Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience.

INTRODUCTION: Electrical injuries can be devastating, and data is lacking in low-resource settings. We aimed to identify predictors of mortality following electrical and lightning injuries (ELI) in Malawi. METHODS: We performed a retrospective observational study of patients presenting with ELI and burn injuries at a tertiary hospital in Malawi from 2011 to 2020. Outcomes were compared and predictors of mortality were modeled. RESULTS: A total of 382 ELI and 6371 burn patients were included. The mean ages for ELI and burn groups were 24 ± 14 and 11 ± 14 years, respectively (p < 0.01). Most patients were injured at home (91% in the burn group versus 51% in the ELI group, p < 0.01). The crude mortality rate in the ELI group was 28%, compared to 12% in the burn group (p < 0.01). On multivariate logistic regression, predictors of mortality included ELI (odds ratio [OR] 13.3, 95% confidence interval [CI] 7.2-24.5) and total body surface area burned (OR 1.1, 95% CI 1.1-1.1). Predicted mortality for ELI has increased over time (p = 0.05). CONCLUSIONS: ELI confers more than 13 times higher odds of mortality than burn injuries in Malawi, with mortality risk increasing over time. More efforts are needed to prevent electrical hazards and implement timely interventions for patients with ELI.

Alarming rise in fatal electrocutions in Bangladesh: Comparison of two national surveys.

BACKGROUND AND OBJECTIVES: Electrical injuries are major contributor to burn-related mortality and morbidity. Mortality data were compared from the two largest community-based health and injury surveys in Bangladesh conducted thirteen years apart to investigate the changes in epidemiological features of this adverse health event. METHODS: The nationwide Bangladesh Health and injury surveys (BHIS) were conducted among 819,429 people in 2003 and 299,216 in 2016 using a pretested semi-structured questionnaire at the household level. History of electrocution death events in previous one year in the household was determined by verbal autopsy method in both surveys. Thus, each survey result represents the scenario of the year before. Descriptive and comparative analysis was done to investigate the changes in the distribution of electrocution deaths. RESULTS: The incidence of electrocution deaths was 1.7 and 4.3 per 100,000 population respectively in the 2003 and 2016 survey. The majority of the cases were aged between 18 to 59 years in both years. The comparison of the two survey results shows that the death rates increased in every age group those were examined. The rates were persistently higher in rural areas compared to the urban. Moreover, the rural mortality rate increased strikingly in 2015. The highest proportion of fatal electrocution events occurred at workplaces and males had a higher mortality rate in contrast to females in both the surveys. The death rate in males doubled in 2015 (6.0 per 100,000) from 2002 rate (3.1 per 100,000). CONCLUSION: Electrocution mortality rates have raisen alarmingly between 2002 and 2015. Working persons and males have a higher susceptibility to deaths from electrocution. Rural areas pose greater threats compared to urban Bangladesh. Being derived from a nationwide survey, these facts provide with useful direction to set priorities for prevention of this emerging unnatural cause of death in the country.

Lightning injuries in Northern Ireland.

INTRODUCTION: Lightning injuries are uncommon in Northern Ireland (NI) with scarce reports detailing incidence and local experience. We present a case study of 3 patients involved in a single lightning strike with a review of the incidence of similar injuries in the province. METHODS: Data from TORRO's National Lightning Incidents Database between 1987 and 2016 (30 years) were searched to identify victims of lightning injuries in NI. Information on 3 patients with lightning injuries that were managed in our regional burns and plastic surgery service was collected and examined. A supplementary search in hospital records was conducted over the last 20 years to identify additional data. RESULTS: Prior to our study, 6 victims of lightning injuries were identified of whom 5 survived and 1 died. Our 3 patients comprised of 2 children and 1 accompanying adult. All survived but the adult suffered cardiac arrest and required a prolonged period of cardiopulmonary resuscitation. CONCLUSION: While lightning injuries are rare in NI, this is the first report of more than one person affected by a single lightning incident in the province. In our limited experience, immediate public response and prolonged cardiopulmonary resuscitation efforts facilitated by automated defibrillators result in a favourable outcome.

Update: Lightning strike injuries, active component, U.S. Armed Forces, 2008-2017.

During 2008-2017, a total of 241 service members had incident lightning-related medical encounters with ICD-9 or ICD-10 codes that documented specific lightning-associated injuries or illnesses. The crude overall incidence rate of lightning strike injury during the surveillance period was 1.9 cases per 100,000 person-years. Compared to their respective counterparts, overall rates of lightning strike injury were higher among males, those aged 20-29 years, non-Hispanic whites, Army members, enlisted service members, those in combat-specific occupations, and those stationed in the Southern region of the U.S. During the surveillance period, there was a peak in incidence of lightning strike injury during 2015, as well as two smaller peaks in 2011 and 2013. "Disturbance of skin sensation," headache, limb pain, and burns were the four most frequent diagnoses during medical encounters for incident lightning strike injuries. The largest numbers of incident lightning strike injuries occurred in June, July, August, and September. Service members who routinely train and work outdoors should be vigilant about the dangers of lightning, especially in field settings during summer months.

Lightning accidents in the Austrian alps - a 10-year retrospective nationwide analysis.

BACKGROUND: Lightning strikes are rare but potentially lethal. The risk for suffering a lightning strike in a mountain environment is unknown. The aim of this nationwide study was to analyse all lightning accidents in the Austrian Alps from 2005 to 2015, to assess the circumstances of the accident, the injury pattern as well as the outcome. METHODS: From 2005 to 2015, data from the national Austrian Alpine Police database as well as the Clinical Information System of Innsbruck Medical University Hospital were searched for the keywords lightning injury, lightning strike, lightning as well as ICD-10 Code T75.0. Additionally, the archive data of Innsbruck Medical University Hospital was searched manually. RESULTS: The Austrian Alpine Police database, containing 109.168 patients for the years 2005-2015, was screened for lightning accidents. Sixty-four patients had been hit by lightning in the Austrian Alps, 54 were male. Four persons died on scene; survival rate was 93.8%. Two deceased persons were hunters, who were killed by the same lightning strike. Sixty-three patients suffered a lightning strike while doing a recreational activity, mostly hiking (n = 55), a few hunting and only one doing occupational timberwork. Sixty-three patients suffered a lightning strike between June and August with nearly half (46.9%) of the accidents happening on a Saturday or Sunday, and mainly (95.3%) between 12:00 and 22:00 h. DISCUSSION: Persons who perform recreational outdoor and occupational activities in an alpine environment during summer and after noon incur a higher risk of sustaining a lightning strike. The primary risk group includes young male mountaineers and hunters. The mortality rate was low. TRIAL REGISTRATION: The study was approved by the Ethics Committee of the Medical University of Innsbruck (AN4757 315/4.4) and retrospectively registered with Clinical Trials NCT03405467 , January 19, 2018.

Case Report: Mass Casualty Lightning Strike at Ranger Training Camp.

BACKGROUND: Although lightning strikes are a rare occurrence, their significance cannot be ignored given military operations in the field during all types of weather. With proper medical management, patients with lightning injuries can return to duty. METHODS: Information for this case report comes from eyewitness account at the 6th Ranger Training Battalion and from review of physician documentation from the 96th Medical Group, Eglin Air Force Base, Florida. RESULTS: A lightning strike injured 44 Ranger School participants during a training exercise on August 12, 2015, at Camp Rudder, Florida. These patients were triaged in the field and transported to emergency department of Eglin Air Force Base. Of the 44 casualties, 20 were admitted. All were returned to duty the following day. One patient had cardiac arrest. This patient, along with two others, was admitted to the intensive care unit. Seventeen other patients were admitted for observation for rhabdomyolysis and/or cardiac arrhythmias. One patient was admitted with suspected acute kidney injury indicated by an elevated creatinine. All patients, including those admitted to the intensive care unit, were released on the day following the lightning strike without restrictions and were allowed to return to duty with increased medical monitoring. DISCUSSION: This case report highlights the need for proper triage and recognition of lightning strike injury, coordination of care between field operations and emergency department personnel, and close follow-up for patients presenting with lightning injury. Symptoms, physical exam, and laboratory findings from rigorous training can be difficult to distinguish from those resulting from lightning injury. Secondary injuries resulting from blunt trauma from falls may have been prevented by the use of the lightning strike posture. Further analysis of procedures and standard operating protocols to mitigate risk during thunderstorms may be required to prevent lightning's effects on large groups of military personnel.

Discusión sobre la necesidad de delimitación de una nueva nosografía psiquiátrica y psicológica. síndrome del accidentado por rayo eléctrico / Discussion on the delimitation of a nosography new psychiatric and psychological need. syndrome of the accident by electric ray

La observación y análisis de las variadas manifestaciones clínicas y secuelas que presentan las víctimas sobrevivientes de accidente por rayo, nos proporciona la posibilidad de cambiar el punto de vista desde el cual consideramos y estudiamos las mismas. Debemos evaluar la conveniencia de considerar tales manifestaciones meramente como un conjunto de signos y síntomas inespecíficos o pertenecientes a múltiples síndromes ya tipificados; o bien, abrir una nueva y profunda discusión en torno a la posibilidad de su agrupación y delimitación de una nueva categoría nosográfica psiquiátrica y psicológica. La metodología de la presente investigación se basa en el análisis de gran parte de la casuística extranjera de estos pacientes y la investigación bibliográfica exhaustiva sobre las escasas publicaciones científicas existentes. Asimismo, se revisan distintos procedimientos habituales en el ingreso de estos pacientes a los centros de salud que dificultan el estudio epidemiológico y sanitario de los mismos.

The observation and analysis of the varied clinical manifestations and sequels surviving accident victims presented by ray, gives us the possibility to change the point of view from which we consider and study them. We must assess the appropriateness of considering such manifestations merely as a set of signs and symptoms nonspecific, or belonging to multiple syndromes already described; Alternatively, open a new and profound discussion about the possibility of their grouping and delimitation of a new category of psychiatric and psychological nosographic. The methodology of this research is based on the analysis of much of the world Casuistry of these patients and the comprehensive bibliographic research on the scarce existing scientific publications. Also reviewed various common procedures in income of these patients to health centers, hindering the health and epidemiological study of them.

[Lightnings--danger while practising sport]. / Blyskawice--zagrozenie podczas uprawiania sportu.

Certain kinds of sporting disciplines are connected with a high risk of the lightning strike. Although most injuries are non-fatal, the transient or permanent damages of the nervous and ciruculatory systems or other internal organs are common. The concomitant psychological trauma may also be crucial. Various cases could be avoided by following simple safety rules. Wide educational programmes how to act during the stormy weather and elaboration of "stormy guidelines" should concern both sportsmen and people responsible for events safety.

Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update.

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.

Pediatric electrical burn injuries: experience of a large tertiary care hospital and a review of electrical injury.

A retrospective review of all patients admitted between February 2004 and December 2009, with a diagnosis of burns associated with electrocution, was conducted at The Hospital for Sick Children, Toronto, Ontario, Canada. Data regarding type of electrocution and associated burns were collected. Of the 36 patients identified, 31 (86%) were shocked by electrical current, and 5 (14%) by lightning. Most burns associated with current were first degree (58%). The upper limbs, most frequently the wrist and arm (n = 23), were injured in 26 patients, and the lower limb in 2 patients, whereas 3 patients suffered multiple sites of injury. Twenty-eight patients were treated conservatively with dressings and minor surgical interventions such as debridement and primary repair. The remainder required excision and/or grafting. Fasciotomy and/or escharotomy were performed in 2 patients, and no one required amputation. Burns associated with electrical injuries remain a worldwide problem, responsible for considerable morbidity and mortality. They can usually be prevented through simple safety measures. An effective prevention program would help address this problem.

Lightning injuries in sports and recreation.

The powers of lightning have been worshiped and feared by all known human cultures. While the chance of being struck by lightning is statistically very low, that risk becomes much greater in those who frequently work or play outdoors. Over the past 2 yr, there have been nearly 50 lightning-related deaths reported within the United States, with a majority of them associated with outdoor recreational activities. Recent publications primarily have been case studies, review articles, and a discussion of a sixth method of injury. The challenge in reducing lightning-related injuries in organized sports has been addressed well by both the National Athletic Trainers' Association and the National Collegiate Athletic Association in their guidelines on lightning safety. Challenges remain in educating the general population involved in recreational outdoor activities that do not fall under the guidelines of organized sports.

[Lightning strikes and lightning injuries in prehospital emergency medicine. Relevance, results, and practical implications]. / Blitzschlag und Blitzunfälle in der präklinischen Notfallmedizin. Relevanz, Folgen und praktische Implikationen.

Up to 32.2% of patients in a burn center suffer from electrical injuries. Of these patients, 2-4% present with lightning injuries. In Germany, approximately 50 people per year are injured by a lightning strike and 3-7 fatally. Typically, people involved in outdoor activities are endangered and affected. A lightning strike usually produces significantly higher energy doses as compared to those in common electrical injuries. Therefore, injury patterns vary significantly. Especially in high voltage injuries and lightning injuries, internal injuries are of special importance. Mortality ranges between 10 and 30% after a lightning strike. Emergency medical treatment is similar to common electrical injuries. Patients with lightning injuries should be transported to a regional or supraregional trauma center. In 15% of all cases multiple people may be injured. Therefore, it is of outstanding importance to create emergency plans and evacuation plans in good time for mass gatherings endangered by possible lightning.

Lightning medicine in South Africa.

South Africa has a rich history of lightning research; however, research on the clinical and pathological effects and features of lightning-related injury (keraunomedicine or lightning medicine) remains neglected locally. By providing an overview of keraunomedicine and focussing on South African perspectives, we hope to raise awareness and propose that a concerted and co-ordinated attempt be made to report and collate data regarding lightning strike victims in South Africa.

Sideline and event management in golf.

Golf has great popularity as a spectator sport, as well as a participation sport. Providing coverage for golf events can range from mass event coverage for large professional tournaments to provision of injury care at local golf events. This article provides a brief introduction to the game of golf for those unfamiliar with its play, an overview of the types of injuries seen, and consideration in providing care for a variety of golf competitions.

Assessment of risk factors for death in electrical injury.

Fatal high-voltage injuries present a problem which has not yet been studied sufficiently in the context of interaction between the human body and electricity, as a technical, anthropogenic and natural phenomenon. The forensic medicine records of 291 cases of death caused by high-voltage current for a 41-year-long period (1965-2006) were examined in retrospect. The descriptive statistical analyses were made using the SPSS 11.0 software. Death was found to result most commonly from contact between the deceased and elements of the power transmission and distribution grid: (41.24%), and from the action of lightning: (32.3%), the difference in their relative share being insignificant. Much more rarely, death was due to contact with construction and repair electrical devices: (7.56%), or with elements of the power transport railway infrastructure: (6.87%). Death resulting from contact with agricultural electrical devices was only occasional: (0.68%). The victims' average age was 36.19 years. Our analysis indicates that the relative share (43.98%) of the victims is the highest in the age period between 25 and 44. The ratio between women and men is 1:21.38.

[Electrical injuries]. / Elektros traumos.

Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can vary a lot and range from mild complaints not demanding serious medical help to life-threatening conditions. Lightning causes serious injuries in 1000-1500 individuals every year worldwide. The case fatality rate is about 20-30%, with as many as 74% of survivors experiencing permanent injury and sequela. The primary cause of death in victims of lightning strike or other electrical trauma is cardiac or respiratory arrest. That is why appropriate urgent help is essential. Subsequently electrical burns, deep-tissue and organ damage caused by electricity, secondary systemic disorders often demand intensive care and prompt, usually later multistage surgical treatment; therefore, prevention of electrical trauma, which would help to reduce electrical injuries in children and working-age population, is very actual. The most important is to understand the possible danger of electricity and to avoid it.