**3. History and limitations of lightning injury studies**

Unlike many infectious diseases and other causes of injury, lightning injury is not reportable to any government agencies or databases worldwide. A number of other data sources and collection techniques have been used with varying degrees of completeness [3, 4].

For example, the general public in the United States might expect that everyone injured by lightning would seek immediate medical care so that hospital diagnoses or admission information would be a good source for the number of lightning injuries and deaths. However, a sizeable number of survivors do not seek care until a few days after the injury when symptoms do not resolve [5]. Those cases do not make it into any databank. Additionally, not all patients seen in emergency departments require admission, and emergency physicians may use symptom-based complaints such as pain, weakness, or mental status changes rather than "lightning injury." Even coroner's reports may not list "lightning injury" [5, 6].

Prior to the internet, U.S. death and injury statistics were collected as news reports provided by contracted clipping services for Storm Data, a monthly publication of the National Centers for Environmental Information [7]. **Figure 1** shows the death rate per million population collected for more than a century in the United States. During the clipping service era, studies showed that between 30 and 70% of deaths were unreported and injuries much more so [8–11]. Data on property damage, while included in Storm Data, are even less well documented than injuries, particularly because insurance companies are loath to share their claims information [12–15].

Of those injured by lightning, 90% survive, although many have permanent disabilities [6, 16]. The derivative 10:1 injury/death ratio has long been used for projecting total injuries in developed countries.

With the development of the internet, online news reports, and online searches have made up-to-the-minute collection of deaths in the U.S. routine with deaths caused by lightning well documented in the United States and studied in many developed countries [17–20].

Even with the internet as a source, there have been few studies in developing countries, and press coverage is marginal [21, 22] (**Figure 2**). As communication

#### **Figure 1.**

*Solid red line: U.S. lightning deaths per million people from 1900 to 2013 [20]. Dashed blue line: Percent rural population. (©Ronald L. Holle).*

**109**

**Figure 2.**

*Mitigating the Hazard of Lightning Injury and Death across Africa*

technology improves and cell phone penetrance grows, it is expected that more incidents will be reported in African media sources. However, for the foreseeable future, single deaths, nonfatal injuries, smaller incidents, and those in distant or hard-to-reach areas are less likely to be reported than those involving multiple people, animals, and children in school [1]. The first source to collect injury data in Africa, the nonprofit African Centres for Lightning and Electromagnetics Network (ACLENet), has been posting news reports across Africa for several years [23].

*Lightning fatality rate per million people per year by continent. Red shading indicates rate > 5.0 fatalities per million per year, orange indicates 0.6–5.0, and yellow indicates 0.5 or less. White indicates no national summaries have been published for datasets ending in 1979 or later (updated from [22]). (©Ronald L. Holle).*

Different papers have estimated total annual global deaths as 6–24,000 [24–27].

Lightning researchers have proposed mathematical models and other strategies for estimating lightning injuries and deaths using lightning stroke density data

Lightning was the second largest storm killer in the United States for over a century, exceeded only by floods [5]. Since data collection began in the United States, lightning deaths have roughly paralleled the percentage of the population living in rural areas ([20], **Figure 1**). Although this has been a consistent finding in countries as they become "developed" [24], urbanization is not the only factor governing lightning injury. In Africa, as people move to cities to find work, huge shantytowns often arise on the periphery of cities (**Figure 3**). These dwellings do not meet the

per year), population density, socioeconomic

Applying the 10:1 injury/death ratio projects up to 240,000 annual injuries. However, survival and disability rates have not been studied in developing countries, and numbers may be considerably higher for both deaths and injuries.

measures, and other factors [5, 26–28], but these need refining and validation before they can be used as predictive tools for developing countries. Although lightning may cause fewer deaths worldwide than some other public health threats, the consequences of lightning strike to individuals, families, communities, schools, and economic progress in countries that are already economically challenged should

(number of lightning strokes per km2

not be underestimated [21, 29–38].

**4. Demographics of lightning injury**

*DOI: http://dx.doi.org/10.5772/intechopen.90468*

#### **Figure 2.**

*Public Health in Developing Countries - Challenges and Opportunities*

**3. History and limitations of lightning injury studies**

injury." Even coroner's reports may not list "lightning injury" [5, 6].

completeness [3, 4].

information [12–15].

developed countries [17–20].

projecting total injuries in developed countries.

Unlike many infectious diseases and other causes of injury, lightning injury is not reportable to any government agencies or databases worldwide. A number of other data sources and collection techniques have been used with varying degrees of

For example, the general public in the United States might expect that everyone injured by lightning would seek immediate medical care so that hospital diagnoses or admission information would be a good source for the number of lightning injuries and deaths. However, a sizeable number of survivors do not seek care until a few days after the injury when symptoms do not resolve [5]. Those cases do not make it into any databank. Additionally, not all patients seen in emergency departments require admission, and emergency physicians may use symptom-based complaints such as pain, weakness, or mental status changes rather than "lightning

Prior to the internet, U.S. death and injury statistics were collected as news reports provided by contracted clipping services for Storm Data, a monthly publication of the National Centers for Environmental Information [7]. **Figure 1** shows the death rate per million population collected for more than a century in the United States. During the clipping service era, studies showed that between 30 and 70% of deaths were unreported and injuries much more so [8–11]. Data on property damage, while included in Storm Data, are even less well documented than injuries, particularly because insurance companies are loath to share their claims

Of those injured by lightning, 90% survive, although many have permanent disabilities [6, 16]. The derivative 10:1 injury/death ratio has long been used for

With the development of the internet, online news reports, and online searches have made up-to-the-minute collection of deaths in the U.S. routine with deaths caused by lightning well documented in the United States and studied in many

Even with the internet as a source, there have been few studies in developing countries, and press coverage is marginal [21, 22] (**Figure 2**). As communication

*Solid red line: U.S. lightning deaths per million people from 1900 to 2013 [20]. Dashed blue line: Percent rural* 

**108**

**Figure 1.**

*population. (©Ronald L. Holle).*

*Lightning fatality rate per million people per year by continent. Red shading indicates rate > 5.0 fatalities per million per year, orange indicates 0.6–5.0, and yellow indicates 0.5 or less. White indicates no national summaries have been published for datasets ending in 1979 or later (updated from [22]). (©Ronald L. Holle).*

technology improves and cell phone penetrance grows, it is expected that more incidents will be reported in African media sources. However, for the foreseeable future, single deaths, nonfatal injuries, smaller incidents, and those in distant or hard-to-reach areas are less likely to be reported than those involving multiple people, animals, and children in school [1]. The first source to collect injury data in Africa, the nonprofit African Centres for Lightning and Electromagnetics Network (ACLENet), has been posting news reports across Africa for several years [23].

Different papers have estimated total annual global deaths as 6–24,000 [24–27]. Applying the 10:1 injury/death ratio projects up to 240,000 annual injuries. However, survival and disability rates have not been studied in developing countries, and numbers may be considerably higher for both deaths and injuries.

Lightning researchers have proposed mathematical models and other strategies for estimating lightning injuries and deaths using lightning stroke density data (number of lightning strokes per km2 per year), population density, socioeconomic measures, and other factors [5, 26–28], but these need refining and validation before they can be used as predictive tools for developing countries. Although lightning may cause fewer deaths worldwide than some other public health threats, the consequences of lightning strike to individuals, families, communities, schools, and economic progress in countries that are already economically challenged should not be underestimated [21, 29–38].
