Electrical & Lightning Injury
Objective: Make the scene dead, reverse-triage lightning victims who look dead, and run the arrest you have.
Why This Is Hard
The wire is down and someone is already a patient. If you grab them you are next. AHA 2025: electrical/lightning is a special circumstance. Lightning reverse triage is real — the ones who look dead may be salvageable VF/asystole.
- Do not touch until the line is dead or they are no longer in the circuit. Utility, not heroics.
- Lightning mass casualty: treat the pulseless first (reverse triage).
- After ROSC they can still have trauma from being thrown, burns, and a spine.
Field Rules (Education)
- Electrical: high vs low voltage, entrance/exit burns, rhabdo/hyperK later, C-spine if thrown.
- Lightning: reverse triage. Standard MCI “left for dead” is the wrong first pass.
- Arrest: defibrillate VF. Prolonged resuscitation may be reasonable. See special circumstances.
- Burns can hide deeper injury. Destination burn/trauma capable.
Field Pitfalls
- Grabbing the victim still in contact with a live line.
- Standard START that skips the apparently dead in lightning.
- No C-spine thought after they were thrown.
Practice
60-second drill
Partner: (1) downed line, still arcing, one victim; (2) lightning, six people, two look dead. Who you treat first.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- AHA 2025 Part 10: Special Circumstances — electrical/lightning: scene safety, reverse triage for lightning, standard defibrillation
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.