional injuries such as tympanic membrane damage and superficial burns have also been reported. In all situations, first responders should be knowledgeable in the mechanisms of lightning strikes and the importance of immediate first aid for the victim(s).
A common myth with the first aid/management of a lightning victim is that the person will still hold a charge from the lightning strike. Touching a lightning victim is safe and first-aid should be provided promptly as long as the rescuer is not putting him or herself in danger from on-going severe weather.1 If possible, lightning victims should be moved to a safe area prior to management and care. Mortality rate for lightning strikes is quite low, only 8-10% of lightning strike victims will die as a direct result of the strike itself. 13 Most lightning deaths result from secondary acute cardiac or respiratory arrest. Therefore, an AED and the ability to perform high-quality CPR is a critical link in prevention of deaths resulting from lightning strikes. In mass strike scenarios, care for lightning victims should be placed on those who appear to be dead first.14,22 Other victims who are moving and breathing should be treated secondarily.
It is recommended that victims of lightning strikes be admitted into a hospital following the lightning event. Additionally, follow-up care with the victim’s primary care physician is recommended to treat and monitor sighs of concussion, muscle pain, temporary paralysis, deafness or blindness.13,19
Lightning Action Plan
- All appropriate personnel will be notified and educated regarding venue specific designated evacuation safe zones. The primary choice for evacuation should be a fully enclosed building with wiring and plumbing.4,6,7,9,10,11,12,23 If a fully enclosed building is not available, seek shelter within a fully enclosed vehicle with a roof. Golf carts, ATV’s, gazebos and under trees are not acceptable areas to seek shelter during lightning activity.
- If sever weather is forecast, designated personnel will discuss the possibility of suspending, cancelling, or rescheduling the event.
- An athletic training staff member or other designated weather watcher at an event will be on the field monitory local weather conditions. This person will actively watch for signs of threatening weather, monitor local weather forecasts and sever weather alerts, and any lightning detection systems in place. The weather watcher will notify appropriate personnel when severe weather becomes a threat.
- If a storm is expected to occur during a practice or game, the weather watcher will notify coaches, officials, and all other designated personnel of the severe weather threat.
- When severe weather is possible, the weather watcher or other designated personnel will provide visiting team personnel with lightning policy information during the medical time out, including evacuation safe zone for their players and personnel.
- When severe weather is possible, the weather watcher or other designated personnel will provide spectators with specific severe weather updates, including evacuation safe zones via public address announcements.
- The designated weather watcher will notify designated officials of weather threats and has the authority to immediately suspend all play and initiate the evacuation plan.
- During games or competitions, the appropriate public address announcements will be made and repeated over the public-address system advising fans of the inclement weather and directing them to evacuate the site to a designated safe zones when play is suspended:
Severe Weather Watch/Warning: “Ladies and Gentlemen, we are now under a severe weather (watch/warning). Please seek shelter immediately. The closest shelter is located ___________. More details will be relayed when it is safe to return to the venue to resume competition. Thank you.”
Lightning Warning: “Ladies and Gentlemen, we are now under a severe weather/lightning delay. Please seek shelter or move to your cars immediately. More details will be relayed when it is safe to return to the venue to resume competition. Thank you.”
Postponement: “This (game/event) has been postponed due to inclement weather. We regret and apologize for the inconvenience. Please follow instructions of ushers, law enforcement and public safety officers in exiting the facility. Thank you.”
Suspending / Resumption of Activities
- Any system notifications indicating lightning strikes within 12 miles, audible thunder, or visible lightning will result in suspension of the event and evacuation of all participants and spectators to designated Safe Zones.
- Once play has been suspended, wait at least 30 minutes after the last system notification, audible thunder, or visible lightning to resume play.
- Any subsequent thunder or lightning indications after the beginning of the 30 minute count will result in the count clock being reset and another 30 minute count will begin.
- When using lightning detection systems refer to the National Weather Service guidelines below:
|NWS / Monitor System Alerts||Risk Level||Prevention Measures|
|No Warning||Low||Monitor skies for onset of dark clouds and high winds, and 30sec lightning/thunder interval.|
|Moderate||Alert personnel to the alert status and potential for alert level upgrade. Monitor for warning upgrades.|
<30s lightening/thunder interval
|High||Alert all participants to the risk and evacuate to venue safe zone. Resume practice in venue safe zone or wait for “All Clear” and warnings to expire before resuming outside activity.|
|Danger||High||Alert all participants to the risk and evacuate to venue safe zone. Resume practice in venue safe zone.|
|All Clear||Low||Reassess that lightning or thunder has not been heard of observed for at least 30 min within 15 miles of venue. If desired, resume outdoor activity. Monitor for additional severe weather activity.|