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Lightning Injuries in Mountain Bikers

Scenario:

You are on patrolling in the high country when a late afternoon thunder storm rolls in. Thunder and lightning is everywhere and it begins to rain. You hear a loud boom and see a flash of light ahead of you. You take cover in a safe area until the storm passes. When you continue down the singletrack you see a dazed but conscious cyclist who appears to have been hit by lightning. The trees around him appear to be scorched. What do you do next?

Demographics of lightning injuries:

Overall, lightning injuries are an unusual form of trauma but are one of the leading causes of death related to the natural environment. In the United States, lightning accounts for 150-300 deaths per year. An additional 1000-1500 will be seriously injured. Those struck by lightning have a 20-30% chance of death. The most common cause of death is related to heart and respiratory issues (usually the heart and breathing stops).

Injury mechanism:

Lightning may injure a cyclist in a variety of ways. The exact way in which a lightning causes an injury will determine if that cyclist lives or dies. Lighting can injure a rider as follows:

 

  1. Direct strike: The lightning bolt comes into direct contact with the person and may pass directly through that person. For example, this may occur when the cyclist is struck in an open flat area or when alone on the top of a hill or exposed ridge. This usually causes the worst injury and death can result when the heart or breathing stops. However, it is possible to survive a direct strike.
  2.  

  3. Side flash (splash): Lightning may hit a nearby object but the energy and current splashes over to the cyclist who may be in close proximity to the direct impact.
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  5. Ground current: The lightning current travels through the ground and travels up the leg of a nearby individual.

Signs and Symptoms:

Lightning victims may display some or all of these injuries:

  1. Burns: These are generally 1st or 2nd degree burns. Burns are usually superficial and are rarely cause severe damage.
  2. Blunt trauma: The cyclist may be thrown by the shock wave landing several feet from the original site of lightning impact.
  3. Spine trauma: Always suspect spinal injury in a lightning victim.
  4. Cardiovascular (heart): The heart can actually stop or the rhythm can slow down.
  5. Respiratory: Breathing can arrest.

Treatment:

Prevention! Make sure your patrollers are trained to recognize safer places to be during lightning storms. Avoid exposed ridges, summits, and areas directly underneath potential rockfall. Also avoid low-lying areas or standing bodies of water. Educate other trail users about lightning safety. The best way to avoid lightning injury is to be prepared and avoid riding during times when lightning storms are common.

But if you do happen upon a lightning victim in the field, always ensure your own safety before providing aid. Once you are certain the scene is safe, do not delay. Immediate evacuation to the hospital is essential. Evaluate the patient for breathing by looking for chest expansion or the movement of air from the mouth and nose. Evaluate the heart by checking pulses. If there is no breathing and no pulse start CPR and rescue breathing if trained. This is a horrible situation and unless help is readily available the outcome could be poor. In the remote backcountry or when help is far away, studies have not shown recovery after prolonged CPR and rescue breathing. If the cyclist does not have a pulse after 20-30 minutes, the chances of recovery may be slim.

Many vicims of splash or ground strikes, however, may retain consciousnes. These individuals will be breathing on their own and have a pulse. They may be disoriented, irritable, or confused. After confirming an adequate airway, breathing, and circulation, assess for shock and hypothermia. Do not move the patient, even if he/she feels ok to walk. Hypothermia is common threat since the cyclist may have been caught in the associated rainstorm. If the cyclist was thrown from the lighting strike, assess for blunt trauma and maintain spinal precautions. Keep the patient still, warm, and arrange for immediate evacuation.

Remember, lightning strikes are horrible injuries but death from the injury is not inevitable. Immediate advanced care is essential. As the first contact in the field, you can dramatically increase a victim's chances for survival with proper care and attention.

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