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Lesson

Electrical & Lightning Injury

10 min Trauma Skip to quiz

Objective: Confirm the power is off before you touch the patient. In a lightning strike, treat the people who look dead first. Then run the arrest you actually have.

Why this matters

A power line is down, and a person is already injured. If you touch them while they are still in the circuit, you become the next patient. Electrical injury and lightning are special circumstances.

Lightning reverse triage is real. The people who look dead may be in ventricular fibrillation or asystole, and they may still be salvageable. The usual mass-casualty habit is to leave the people who look dead. That is the wrong first choice here.

Key points
  • Do not touch the patient until the line is de-energized or they are clear of the circuit. Call the utility. Do not become a second patient.
  • In a lightning mass casualty, treat the pulseless patients first. That is reverse triage. They may still respond to defibrillation.
  • After return of spontaneous circulation, still look for trauma. They may have been thrown. They may have burns. They may have a spine injury.
Verbalize
  • The line is off before we touch.
  • Lightning: work the apparently dead patients first.
  • After pulses return, this is still a trauma patient.

Clinical sequence

  1. Do not touch the patient until the power is confirmed off or they are no longer in the circuit. Call the utility.
  2. In a lightning mass casualty, treat pulseless patients first. That is the opposite of the usual START approach that leaves the apparently dead. START means simple triage and rapid treatment.
  3. After pulses return, look for injuries from being thrown, burns, and spine injury. Treat those too.

Teaching points

  • Electrical injury: note high versus low voltage if you can, look for entrance and exit burns, and expect later muscle breakdown with high potassium. If they were thrown, protect the spine while you manage the airway.
  • Lightning: use reverse triage. Do not start by skipping the people who look dead.
  • Arrest: defibrillate ventricular fibrillation the same way you always do. A longer resuscitation attempt may be reasonable. Follow special-circumstances teaching and your protocol.
  • Burns can hide deep injury. Go to a hospital that can manage burns and trauma.

Common errors

  • Touching a victim who is still in contact with a live line.
  • Using standard START triage that skips the apparently dead after lightning.
  • Forgetting the spine after the patient was thrown.

Practice

One-minute check

Answer two scenes. A downed line is still arcing and one person is down. Who do you treat, and when do you touch them? Lightning has dropped six people and two look dead. Who do you work first?

Related: Burns, CPR.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. The victim is still in contact with a live line. What do you do?
2. Lightning strike, several people down, two look dead. Who do you work first?
3. VF after electrocution. What is the shock plan?
4. They were thrown by a blast of current. How do you frame the rest of the call?
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