SECOND IN A SERIES

Last week's column covered risk factors, types of injuries and prevention of injuries from lightning strikes. It, as well as this week's column, is abstracted from a recent issue of the "Journal of Emergency Medical Services." (JEMS)The article in JEMS written by Dr. Phil Fontanarosa identified two main factors considered important in providing appropriate pre-hospital care or first aid for lightning struck victims. These are: 1. Persistance in resuscitation and 2. What to do when multiple victims are involved.

Resuscitation

First aiders must start aggressive, vigorous resuscitation for victims in cardiac arrest.

Since lightning-strike-victims are often young and otherwise healthy, they generally have responsive cardiovascular systems, and therefore, the chance for successful resuscitation exists.

First aid begins with the ABCs. Rapid assessment and establishment of an open airway is the first step. Open the airway by using the modified jaw thrust method in order to avoid neck hyperextension because of the possibility of a neck spine injury.

If the victim is found in cardiopulmonary arrest, cardiopulmonary resuscitation (CPR) should be started.

Persistent first aid is crucial for these victims.

Shock is always a possibility, so treat these and any other trauma victim for shock.

Since spinal cord injuries can occur with lightning strikes, precautions should be taken for immobilizing the spine. Splinting of fractures and controlling bleeding with direct pressure may also be required.

Multiple victims

More than one victim may be struck by lightning at the same time. In such situations, when several victims are injured, first aiders must give highest priority to those in cardiac arrest and must provide long-term resuscitation efforts.

Victims with respiratory arrest only can be given mouth-to-mouth resuscitation. Victims who are breathing and have a pulse will generally be able to wait for medical assistance, although there may be significant injuries requiring immediate medical attention. Victims with cardiac arrest must be given cardiopulmonary resuscitation (CPR).

Lightning-struck victims are not "charged" and do not represent a hazard to the first aider. However, with electrical storms in the area, first aiders may also be in jeopardy of being struck.

* Alton Thygerson is a professor of health sciences at Brigham Young University.