Adapted from Seminars in Neurology, Volume 15, Number 4, December 1995

Copyright © 1995

(Permission for use on this page kindly granted by Thieme Medical Publishers Inc.)

Injuries from man-made, generated, or "technical" electricity have been reported for only about 150 years; but injuries from lightning must surely predate written records.  Depictions of lightning affecting people or events appear in writings and drawings from almost every ancient religion.  Although such an occurrence was sometimes interpreted as a positive sign of blessing, more often it was seen as a sign of the god's warning or vengeance.
 
Priests, the earliest astronomers and meteorologists, became proficient at weather prediction, interpreting changes in weather as omens of good or bad fortune, sometimes to the advantage of their political mentors.  Observations of lightning and other natural phenomena were often used to decide matters of state, the scheduling of battles or other events. Lightning from the east was usually seen as a good omen. This is reasonable because it is probably the end of a storm.  Lightning from the west was ominous, but also meant a storm was  probably approaching.
 
Over the centuries, superstitions and myths have grown up about lightning that include avoidance, protection, the types of injuries, and their treatment. In this article, I cannot be all  inclusive but will attempt to discuss some of the more common ideas, particularly those related to the medical field, as well as some myths about injuries from the newer form of injury by generated electricity. I will leave discussion of appropriate lightning and electrical protection to those who are more knowledgeable in these areas and have been kind enough to write articles for these issues of Seminars.
 
Disclaimer: This article is not meant to be a scientific treatise but to be entertaining and perhaps enlightening (no pun intended since it is a different spelling). I am giving my best reply to these myths based on a composite of 20 years of experience, reading, and discussions with patients, families, and professionals from many areas of expertise. I have had to reverse myself enough times since I began investigating lightning injuries in 1977 to ever claim that I know all there is to know about it and will be the first to encourage research into any of these questions. It seems that everyone has a lightning story.  I hope you will have fun reading this and investigating these areas for yourself. Lightning and electrical injuries are fascinating and the myths that have grown up about them are myriad. I invite you to collect your own. If you will be kind enough to send them to me, I will forever be in your debt.
 

                        CLASSIFICATION OF MYTHS

 
Beliefs have grown up about these injuries that I will arbitrarily divide into the following groups:
 
            1. Occurrence and demographics
            2. Effects of the strike/types of injuries
                    a. Positive effects
                    b. Negative effects
            3. Significance of the strike
            4. Prevention/ avoidance
 

 OCCURRENCE AND DEMOGRAPHICS

 
    "I will probably never treat a victim of a lightning injury in my practice because they are so rare. "
 
    False. It is true that injuries from electrical injuries are probably more common than lightning injuries, especially when low-voltage injuries are included. Best estimates place lightning injuries at somewhere between several hundred and a few thousand per yearn 4 It is common for the victims to avoid medical care initially, hoping that the symptoms will subside in a few hours or days. Most are not admitted to the hospital and thus do not become part of any state hospital admission databank. Lopez and Holle have done some of the best studies on the epidemiology of lightning injuries and I refer you to their articles in these issues and elsewhere. (5,6) It would be unusual to meet a neurologist who has not had at least one patient with complaints referable to an electrical event.  Much research remains to be done into the best treatment, the differences between these groups, and long-term effects.
 
    "I will probably never treat a victim of a lightning injury in my practice because no one lives to Tall about it."
 
    False. In 1980, I published a study of collected literature and found only a 30% mortality.(7) Andrews (8) repeated the study a few years later and calculated it slightly differently at 20%. Both reviews would overestimate the mortality, as case reports will always be biased toward the more severe or interesting cases.  Although Holle and Lopez report figures somewhat differently, my best guess on the mortality from lightning would be about 3 to 10% of all incidents. Projecting from numbers of between 75 and 150 reported deaths per year (and many do not get coded appropriately), there may be as many as 750 to 5000 injuries per year.
 
    "Nowadays  most lightning injuries occur on the golf course. "
 
    False. Indeed, a large number are work-related. These include injuries to postal and construction workers and persons using telephones that have not been properly grounded. (5) The numbers of farmers injured has decreased farmers to work larger fields in better-protected vehicles. Injuries during recreation have increased. They occur to joggers, hikers, and campers, as well as golfers. In addition, a significant number of people are injured while participating in team sports.

    "Some people can attract lightning."
 
    Some have called themselves "human lightning rods," claiming that thunderstorms would change course to find them or that they had been struck multiple times. Given my experience with lightning victims, I must say that, although some may suffer little injury from a single strike, the majority have some type of sequela. When one claims to have been hit 20 or more times, the odds of being able to talk about it decrease logarithmically. Would any reasonable person not have enough sense to learn to avoid lightning after the first couple of hits?
 
 

                      EFFECTS OF LIGHTNING STRIKE/ELECTRIC SHOCK

 
    These effects are what these two issues of Seminars in Neurology are all about: we have tried to address most of the questions that arise about electrical and lightning injuries, and the differences between lightning and electrical injuries and their treatment have been discussed in other articles.

    Because so little has been studied in these injuries, it is often difficult to sort out the complaints that are real from those that are metaphysical, compensation-related, or due to normal aging. As discussed in the article by Engelstatter and Primeau, (9) a marginally compensated individual may see the injury as the precipitant for all subsequent problems in life. Although the physical and cognitive complaints are sometimes vague and often  do not show on standardized testing, nevertheless, they present a consistent complex that is difficult to disbelieve after listening to them for 15 years from people who have nothing to gain from their disability. Even the complaints that we can objectify often have no good treatment, frustrating both the patient and the physician.

    Among the claims of positive effects of lightning strike (and sometimes electrical injury) are the cures for persons who have   been blind, deaf, or had serious illnesses. A few years ago there was a very well-publicized case of an elderly gentleman who was cured of his blindness and deafness by a lightning strike. Those of us who were consulted on this knew that these were hysterical complaints suffered as a result of a truck accident many years before but forbade the press to quote us out of respect for the gentleman.

    I have had one call from another gentleman who asked if lightning could cause "hyper sexuality" because after his lightning injury he could not seem to get enough sex. While there is a neurological injury that can cause hypersexuality, more commonly lightning and electrical injury causes impotence, as a result of either direct nerve or spinal cord injury or depression. There is one published claim of improved intelligence on psychological testing after a prolonged cardiac arrest in a pediatric patient. A woman in southern Illinois became psychic after suffering a lightning strike while asleep in bed. Reportedly, her powers have been used by police agencies in locating missing persons and solving cases.

    If remissions or cures of serious illness have occurred, as some have claimed, praise God, and I am happy for them and will not dispute their conclusions, but I cannot explain it by any medical literature, only supposition.

    The medical literature and medical practice are resplendent with examples of myths that grow out of misread, misquoted, or  misinterpreted information and that then continue to be  propagated without further investigation, particularly when the author is an individual well-respected for other accomplishments. Not the least of these is the tenet that lightning victims who have     resuscitation prolonged for several hours may still successfully recover. This belief seems to be grounded in the old idea of    "suspended animation" the concept that lightning is capable of  shutting off systemic and cerebral metabolism, allowing rescuers a longer period in which to resuscitate the patient. This concept, credited to the only article that Taussig ever wrote on lightning, actually first appeared in an article that was published quite some time before hers. The case recounted by Taussig that is the basis  for this myth, when searched to its source, was a case reported by Morikawa and Steichen, F. While it does show a somewhat longer resuscitation period than usual, it is not as miraculous as reported in her paper or as propagated in subsequent references to it.

    On the other hand, in a study of lightning survivors, Andrews has shown increasing prolongation of the QT interval, bringing up the theoretical possibility of toursades as a mechanism for the suspended animation reports.' Theoretically, if lightning hit at the right instant of the QRS interval, a toursades type of rhythm might occur, not only supplying minimal cerebral  perfusion, but also perhaps resolving spontaneously. Toursade certainly has a better prognosis than fibrillation or asystole.     There is new evidence from animal experiments to support the teaching that respiratory arrest may persist longer than cardiac arrest.  (13,14) This study, in which Australian sheep were hit with simulated lightning strokes, showed histologic evidence of greater damage to the respiratory centers than the cardiac center in the  medulla. Prolonged assisted ventilation may then, in some cases, be successful after cardiac activity has returned.

    Among the myths about negative effects is the "crispy critter" myth.(3)  This is the belief that the victim struck by lightning bursts into flames or is reduced to a pile of ashes. In reality, lightning often flashes over the outside of a victim, sometimes blowing off the clothes but leaving few external signs of injury and few, if any, burns.

    Two other myths held by the lay public as well as many physicians that are particularly harmful to the lightning survivors are, "If you're not killed fly lightning you A be OK" and, "If there are no outward signs of lightning injury, the injury can't be serious.(8)  The medical literature, by lack of follow-up case reports, implies that there are also few permanent sequelae of lightning  injury. However, in the last few years, it has become apparent  that permanent sequelae may and often do occur. In addition, both lightning and electrical victims with significant sequelae may have no evidence of burns. While the effects of amperage and voltage have been studied in animals, the effect of frequency, radio waves, and body impedance, as well as other effects, have not been elucidated well enough for us to be able to explain many injuries.

    A myth that is still prevalent today is that the victim of lightning retains the charge and is dangerous to touch, since he is still "electrified " This idea has led to unnecessary deaths because of delaying resuscitation efforts.

    Many patients, particularly those without external signs of injury, have been told, most often by medical professionals, that they have "internal burns" that are the cause of their problems. This is both a misnomer and an oversimplification for the cellular, vascular, biochemical, or other types of damage they may have incurred. So many questions need to be investigated in lightning and electrical injuries.
 

   SIGNIFICANCE

 
    "Lightning is a sign from God. "
 
    I can claim no inside track on this one. Ancient Romans saw Jove's thunderbolts as a sign of condemnation and denied burial rites to those killed by lightning. Andeans hold similar beliefs and may ostracize the victim. In some cultures, medicines are made from stones that are believed to be a result of lightning strike. Roman, Hindu, and Mayan cultures all have myths that mushrooms arise from spots where lightning has hit the ground.(5)

    In the poly-ethnic United States, belief in "fate" or "God's will" may affect how family, friends, or coworkers relate to the victim or how the victim feels about himself and his recovery. Some patients may have already consulted a healer before finally seeking the advice of a physician and in rare instances it may be difficult to treat a patient unless the help of a shaman or priest is employed to address the religious issues while the physician addresses the physical ones.
 

 
    Several Roman emperors wore laurel wreathes and sealskin, which were believed to be protective. Pliny taught that a sleeping person was safe from lightning. Some of the references at the end of this article detail even more curiosities and myths.

  "Wearing a rubber raincoat (substitute sneakers or other forms of clothing here) will decrease my chances of being hit." Conversely: "Wearing cleated shoes increases my chances of being struck."

    False, and probably false. The first is easy to dispel:  if lightning has burned its way through a mile or more of air (which is a superb insulator), it is hardly logical to believe that a few millimeters of any insulating material will be protective. The second is a subject of contention but I tend to believe that there would be little effect from whatever is on the bottom of your feet. Certainly metal on the bottom of the feet can heat up and cause secondary burns, but it is unlikely to "draw" lightning to the person.
 
    "I am safe in a car because the rubber tires protect me."
 
     True and False. True because there have been no documented lightning deaths that have occurred in a hard topped metal vehicle with the windows rolled up. However, the composite tires have little, if any, part in this, for the same reasons as those just discussed with regard to insulation. The safety has to do with the fact that electrical current travels along the outside of a conductor (the metal body of the car) and dissipates to the ground through paths that include the tires and the rainwater.
 
    "Wearing metal in my hair increases my chances of being hit. "
 
    Questionable, although opinions exist both ways. Hairpins (who uses those anymore?) may be safe; metal helmets may not. The issue needs more study (and more publication).  Kitigawa has shown fairly conclusively with dummies that metal about the head does not increase the likelihood of being hit (unless it projects far above the head, increasing the person's height).

 
    "Carrying an umbrella increases my risk of being hit. "
 
    True. Increasing your height by any amount increases your chances of being hit by a calculable amount, although a prospective, population-based, double-blind, randomized study has not been done to prove this, nor has the composition (metal versus composite or plastic) of the umbrella or one-iron been studied. Other dangerous things to avoid:  avoid being the highest object anywhere, be it a beach, small open boat, pier, meadow, or ridge. Avoid being under a lightning rod (except when inside a substantial habitable building that is protected) or standing near a metal fence, underground pipes, or other metallic paths that can transmit lightning energy from a nearby strike. Avoid swimming, because lightning energy can be transmitted through the water to you. Sailboats should be equipped with adequate lightning protection systems.
 
    "When outdoors, I should stay away from trees."
 
    Mostly true. Certainly you should stay away from the tallest trees, which are more likely to be hit and side-flash or splash to you. However, one would not want to become the tallest object in an area by standing in a meadow, either. Making the shortest, smallest target is probably the best answer if caught in the open. If you are in a forested area, it may be wise to pick an area of dense growth of saplings or smaller trees, rather than either a large meadow or tall trees. If on a ridge, get to a lower area.

    Seeking shelter in a substantial building when possible is advisable. The sheds on golf courses, unless adequately protected by a lightning mitigation system, are potentially more dangerous because they offer height but little protection and lightning may splash from a hit to the shelter onto the inhabitants.

"When lightning hits the ground nearby, it is 'grounded ' and I am safe. "
 
    Totally and absolutely FALSE. Despite the fact that we call the earth a "ground," it is very difficult to pump electricity into the ground. Most "earth" is a very good insulator.  When lightning hits the ground, it spreads out along the surface and first few inches of the ground in increasing circles of energy called "ground current." If it contacts a fence or a water pipe or wire entering a house it can be transmitted for quite a distance and cause injury to persons near these paths. People, being bags of electrolytes, are better transmitters of electrical current than most ground is, and many are injured by ground current effect each year as the lightning energy surges up one leg that is closer to the strike and down the one further away.
 
"My mother always told me to stay off the telephone (out of the bath tub, away from windows, unplug the appliances, etc.) during a thunderstorm. "
 
    Good advice, if not always practical. Again, the ground current effect of energy transmitted into the structure along wires or pipes may find the person a better conduit to ground.(3,4) Many injuries occur every year to telephone users inside the home. One of the biggest new areas of consumer fraud has to do with claims of loss of "valuable" databases on computers damaged by lightning.(5)

    "Lightning only occurs with thunderstorms."
 
    Most people know to seek shelter once the storm clouds roll overhead. Few realize that one of the most dangerous times for a fatal strike is before the storm. Lightning may travel as far as 10 km nearly horizontally from the thunderhead and seem to occur "out of the clear blue sky" or at least when the day is still mostly sunny. The faster the storm is traveling and the more violent it is, the more likely this is to occur. Another time underestimated for its potential danger is the end of a thunderstorm.(2-6)
 
    "If we could just harness lightning we could use that to power the world for months. "
 
    Uman eloquently explains the reason this cannot be done and is false in his book, All About Lightning.(2)  He makes two points:  it is impractical to intercept a sufficient number of the lightning strikes occurring in the world, and most of the energy in a lightning strike is converted to thunder, heat, light, and radio waves. He notes, "If its total energy were available, a single lightning flash would run an ordinary household light bulb for only a few months."(2)
 
    "Lightning could be used for a military weapon. "
 
    Again, Uman (2), a professor of electrical engineering who writes with wonderful clarity, is my source. "In view of the awesome destructive power of modern weaponry, the military use of lightning . . . would probably be more as a psychological than as a destructive weapon."(2)

And last but not least, "Lightning never strikes the same place twice."

    In reality, the Empire State Building and the Sears Tower get hit thousands of times a year, as do mountain tops and radio-television antennas. If the circumstances facilitating the original lightning strike are still in effect in an area, then the laws of nature will encourage lightning strikes to continue to be more prevalent there. After all, that is the reason that lightning protection systems are required on many public buildings (including hospitals) by building codes.
 

                CONCLUSION

 
    Lightning and electrical injuries are fascinating and the myths that have grown up about them are myriad. I invite you to collect your own. If you will be kind enough to send them to me, I will forever be in your debt.
 

                REFERENCES

 
1. Prinz:  Lightning in history. In Golde RH, ed.  Lightning, Vol 1. San Francisco: Academic Press, pp1-20, 1977.
 
2. Uman MA. All about lightning. New York: Dover, pp 1-160, 1986.

3. Cooper MA, Andrews CJ:   Lightning injuries.  Auerbach P ed. Wilderness Medicine, Management of Wilderness and Environmental Emergencies, 3rd ed. St. Louis: CV Mosby, pp 261-89, 1995.
 
 4. Andrews CJ, Cooper, MA, ten Duis HJ, Sappideen C. The pathology of electrical and lightning injuries. In Wecht CJ, ed. Forensic Sciences, release 19 update. New York: Matthew Bender & Co., 1995:23A-3-23A-165
 
 5. Lopez RE, Holle RL, Heitkamp TA. Deaths, injuries, and property damage due to lightning in Colorado from 1950 to 1991 based on Storm Data. In National Oceanic and Atmospheric Administration Technical Memorandum ERL NSSL-103
 
 6. Holle RL, Lopez RE, Ortiz R. et al. Cloud-to-ground lightning related to deaths, injuries and property damage in central  Florida. In Proceedings, International Conference on Lightning and Static Electricity, October 6~, Atlantic City, NJ, FAA Report No. DOT/FAA/CT-92/20,, 1992.
 
 7. Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med 9:134-8, 1980.
 
 8. Andrews CJ, Darveniza M, Mackerras D. Lightning injury a review of clinical aspects, pathophysiology and treatment.   Adv Trauma 4:241-52, 1989.
 
 9. Primeau M, Engelstatter GH, Bares KK Behavioral consequences of lightning and electrical injury. Semin Neurol 15:279-85, 1995.
 
10. Taussig H. "Death" from lightning and the possibiliq of living again. Ann Intern Med 68:1345-50, 1968.
 
11. Morikawa S. Steichen F. Successful resuscitation after "death" from lightning. Anesthesia 21:222-3, 1960.
 
12. Andrews CJ, Colquhoun DM, Darveniza M. The QT interval in lightning injury with implications for the 'cessation of  metabolism' hypothesis.J Wilderness Med 4:155-66, 1993.
 
13. Andrews CJ, Darvenia M: Effects of lightning on mammalian tissue. Proceedings, 1989 International Conference on  Lightning and Stahc Electricity, Sept 26 28, Bath, England,  4A.4.1-4A.4.4, 1989.
 
14. Andrews CJ, Darveniza M. New models of the electrical insult in lightning strike. Proceedings, 9th International Conference on Atmospheric Physics, St. Petersburg, Russia, 1992.
 
15. Lowy B. Amanita muscaria and the thunderbolt legend in Guatemala and Mexico. Mycologia 66:188-90, 1974.
 
16. Ackerman L. Personal communication, Price-Hollingsworth Company.
 

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