Wilderness Medical Society Issues Important New Practice Guidelines for Prevention and Treatment of Lightning Injuries

Published in Wilderness & Environmental Medicine

Philadelphia, PA, August 28, 2012 – About 24,000 people are killed by lightning every year, with about 10 times as many people injured. The Wilderness Medical Society has issued important new practice guidelines for precautions that can lower the likelihood of being killed or injured and recommendations for effective medical treatments post-strike. These guidelines appear in the September issue of Wilderness & Environmental Medicine ( www.wemjournal.org/article/S1080-6032(12)00180-9/fulltext).

Updating the 2006 guidelines, a panel of experts chosen for their clinical or research experience convened at the 2011 Annual Meeting of the Wilderness Medical Society in Snowmass, CO. Their task was to develop evidence-based practice guidelines for the prevention and treatment of lightning injuries to guide clinicians and disseminate knowledge about best practices.

“With some basic prevention strategies and common sense the vast majority of lightning injuries can be prevented,” commented Chris Davis, MD, Wilderness Fellow and Clinical Instructor, University of Colorado Hospital, Department of Emergency Medicine, Aurora, CO. 

Lightning-related deaths in the United States have declined consistently over the last 50 years to approximately 40 per year. More than 80% of victims are male and most deaths occur in individuals between 20 and 45 years of age. The prevention strategies outlined in these guidelines have the potential to reduce these fatalities and injuries further.

Using the American College of Chest Physicians classification scheme for the quality of evidence and recommendations, the panel identified 5 stronger and 2 weaker recommendations concerning prevention strategies. These include taking shelter when thunder is heard and avoiding bodies of water during lightning events.

The mechanism of sudden death from lightning strike is simultaneous cardiac and respiratory arrest. In many victims, despite return of spontaneous circulation (ROSC), a second cardiac arrest may occur if ventilation is not supported. This highlights the need for a “reverse triage” system for lightning strike victims where priority is initially given to those individuals without vital signs or spontaneous respirations. This and 17 other strategies for the treatment of injuries are included in the guidelines.

The panel concludes that "This article provides a summary of available evidence for the prevention and treatment of lightning injury. Most available data are based on small, retrospective case reports or series because the prospective study of lightning injuries is not logistically and ethically possible. Although the strength of the overall evidence is limited, the authors believe that many recommendations can be strongly supported as there is little risk of associated harm."
 

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Notes for editors
“Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries" by Chris Davis, MD; Anna Engeln, MD; Eric Johnson, MD; Scott E. McIntosh, MD, MPH; Ken Zafren, MD; Arthur A. Islas, MD, MPH; Christopher McStay, MD; William ‘Will’ R. Smith, MD; and Tracy Cushing, MD, MPH. It appears in Wilderness & Environmental Medicine, Volume 23, Issue 3 (September 2012) published by Elsevier. As a service to the medical community the article is freely available at www.wemjournal.org/article/S1080-6032(12)00180-9/fulltext.

To schedule an interview with the authors please contact Chris Davis, MD at christopher.davis@ucdenver.edu.

The panel on Lightning Injury Prevention and Treatment met during the 2011 Meeting of the Wilderness Medical Society (WMS) in Snowmass, CO. Panelists were:

Chris Davis, MD
Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO

Anna Engeln, MD
Tracy Cushing, MD, MPH
Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, CO

Eric Johnson, MD
Department of Wound Healing and Hyperbaric Medicine, St Alphonsus Hospital, Boise, ID, and Emergency Services, Teton Valley Hospital, Driggs, ID

Scott E. McIntosh, MD, MPH
Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT

Ken Zafren, MD
Division of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, the Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, and the International Commission for Mountain Emergency Medicine

Arthur A. Islas, MD, MPH
Department of Family & Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX

Christopher McStay, MD
Department of Emergency Medicine Bellevue Hospital Center/New York University School of Medicine, New York, NY

William ‘Will’ R. Smith, MD
Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, and the Department of Emergency Medicine, St. John’s Medical Center, Jackson, WY

About Wilderness & Environmental Medicine
Wilderness & Environmental Medicine (WEM), the official journal of the Wilderness Medical Society, is a peer-reviewed international journal for physicians practicing medicine in austere environments. It is devoted to original scientific and technical contributions on the practice of medicine defined by isolation, extreme natural environments, and limited access to medical help and equipment. Sampling of topics covered: high altitude and climbing; hypothermia and cold-induced injuries; drowning and near-drowning; hazardous plants, reptiles, insects, and marine animals; animal attacks; search and rescue. www.wemjournal.org

About the Wilderness Medical Society
Founded in 1983, the Wilderness Medical Society (WMS) is the world's leading organization devoted to wilderness medical challenges. Wilderness medicine topics include expedition and disaster medicine, dive medicine, search and rescue, altitude illness, cold- and heat-related illness, wilderness trauma, and wild animal attacks. WMS explores health risks and safety issues in extreme situations such as mountains, jungles, deserts, caves, marine environments, and space.

Society members have a long-standing commitment to education and research. WMS sponsors accredited continuing medical education conferences that combine exceptional educational presentations with a variety of hands-on workshops. The Society publishes a peer-reviewed medical journal, a quarterly newsletter, educational presentation series on wilderness medicine topics consisting of slides and a text, and practice guidelines for wilderness emergency care. Each year the Society awards research grants, advancing academic careers and expanding the knowledge and understanding of wilderness medical issues. WMS also fosters Student Interest Groups (SIGs) on seventy-one medical school campuses. For more information on the WMS, or to become a member, please visit us at www.wms.org.

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