Lightning Safety in Athletics

Introduction

Most lightning related injuries are neurological in nature

• Cardiac and respiratory arrest

• Loss of consciousness

• Seizures

• Transitory paralysis to the extremities

• Confusion and amnesia

Other lightning related injuries include:

• Fractures

• Internal organ damage

• brain damage secondary to hypoxia

• Epidural and subdural hematomas

• Ruptured tympanic membranes

• Ocular injuries

Epidemiology

• The number of lightning related deaths decreased between 1968-85 from 130 to 85

◦Better resuscitation techniques

◦Better prevention methods

◦Decreased exposure

• Age related risk

◦Lightning deaths are most common ages 10-14 and 15-19

◦About 2.5-3 per 100,000, respectively

Risk factors in athletics: Geography

• Most lightning occurs in the eastern half of the united states

• Area of high occurrence of lightning deaths due to lightning runs from New York to Florida and extends west to the Mississippi River

• Mid atlantic states are among the highest in terms of lightning deaths

Risk Factors: Time of Day

Most lightning deaths occurred between 3 and 7 pm

• 95% of deaths occurred between Noon and 8pm

Risk factors: locality

• Outdoor athletic events most often occur on flat, open areas

  • fields

  • tracks

• Very rarely is there appropriate protection from the elements

• If there is protection, it is unlikely that it can accommodate participants, officials, and spectators

Risk factors: Summary

In terms of lightning risk, athletic events often occur at the worst possible time and the worst locations for us:

◦April to September

◦Practices and games usually mid afternoon to early evening

◦Eastern half of the United States

◦Mid-Atlantic Region

◦Inadequate protection at sites

Lightning Emergencies

•  A single bolt can strike a playing field, and the ramification of that strike can radiate out affecting nearly everyone within the area.

• Ground current is most common cause of death related to lightning

• Any lightning is dangerous (including cloud to cloud)

Prevention Strategies

Preparation

• become aware of your regions typical thunderstorm activity pattern

  • prevailing weather patters and direction

  • time of day storms typically form

• Have a plan of action if thunderstorms do occur in the area you are located

• Develop a lightning safety policy for your teams or institution to follow in the case of severe weather

Check the weather report the morning of the event at the very minimum

• television, radio, daily newspaper

Awareness of Storm Development

• Recognize the development of conditions which are prime for thunderstorms

  • high heat

  • high humidity

  • Cumulus clouds which develop vertical towers

    - characterized by a rounded bubble of cloud at the top

National Weather Service Guidelines

When should Activities Stopped?

• In general, a significant lightning threat extends outward from the base of a thunderstorm cloud about 6 to 10 miles. It’s important to account for the time it will take for everyone to get to safety. Here are some criteria that could be used to stop activities.

  • If you see lightning. The ability to see lightning varies depending on the time of day, weather conditions, and obstructions such as trees, mountains, etc. In clear air, and especially at night, lightning can be seen from storms more than 10 miles away provided that obstructions don’t limit the view of the thunderstorm.

  • If you hear thunder. Thunder can usually be heard for a distance of about 10 miles provided that there is no background noise. Traffic, wind, and precipitation may limit the ability to hear thunder to less than 10 miles. If you hear thunder, though, it’s a safe bet that the storm is within ten miles

  • If the skies look threatening. Thunderstorms can develop directly overhead and some storms may develop lightning just as they move into an area.

Lightning EAP!!

Safe Shelter

Buildings normally occupied by people

• Large metal buildings connected to ground

• Residences

Vehicles with solid metal tops such as automobiles, busses, vans

Unsafe Shelter

Metal topped structures with non conducting walls

Small buildings not connected to ground

• sheds

Under trees or other tall objects

Stay away from poles, antennas, or towers

Return to Activity

• Allow 30 minutes to pass after the last sound of thunder or flash of lightning before returning to activity

• As many lightning injuries occur after the peak lightning activity as before

  low flash rate periods had more casualties than high rate periods

Medical Consequences of Lightning strikes

• 50% of people struck by lightning will experience a ruptured tympanic membrane

• Fractures and contusions from being thrown by the air explosion resulting from lightning

• Concussions, ocular trauma, or burns

• Cardiac arrest

• Neurological system is most susceptible to injury and long-term consequences

• When treating victims of lightning, treat the apparently dead first (opposite of usual trauma triage)

S/SX of lightning strikes

• Usually obvious; thunderstorm is present

• Alert patients; may be dazed or confused (concussion-like symptoms)

Field Assessment techniques for lightning strikes

• The environment must be safe for HCP

  • 30 minutes without seeing lightning or hearing thunder

• There is limited data to determine true accuracy of various lighting detectors or apps

  • look for ones with external (not the company) research and validation

  • Use National Weather Service slogan: “When thunder roars, go indoors”

• Follow normal assessment for a patient

  • key is to quickly determine whether a patient can be moved inside or somewhere else

Diagnostic Accuracy of Lightning Strikes

• No specific diagnostic tools to determine lightning injury

• A victim of an unwitnessed lightning strike may be unconscious or semiconscious

• Clothing may be torn like they were attacked; indicates possible lightning strike

•  Lichtenberg figure

◦ Distinctive feathering marking found on lightning strike victims

◦ Transient sign; dissipates over time

Immediate Management Techniques for Lightning Strikes

• Patients are to be treated for the trauma sustained

• Each victim will have different injuries and should thus be treated for their respective injuries

• If patient is unconscious, always assume a cervical spine injury and treat accordingly

• if patient is not breathing and no pulse is present, activate CPR and EMS; apply an AED

Criteria for deciding to transport

• Consider transporting lightning strike victims to a health care facility as one would any other patient

• Transport anyone who is unresponsive, semiconscious, or has signs of shock

• Patients who are unstable, have open fractures, dislocations, or possibility of a cervical spine injury must be stabilized and sent via ambulance to an appropriate medical facility