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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).

Table 213-1 Comparison of Lightning and Electrical Injuries

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