when lightning strikes

Monday, December 22, 2014

Christmas came early at Raymond James Stadium in Tampa this weekend, where the Packers played the Buccaneers. It wasn’t that Green Bay secured a playoff spot, or that the season was one game closer to being over for the Tampa faithful. Instead, it was that the lightning strike in the stadium parking lot, just as the game ended, didn’t kill anybody. The storm moved in quickly and had Mother Nature struck a few minutes earlier and a few yards to the right, a stadium full of fans could have been killed. Seven people were hospitalized and all survived being struck.

Lightning is the second most common cause of storm related deaths after flash floods and can attack a victim in many ways. Getting a direct hit by lightning is relatively rare; it’s the side splash from another object getting hit and ground current effect where lightning spreads along the surface of the earth to attack its victim. While tall, isolated objects tend to attract lightning, standing near a tree decreases the risk from a direct hit, but doesn’t protect against the splash or the ground effect.

The physics of a lightning strike are totally different from being electrocuted, and the injury patterns are different as well. Lightning spreads through the body but doesn’t cause tissue destruction like an electrocution. There is no muscle damage or kidney failure but there are electrical consequences. Death happens because the heart’s electrical conduction can fail. The electrical system within muscles can temporarily shut off. The brain, spinal cord and nerves’ electrical system can be damaged. Shockwaves causes by lightning can cause eardrums to burst, eye damage can occur and ferning or superficial burns to the skin may be seen. And then there are all the injuries if the victim is thrown a long way blown up by the force of the lightning strike.

After a group lightning strike, most people are just dazed and walk away but others may not be so lucky and sudden death befalls them. The lightning short circuits the heart’s electrical conduction system causing ventricular fibrillation. Instead of a coordinated rhythm that results in a heartbeat, the electricity is chaotic and the ventricle, the pumping chamber of the heart jiggles like a bowl of jello. In some cases, the heart restarts itself, but more likely, the patient will die without bystander CPR and an AED to defibrillate the heart and restore a normal heartbeat.

For lightning strike survivors, and more than 90% do, the most common minor injury is a burst eardrum, but it’s the central nervous system that may cause long term issues. The injured brain can sustain personality changes and seizures,   but other post-concussion type symptoms like headache, irritability and sleep disturbances can be more sever and last longer than the routine head bonk. The peripheral nerves can also be affected and the victim can develop with numbness and tingling of the extremities as well as chronic pain issues.

There are more than 100,000 thunderstorms in the US every year and all of them are associated with lightning. Not getting hit is the best treatment and that means getting indoors. A car is perhaps the most the accessible place to seek shelter. The thin rubber tires don’t protect against lightning, instead, the electricity flows through the metal in the car’s structure, and doesn’t attack the people inside. The experience may not be the most pleasant because there is still great force in a strike, but it is safe.

The Tampa storm emerged quickly and it would have been difficult to clear the stadium of spectators and get them to the safety of the concourses. As opposed to the metal stands that offered little protection to the fans at the Pocono Raceway when lightning struck there in 2012, football stadium concrete is a great barrier to lightning. The hard part is reminding people that the decision to evacuate tens of thousands of people out of their seats is not made just for show but can be lifesaving. Who knew the guy who predicts the weather would be the most important person at the game; maybe not for the scoreboard, but for everybody else in the stands.


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small favors

Monday, November 25, 2013

A crisis was brewing in room 12. Instead of the Green Bay-Vikings game, there was nothing but fuzz on the local Fox channel. The patient and family mentioned it in passing but clearly they were distraught. All were wearing Aaron Rodger jerseys and there was no doubt that it took a true emergency to bring them to the hospital, instead of being at home watching their beloved Packers play on TV.

There is nothing funny about being a patient in the ER. First, there is the illness or injury that prompted the visit. Second, there is the uncertainty of what the future might bring. Third, there is the unknown wait time, realizing that your care could be delayed because you are deemed less sick or hurt than the person being wheeled in on the next ambulance. And of course you have no real say in who is providing your care. Loss of control is a frightening thing.

But circumstance do arise that remind us of the humanity of the situation and in Wisconsin, football Sunday can bring the world to a stop. The Packers were playing and nothing much else matters to the bulk of state’s population. Our ER sits on the banks of Mississippi and across the river the green and gold is replaced by the purple of Minnesota and it is an easy way to break the tension when walking into the room to mention the colors that the patient is wearing. I’m certain the same situation happens on Saturdays in Alabama and Oklahoma but in Wisconsin, the fans own the team and having an undying allegiance.

The department was busy yesterday, even though the game was on at noon. Often we sometimes joke that patients try to rush in to be seen before the game starts or wait until after the final whistle to seek care, but in truth, the number of patients who register isn’t really affected by when the game is being played. Patients tend not to plan their emergencies, but it seems a little more festive hen the game is on. Normally, the television are turned to a variety of channels from CNN to HGTV (the Property Brothers seem to be a favorite), but on football Sunday, it’s wall to wall Packers. There are occasional cheers that are not because the lab test came back normal and that groan might be from a penalty or missed tackle instead of a spasm of pain.

I saw four plays all game. I watched with a family dressed in Viking home jerseys as Scott Tolzien rushed for his first touchdown as a Packer. They were not happy. They were less happy to know that abdominal CT scan that I had just ordered would take a couple of hours to complete. Never mind that all tests on House or Grey’s Anatomy can be done within the hour including commercials, but real world technology moves a little slower. I watched two plays with an older gentleman who remembered Bud Grant and Joe Kapp from Vikings history. I told him that I remembered those two from the Canadian Football League. He smiled. Play four was a Jordy Nelson catch, or I think it was but I couldn’t be certain in the fuzz of room 12.

There are small things that make the ER tolerable for patients. We have volunteers who provide coffee to families or help watch children. Our social workers try to find ways to keep elderly patients independent in their homes. There are nurses who stay late to comfort the family of a patient who is doing poorly. The art of medicine seems to be on display at the same time the science is being tended to.

And sometimes all it takes is the Packers and Vikings on the screen in the corner of the room to make even the most frightened patient smile just a little. I guess we’re readyfor some football.

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