An Autopsy Series: Lightning-related Deaths in Van and Hakkâri Provinces, Turkey

ABSTRACT Objective: To report the largest series of lightning-related deaths in Turkey, to review the literature on this subject, and to identify similarities and differences between the autopsy findings in this study and the information available in literature. Methods: In this study, autopsy reports and crime scene investigation data on 11 lightning-related fatalities that occurred in the Van and Hakkâri Provinces, Turkey, from January 1, 2011 to December 31, 2015 were retrospectively reviewed. Results: Of the 1699 fatalities, 11 (2.53%) evaluated by medico-legal autopsy in the Van and Hakkâri Province in a 5-year period died from lightning strikes. Of these cases, 10 (90.1%) were males and 1 (9.9%) was female (p < 0.05). All cases were in the 11 to 33 years age group. All cases were injured outdoors. Conclusion: We concluded that deaths due to lightning strikes are relatively rare in Turkey, and may be reduced with precautions such as avoiding staying under trees or in the vicinity of high towers, refraining from touching metal objects, avoiding lying on the ground, leaning on walls, and crouching outdoors.

Injuries and deaths from lightning.

This paper reviews recent academic research into the pathology of trauma of lightning. Lightning may injure or kill in a variety of different ways. Aimed at the trainee, or practicing pathologist, this paper provides a clinicopathological approach.

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.

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.

Muerte por fulguración / Death by lightning

En el Servicio Provincial de Medicina Legal de Villa Clara, se realizó un estudio descriptivo, longitudinal, retrospectivo, de los fallecidos por fulguración entre el 1ro. de enero de 2009 y el 31 de diciembre de 2014, para determinar sexo, edad y ocupación de los afectados, zona y época del año de mayor ocurrencia, así como las lesiones externas más frecuentes. En el libro de registro y las actas de necropsias, se encontraron 16 fallecidos por esta causa. Predominó el sexo masculino, en la edad laboral; septiembre, mayo y junio fueron los meses de mayor incidencia. Todos los hechos ocurrieron en la zona rural, y el 62,5 %, a la intemperie. La zona noroeste de la provincia resultó la más afectada y las lesiones más frecuentes fueron las quemaduras. Aunque el número de fulguraciones no parece alto, es el fenómeno natural que provoca más muertes en Cuba.

A retrospective, longitudinal and descriptive study of deceased people due to lightning was carried out from January 1st, 2009 to December 31st, 2014 in order to determine gender, age and occupation of the affected individuals, location and time of the year of higher occurrence, as well as, the most frequent external lesions. Sixteen deaths due to this cause were registered in the logbook and in the autopsy reports. Working-age men predominated; the months with the highest incidence were September, May and June. All the incidents happened in rural area, and the 62.5 % was in the outdoors. Northwest region of the province turned out to be the most affected one and burns were the most frequent lesions. Although the number of deaths by lightning doesn't seem to be very high, this is the natural phenomenon that causes more deaths in Cuba.

Muerte por fulguración / Death by lightning

En el Servicio Provincial de Medicina Legal de Villa Clara, se realizó un estudio descriptivo, longitudinal, retrospectivo, de los fallecidos por fulguración entre el 1ro. de enero de 2009 y el 31 de diciembre de 2014, para determinar sexo, edad y ocupación de los afectados, zona y época delaño de mayor ocurrencia, así como las lesiones externas más frecuentes. En el libro de registro y las actas de necropsias, se encontraron 16 fallecidos por esta causa. Predominó el sexo masculino, en la edad laboral; septiembre, mayo y junio fueron los meses de mayor incidencia. Todos los hechos ocurrieron en la zona rural, y el 62,5 por ciento, a la intemperie. La zona noroeste de la provincia resultó la más afectada y las lesiones más frecuentes fueron las quemaduras. Aunque el número de fulguraciones no parece alto, es el fenómeno natural que provoca más muertes en Cuba(AU)

Lightning deaths: a retrospective review of New Mexico's cases, 1977-2009.

To better understand lightning deaths, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 1977 and 2009 to update and assess current risk factors. Information on demographics, circumstances, autopsy, and death certificates were collected and analyzed. Fifty-four decedents were identified, ages 2-71 years old (mean 34 years old), 42 males and 12 females. Common racial/ethnic groups were non-Hispanic Whites and American Indians (together comprising 72% of all cases). Physical findings were often related to the heat carried by the electrical current including clothing alterations (29.6%) and burning of skin (53.7%). Most deaths occurred on weekend afternoons in summer months, associated with recreational activities or agricultural work, and rural locations (77.8%). Utilizing the demographic information, clustered events, and associated outdoor activities will assist in creating public awareness and provide a framework to support targeted warnings in an attempt to prevent future deaths.

Remarkable rates of lightning strike mortality in Malawi.

Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area.

Fatal lightning strikes in Malaysia.

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the important causes of deaths from environmental phenomena. Almost every organ system may be affected as lightning current passes through the human body taking the shortest pathways between the contact points. A 10 years retrospective study (1996-2005) was conducted at University Hospital Kuala Lumpur (20 cases) also including cases during last 3 years from Hospital Tengku Ampuan Rahimah, Klang (7 cases) from the autopsy reports at Forensic Pathology Units of these 2 hospitals. Both these hospitals are attached to University of Malaya. There were 27 fatal cases of lightning strike with male preponderance(92.59%) and male to female ratio of 12.5:1. Majority of victims of lightning strike were from the age group between 30 and 39 years old. Most of the victims were foreign workers. Indonesians workers contributed to 59.26% of overall cases. Majority of them were construction workers who attributed i.e.11 of 27 cases (40.74%). Most of the victims were brought in dead (37.04%). In majority of the cases the lightning incidence occurred in the evenings, with the frequency of 15 of 27 cases (62.5%). The month of December represented with the highest number of cases (5 cases of 23 cases); 2004 had the highest incidence of lightning strike which was 5 (19.23%). Lightning strike incidence occurred when victims had taken shelter (25.9%) under trees or shades. Lightning strike in open areas occurred in 10 of 27 cases (37.0%). Head and neck were the most commonly affected sites with the incidence of 77.78% and 74% respectively in all the victims. Only 29.63% of the cases presented with ear bleeding.

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.

Struck-by-lightning deaths in the United States.

The objective of the research reported here was to examine the epidemiologic characteristics of struck-by-lightning deaths. Using data from both the National Centers for Health Statistics (NCHS) multiple-cause-of-death tapes and the Census of Fatal Occupational Injuries (CFOI), which is maintained by the Bureau of Labor Statistics, the authors calculated numbers and annualized rates of lightning-related deaths for the United States. They used resident estimates from population microdata files maintained by the Census Bureau as the denominators. Work-related fatality rates were calculated with denominators derived from the Current Population Survey of employment data. Four illustrative investigative case reports of lightning-related deaths were contributed by the New Mexico Office of the Medical Investigator. It was found that a total of 374 struck-by-lightning deaths had occurred during 1995-2000 (an average annualized rate of 0.23 deaths per million persons). The majority of deaths (286 deaths, 75 percent) were from the South and the Midwest. The numbers of lightning deaths were highest in Florida (49 deaths) and Texas (32 deaths). A total of 129 work-related lightning deaths occurred during 1995-2002 (an average annual rate of 0.12 deaths per million workers). Agriculture and construction industries recorded the most fatalities at 44 and 39 deaths, respectively. Fatal occupational injuries resulting from being struck by lightning were highest in Florida (21 deaths) and Texas (11 deaths). In the two national surveillance systems examined, incidence rates were higher for males and people 20-44 years of age. In conclusion, three of every four struck-by-lightning deaths were from the South and the Midwest, and during 1995-2002, one of every four struck-by-lightning deaths was work-related. Although prevention programs could target the entire nation, interventions might be most effective if directed to regions with the majority of fatalities because they have the majority of lightning strikes per year.

Lightning fatalities on the South African Highveld: a retrospective descriptive study for the period 1997 to 2000.

A review of the Southern Africa medical literature shows a paucity of published data regarding lightning fatalities. The South African Highveld has a lightning ground flash density of 6 to 9 flashes/km/year, with a high incidence of thunderstorm days per year (some 40-70). The Highveld has a largely urban population, many of whom have low socioeconomic status and poor education, housing, and other infrastructures and hence (possibly) are at greater exposure risk. Thirty-eight victims of lightning-related death were identified from the records of the 6 large medicolegal mortuaries on the South African Highveld, serving a population of approximately 7 million, for the period 1997 to 2000. Analysis of the records revealed that 95% of all victims were black, 79% were male, and the average age was 36 years. Lightning strikes occurred from September through to April (normal summer rainfall period), and the most strikes took place in the late afternoon (3:00 pm to 6:00 pm). All except 1 case occurred outdoors. In the autopsy reports, mention was made of singeing of hair in 68% of cases, and mention of damage to clothing was made in 26% of cases. Cutaneous thermal injuries were noted in 34 of the 38 cases, with apparent electrothermal injuries of the feet noted in 4 cases. Fifty-two percent of victims sustained some form of associated blunt-force injury (including abrasions, contusions, etc). Specific keraunopathologic injuries were described in only 2 of the cases. Twenty-one cases had some form of internal organ injury. This study serves to illustrate the relatively high incidence of lightning strikes in the region and calls for a more systematic and detailed investigative protocol in lightning-related deaths.

Epidemiology of electrical and lightning related deaths and injuries among Canadian children and youth.

Among burn injuries, electrical injuries constitute a small but devastating fraction. To describe the epidemiology of electrical injuries in Canadian children, data on deaths and emergency department visits related to electrical injuries, including lightning strikes, were obtained from provincial coroners' offices and the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) respectively, for the years 1991-96. Twenty one deaths and 606 emergency visits highlight that electrical related deaths, more frequent among school age children, are more likely the result of high voltage and lightning strike, while emergency department visits, more frequent among younger children, are more likely the result of low voltage. While the introduction of legislated standards for child safe outlets and educational programs for parents, children, and youth are recommended strategies toward reducing the frequency of these incidents, these strategies require further evaluation before their effectiveness can be estimated.

External cause-specific summaries of occupational fatal injuries. Part II: an analysis of years of potential life lost.

BACKGROUND: Fatal injury surveillance data provide an opportunity to assess the impact of occupational injuries and may indicate which industries or occupations are appreciably more hazardous than others, and thus should be given priority in public health intervention. METHODS: Fatalities from the National Traumatic Occupational Fatality surveillance system served as the basis for examining external cause (E-code) specific impact summaries. Years of potential life lost (YPLL) were calculated for fatal injuries in the years 1983-1994. Industries and occupations were compared with respect to frequency of fatal injuries. In addition, injuries in categories of external causes are examined across all industries and occupations. RESULTS: Machinery, electric current, homicide, falls, and transportation-related are the external cause groups highlighted by high frequency/rate of occurrence. Electric current event groups are also characterized by high average YPLL. Poisoning, conflagration, and lightning were also identified in several occupations as having high associated average YPLL. CONCLUSIONS: The external-cause-specific analysis of average YPLL identified industries and occupations where, on average, younger workers were dying in fatal injuries. Noteworthy in this assessment were homicides and falls. The YPLL measure coupled with more commonly employed indices (e.g., rates) may provide a fuller description of the impact of occupational fatal injuries.

Case report of a 13-year-old struck by lightning.

Lightning strikes kill 1,000 people per year worldwide. Cardiac arrests resulting from lightning strikes have good survival rates but there is a significant degree of morbidity amongst the survivors. This is the case report of a 13-year-old boy who had a cardiac arrest following a direct lightning strike, and his subsequent management.

Lightning-associated injuries and deaths among military personnel--United States, 1998-2001.

After flooding, lightning is the second leading cause of weather-related death in the United States; approximately 300 injuries and 100 deaths are associated annually with lightning strikes in the United States. To characterize lightning-associated injuries and deaths among U.S. Armed Forces personnel, the U.S. Army and CDC analyzed data from the Defense Medical Surveillance System (DMSS). This that the highest lightning-related injury rates during 1998-2001 occurred among male U.S. military members who were aged <40 years, single, with a high school education or less, stationed near the Gulf of Mexico or the East Coast, and in the U.S. Army. The findings suggest that the risk for lightning-associated injury depends primarily on the frequency, timing, duration, and nature of outdoor exposure to thunderstorms. Military personnel should be aware of severe weather onset and take reasonable precautions to protect themselves and their companions from exposure to lightning.