Case Study 24

The Answer

Assessment

  • The patient does not appear to be injured from the lightning.
  • Bruise to left shoulder.
  • Dirty abrasions to left knee and hip.

The Plan

  • Clean and dress the abrasions.
  • RICE therapy for the shoulder.
  • Observe closely for any effects from the lightning.

Anticipated Problems

  • We anticipate the abrasions and shoulder soreness will be manageable and will not interfere with the trip.

Comments

Patient assessment and wound care are important, but the message in this tale is prevention.

The lightning experts tell us "when thunder roars, go indoors." This sound urban advice is impractical in the wilderness. 

The lightning experts also tell us that in the face of the massive unpredictable power of lightning there is no place outside that is safe. We can only reduce our risk by avoiding dangerous places and dangerous habits.

In some places storms happen at any time of day. In the Rocky Mountains they are predictable summer afternoon events. Learn these patterns, plan ahead, and act early.

Flash-bang ranging systems (sound traveling 1 mile/5 seconds or 1km/3 seconds) are illusions of predictability, especially in the mountains where sound swirls and bounces and storms move at varying speeds. Additionally, lightning reaches far in front and behind storms, occasionally striking "out of the blue."

Be watchful. React early. Seek a better location while you have time to improve your position. Choose uniform cover--trees of the same height and rolling hills (this may be an illusion of safety, but it seems better than being on top of the hill or under the only tree in the meadow). Get away from obviously poor locations: mountain summits, open water and open terrain, isolated trees, shallow overhangs and caves, and shorelines.

Only when you are out of options should you disperse your group to limit causalities (within reason, keep people safe and within contact) and assume a lightning position (sit on a pad, knees together). There is no science proving this position helps, but when we've exhausted options and can't go indoors it might provide a measure of comfort and perhaps some protection from ground current.

Be mindful of the human factor. I have heard lightning expert Mary Ann Cooper MD say that the primary risk factor is unwillingness to acknowledge the danger and to change plans. We knew better than to risk exposure on a high pass and an open meadow when thunderstorms were obviously brewing, but changing our plans was inconvenient. We rationalized that youth and speed reduced our risk and chose to believe that this wouldn’t happen to us. We waited too long before seeking the shelter. We were speedy hikers, but lightning moves, well, fast as lightning.

End of the Tale

This experience scared me. I was offered a lesson, and I learned it.