++
Lightning causes approximately 1000 injuries each year in the
U.S. and is the second leading cause of weather-related death, with
approximately 100 reported deaths each year.1,2
++
Reported mortality rates vary from approximately 0.5 per million
in the general U.S. population to as high as 8.8 per million in
the rural South African population.3 Lightning
injury reporting is biased toward the more severe and fatal events,
and it is estimated that many unreported lightning injuries occur
each year, perhaps up to several thousand cases. Approximately 70% to
90% of persons struck by lightning survive, but as many
as three quarters of these survivors have permanent sequelae.4,5 Livestock
and other animals also experience deaths and injuries from lightning.
++
Lightning most often occurs during thunderstorms in association
with large cumulonimbus clouds. However, approximately 10% of
lightning occurs without rain and when the sky is blue.6 In
addition, lightning can occur during dust storms, sandstorms, tornados,
hurricanes, snowstorms, and nuclear explosions, and in the clouds
over volcanic eruptions.
++
Lightning injuries can occur while riding in airplanes (both
private and commercial) and engaging in water sports. Lightning
injury associated with indoor telephone use during lightning storms
has been reported. A study in Australia identified up to 80 such
injuries yearly without any reported fatalities.7
++
Even though lightning is electrical energy, lightning injuries
differ substantially from high-voltage electrical injuries seen
in association with human-generated sources. There are differences
in injury patterns, injury severity, and emergency treatment3,8,9 (Table 213-1).
++