Lightning-Associated Deaths -- United States, 1980-1995

A lightning strike can cause death or various injuries to one or several persons. The mechanism of injury is unique, and the manifestations differ from those of other electrical injuries. In the United States, lightning causes more deaths than do most other natural hazards (e.g., hurricanes and tornadoes) (1), although the incidence of lightning-related deaths has decreased since the 1950s (1,2). The cases described in this report illustrate diverse circumstances in which deaths attributable to lightning can occur. This report also summarizes data from the Compressed Mortality File of CDC's National Center for Health Statistics on lightning fatalities in the United States from 1980 through 1995, when 1318 deaths were attributed to lightning. Case Reports Case 1. In April 1997, a 34-year-old woman in Florida was struck by lightning at approximately 12:30 p.m. after a severe thunderstorm had passed through the area. She had gone into her back yard to tend animals in a pen. As she walked toward the pen gate, lightning stuck her, throwing her several feet. A neighbor immediately administered cardiopulmonary resuscitation (CPR) but could not revive her and called the emergency medical service (EMS). EMS personnel were unable to resuscitate her, and she was pronounced dead at the scene. She had metal screws in her breast pocket and a cordless hand drill in her hand. The clothing of her upper torso was torn. Autopsy findings included arborization -- erythematous marks in a branching pattern characteristic of lightning injury -- on her left anterior torso but no other visible pathology related to the lightning strike. Case 2. In July 1997, a 47-year-old man in Florida was struck by lightning while golfing at a driving range at approximately 5:30 p.m. The skies reportedly were clear but a storm may have been forming in the area. EMS personnel arrived at 5:40 p.m. and found him without a pulse or spontaneous respirations. He was intubated at the scene, but resuscitation efforts were unsuccessful. He was transported to an emergency department, where his pulse rate and blood pressure were obtained. However, his pupils were fixed and dilated, and he was unresponsive to stimuli. A computerized tomogram (CT) of his head showed cerebral edema but no hemorrhage. Bloody drainage was noted from his nose and right ear. He gradually became hypotensive, and his blood pressure failed to increase with intravenous fluid. He was pronounced dead at 1:25 p.m. the following day. Autopsy indicated burns on his left hand and a second-degree burn with vesicle formation on his right back. His heart had epicardial petechiae on the anterior and posterior surfaces. His brain was edematous and had hypoxic injury to the neurons. Case 3. In September 1996, a 14-year-old boy in Washington was struck by lightning while riding his motorcycle during a thunderstorm. A bolt of lightning struck a tree near the motorcyclist, traveled along the trunk of the tree, then jumped from the tree to the motorcycle and the rider's feet and groin. Persons who saw the incident found him apneic and immediately began CPR. He was transported to the nearest hospital and was in cardiac arrest on arrival. Although he was successfully resuscitated and admitted to a hospital, he died 5 days later. Autopsy findings included a soft swollen brain with axial herniation and hypoxic injury to the neurons. The right side of his chest had singed hair, a healing burn injury, and damage to the underlying pectoralis muscles. His heart had multiple microscopic foci of myocardial necrosis, and his kidney had pink tubular casts consistent with myoglobinuria. Summary, 1980-1995

Death attributed to lightning was defined as any recorded death for which the underlying cause of death, or at least one cause of death, was coded E907 (lightning, excluding injury from fall of a tree or object caused by lightning) according to the International Classification of Diseases, Ninth Revision. The 1940 census was used for age-adjusted rates.

In the United States from 1980 through 1995, a total of 1318 deaths were attributed to lightning, (average: 82 deaths per year {range: 53-100 deaths}). Of the 1318 persons who died, 1125 (85%) were male, and 896 (68%) were aged 15-44 years. The annual death rate from lightning was highest among persons aged 15-19 years (6 deaths per 10,000,000 population; crude rate: 3 per 10,000,000). The greatest number of deaths attributable to lightning occurred in Florida and Texas (145 and 91, respectively), but New Mexico, Arizona, Arkansas, and Mississippi had the highest rates (10.0, 9.0, 9.0, and 9.0, respectively).

Reported by: S Nelson, MD, District Medical Examiner's Office, 10th Judicial Circuit of Florida, Lakeland; V Adams, MD, Hillsborough County Medical Examiner Dept, Tampa, Florida. D Selove, MD, Snohomish County Medical Examiner's Office, Everett, Washington. Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: The National Weather Service estimates that 100,000 thunderstorms occur in the United States each year; lightning is present in all thunderstorms. A cloud-to-ground lightning strike, the most destructive form of lightning, occurs when the electrical difference between a thundercloud and the ground overcomes the insulating properties of the surrounding air. The danger may not be apparent; lightning has struck 10 miles away from the rain of a thunderstorm (3). In the United States, cloud-to-ground lightning strikes occur approximately 30 million times each year (4), most often in Florida and along the southeastern coast of the Gulf of Mexico (5).

Data from the National Oceanic and Atmospheric Administration compiled primarily from newspaper clippings for 1959-1990 identified an annual average of 93 deaths and 257 injuries attributable to lightning (2). A study based on national mortality statistics from death certificates for 1968-1985 identified an annual average of 107 deaths and an annual death rate of 6.1 per 10,000,000 (2). Differences in these averages may be explained by the general decrease in the number of lightning-related deaths since the 1950s (1,2). Possible explanations for the decrease include fewer persons living and working in rural areas, improved warning systems, increased public education about safety regarding lightning, and improved medical care (2).

Previous studies have identified patterns associated with lightning fatalities. For example, approximately 30% of persons struck by lightning die, and 74% of lightning strike survivors have permanent disabilities. In addition, persons with cranial burns or leg burns from lightning are at higher risk for death than others struck by lightning (6). Sixty-three percent of lightning-associated deaths occur within 1 hour of injury (1), 92% occur during May-September, and 73% occur during the afternoon and early evening. Of persons who died from lightning strikes, 52% were engaged in outdoor recreational activities, and 25% were engaged in work activities (2). Most lightning injuries and deaths can be prevented by taking precautions (see box) (7).

Neurologic and cardiopulmonary injuries associated with lightning strikes are the most life-threatening. A lightning strike may immediately cause asystole, ventricular fibrillation, or direct central nervous system injury to the respiratory center. A direct lightning strike (i.e., when the major pathway of current flow is through the victim) can result in cardiac injury that can manifest as life-threatening pericardial effusion or severe cardiac dysfunction (8). Because persons struck by lightning have a better chance of survival than persons suffering cardiopulmonary arrest from other causes, resuscitation of persons struck by lightning should be initiated immediately (9).

References

1. Duclos PJ, Sanderson LM. An epidemiological description of lightning-related deaths in the United States. Int J Epidemiol 1990;19:673-9.

2. Lopez RE, Holle RL. Demographics of lightning casualties. Semin Neurol 1995;15:286-95.

3. Holle RL, Lopez RE, Howard KW, Vavrek J, Allsopp J. Safety in the presence of lightning. Semin Neurol 1995;15:375-80.

4. Krider EP, Uman MA. Cloud-to-ground lightning: mechanisms of damage and methods of protection. Semin Neurol 1995:15:227-32.

5. MacGorman DR, Maier MW, Rust WD. Lightning strike density for the contiguous United States from thunderstorm duration records. Washington, DC: US Nuclear Regulatory Commission, 1984; report no. NUREG/CR-3759.

6. Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med 1980;9:134-8.

7. National Weather Service. Thunderstorms and lightning...the underrated killers! -- a preparedness guide. Washington, DC: US Department of Commerce, National Oceanic and Atmospheric Administration, National Weather Service, 1994.

8. Lichtenberg R, Dries D, Ward K, Marshall W, Scanlon P. Cardiovascular effects of lightning strikes. J Am Coll Cardiol 1993;21:531-6.

9. Lifschultz BD, Donoghue ER. Deaths caused by lightning. J Forensic Sci 1993;38:353-8.

Preventing Deaths and Injuries from Lightning Strikes

• When participating in outdoor activities, be aware of weather forecasts during the thunderstorm season (generally May through September).

• Because lightning often precedes rain, preparations to avoid potential lightning strikes should begin before the rain begins.

• When thunder is heard, seek shelter inside the nearest building or an enclosed vehicle (e.g., a car or truck). If shelter is not available, avoid trees or tall objects because electricity may be conducted from that object to other nearby objects or persons.

• Avoid high ground, water, open spaces, and metal objects (e.g., golf clubs, umbrellas, fences, and tools).

• When indoors, turn off appliances and electronic devices and remain inside until the storm passes.

  
  

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