Case Report: Mass Casualty Lightning Strike at Ranger Training Camp

Abstract

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.

Lightning and the Forensic Pathologist

“…If left untreated without correct diagnosis, severe hyponatremia may result in seizures and worsening cerebral edema (25). Likewise, the electrical component of lightning may lead to rhabdomyolysis and acute kidney injury (indicated by an elevated creatinine) and delayed-onset psychiatric and cognitive symptoms, which may perhaps be due to a post-concussive syndrome (22, 26).…”

“…The most feared complication of lightning injury is cardiac arrest and cardiac dysrhythmias, both of which can occur in the immediate aftermath (22)(23)(24). Lightning injury may cause abrupt cerebral salt wasting syndrome.…”

“…Lightning may injure or kill individuals or groups of people (22). The spectrum of pathology sustained may vary markedly between individuals.…”

“…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 (22).…”

Weltweite Unfälle mit Blitzschlägen: regionale Analyse und medizinische Therapie

“…Carte et al berichten 2002 von einem Blitzschlag auf einem Campingplatz in Süd afrika mit 28 Verletzten, darunter 26 Kinder, 2 Erwachse ne und 7 Hunde -4 Menschen kamen ums Leben [4]. Im Jahr 2015 kam es während eines Ranger TrainingCamps in Florida/USA zu einem Blitzschlag mit 44 Verletzten [5]. 2016 wurden während des Festivals "Rock am Ring" in RheinlandPfalz mehr als 80 Personen verletzt, als ein Blitz auf das Festivalgelände einschlug [6].…”