Adventure Medical Kits - Adventure Discussions

Lightning Strike Treatment



Excerpt from A Comprehensive Guide to Wilderness and Travel Medicine, by Eric A. Weiss, M.D.

Lightning kills more people every year in the United States than all other natural disasters combined. Read our post on minimizing risk of lightning strike to prevent injury.


1.Direct Hit
Lightning directly strikes a person in the open. It usually does not enter the body, but instead is conducted over the skin surface (“flashover”), producing a variety of injuries. The greatest damage may occur to skin beneath metal objects worn by the victim, such as jewelry, belt buckles, or zippers, which tend to disrupt the flashover and allow current to penetrate. Current may also penetrate the body through the eyes, ears, and mouth, causing deeper injuries to those parts. The victim is exposed to a tremendous elec-tromagnetic field, which can disrupt the workings of the brain, lungs and heart and lead to a cardiac and respiratory arrest. Finally, the instant vaporization of any moisture on the victim’s skin can blast apart his clothing and shoes.

2. Splash
A more common scenario is for the victim to be struck by lightning “splash,” which occurs when a bolt first hits an object, such as a tree or another person, and then “jumps” to the victim who may have found shelter nearby. Splashes may also occur from person to person who are standing close together.

3. Step Voltage
Lightning hits the ground or a nearby object and the current spreads like a wave in a pond to the victims. Step voltage is often to blame when several people are hurt by a single lightning bolt.

4. Blunt Trauma
The explosive force of the pressure waves created by lightning can cause blunt trauma, such as spleen or liver injuries and ruptured ear drums.


1. Heart and Lung
Lightning can cause a cardiac arrest and paralyze the lungs. The heart will often restart on its own, but because the lungs are still not working, the heart will stop again from lack of oxygen.

2. Neurologic Injuries 
The victim may be knocked unconscious and suffer temporary paralysis, especially in the legs. Seizures, confusion, blindness, deafness, and inability to remember what happened may result.

3. Traumatic Injuries 
Bruises, fractures, dislocations, spinal injury, chest and abdominal injuries from the shock wave may occur. Ruptured eardrums can result in hearing loss.

4. Burns
Superficial first or second-degree burns are more common than severe burns after a lightning strike and form distinctive fern patterns on the skin.

Lightning strike victims are not “charged” and thus pose no hazard to rescuers.

  1. The immediate treatment of lightning strike victims differs from other situations in which you have multiple trauma victims. Rather than adhere to the standard rescue dogma of ignoring the victims who appear dead and giving priority to those who are still alive, after a lightning strike, treat those victims first who appear dead, because they may ultimately recover if quickly given mouth-to-mouth rescue breathing and CPR. If you’re successful in obtaining a pulse with CPR, continue rescue breathing until the victim begins to breathe on his own or you are no longer able to continue the resuscitation.
  2. Stabilize and splint any fractures.
  3. Initiate and maintain spinal precautions if indicated.


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