**7. Lightning injury**

As noted in Section 3, in developed countries, nearly 90% of those injured by lightning survive but are often left with disabling sequelae [5, 10, 11, 16, 55, 67]. The percentage of survivors in developing countries may be considerably smaller where people are exposed 24/7/365, may be affected by keraunoparalysis in unsafe structures that catch on fire, and cannot access high-quality medical and rehabilitative care.

A large range of injuries has been reported including damage to the ears, eyes, skin, heart, and brain. For a more complete and referenced discussion, see Cooper et al. in Auerbach [5]. The proximate cause of death is cardiac arrest and anoxic brain injury at the time of the strike, even if a partially successful resuscitation delays the legal pronouncement for a few days [5, 11, 74]. Later, deaths may be due to suicide as survivors become despondent when they cannot find help for their brain injury and other sequelae, may not be able to return to work and lose their homes, or lose the support of their friends and family due to personality changes and other stressors [75, 76]. Others may self-medicate with alcohol, drugs, or herbs for their post-injury chronic pain and frustration [76].

People tend to take their experience with common household electricity and scale it up, predicting that lightning must cause horrible burns [5, 66]*.* They may even have heard of the destructive injuries caused by high-voltage injuries. However, in developed countries, lightning burns tend to be superficial and insignificant compared to the neurologic injuries that are suffered. Less than ½ of lightning survivors surveyed by the Lightning Strike and Electric Shock Survivors, International (LSESSI) support group several years ago had damage of any kind to their skin [16, 74–76]. Given the majority of injuries are not direct strikes or direct injuries but from mechanisms where the strength of the strike has been mitigated by dissipation across longer distances or other factors (ground current, contact injury, upward streamer), this is a reasonable finding. However, the lack of burns will often result in physician skepticism and legal disputes with worker insurance denial [5, 57, 75, 76].

Long term, lightning survivors may suffer temporary or permanent neurological sequelae including chronic pain syndromes and cognitive damage similar to those reported in the now widely recognized post-concussive syndrome with attention deficit, memory problems, learning difficulty, frontal lobe damage causing irritability and personality changes, and loss of multitasking and executive function, all resulting in inability to return to their previous level of employment [5, 16, 75, 76]. Blunt injury from being thrown may also cause musculoskeletal pain [5, 68]. As with other brain injured people, frustration, impatience, instant rage, and other personality changes may drive away family members, further compromising the survivor's recovery [5, 16, 75, 76].

Disability may significantly affect a family's socioeconomic status if the survivor is unable to return to work or needs chronic care [5, 16, 40, 49, 57, 75, 76]. A further setback to the victim's family, particularly in developing countries such as those in Africa, is a common belief that a family affected by lightning injury is "cursed" or was punished for bad behavior such as beating their wives or children. The community may shun the entire family so that they have little choice but to leave their community, home, and employment to start over in a new community where their tragedy is unknown [5, 30, 40].

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**Table 4.**

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

Currently there is no way to reverse or decrease the damage cascade that is set in motion when the injury first occurs. The Lightning Strike and Electric Shock Survivors, International is a support group that has helped hundreds of survivors and their families to find help and knowledge about their injuries [16, 47, 75, 76]. Treatment is standard for pain syndromes, anoxic brain injury, eighth nerve tinnitus and balance problems, and cognitive disability. Unfortunately, this type of care is expensive and seldom available in developing countries. In the developed world, some survivors may return to work, but it may be in a different field or with lesser

As in most injuries and illnesses, prevention is far better than caring for those injured by lightning. In developed countries, lightning injury prevention through public education is simple and cost-effective [17, 18, 60, 62, 77]. However decreasing lightning injuries in developing countries is a much more complex task than in countries where lightning-safe structures and vehicles are common and almost

**8. African Centres for lightning and electromagnetics network, Inc.**

injuries and deaths as well as property damage [23].

protected and are not lightning-safe [1, 42].

To assess the impact of lightning on each nation's citizens and economy

To work with universities to train Africa's own lightning experts for the future

To improve engineering training and professional qualifications in lightning protection

**ACLENet's multifaceted goals**

schools and other important buildings

*Modified from Cooper et al. [1] (©MACooper).*

The African Centres for Lightning and Electromagnetics Network (https:// ACLENet.org) is a pan-African network of national centers dedicated to reducing deaths, injuries, and property damage from lightning across Africa [1]. It was formed with multiple goals in mind (**Table 4**). Among its many activities, ACLENet is attempting to establish an injury and damage database by collecting news reports for each of the countries in Africa and working with citizen reporters to document

The majority of lightning deaths can be avoided if there are "lightning-safe" areas to evacuate to, if good weather forecasts and warning systems are available to the public, and if individuals have been educated in actions they can take to avoid injury [1, 17, 18]. Almost none of these are available to the vast majority of sub-Saharan Africans, particularly in rural areas, leaving entire families at risk 24/7/365 whether they are working in their fields, walking to the market, cooking near their homes, worshipping, or in school [1]. Children in school tend to be at particular risk because typical classes have about 50 children packed into classrooms that are not

In June 2011, 18 children were killed by one lightning strike with another 38 children injured and transported to the hospital from Runyanya Primary School in Kiryandongo, Uganda [78]. Prior to this incident, the head teacher related that

To work with governments to assure that code-compliant lightning protection systems are designed for new

To advise on code-compliant lightning protection of utilities and other economically important industries To improve the availability of accurate and timely lightning data, weather forecasting, and warnings

To educate teachers, parents, pupils, and the public on lightning safety and injury prevention

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

responsibility and income.

universally close at hand.

*Mitigating the Hazard of Lightning Injury and Death across Africa DOI: http://dx.doi.org/10.5772/intechopen.90468*

*Public Health in Developing Countries - Challenges and Opportunities*

for their post-injury chronic pain and frustration [76].

**7. Lightning injury**

barotrauma in his dissertation and likened it to being near a 5 kg of TNT blast [68]. Barotrauma is independent of the other electrical mechanisms of injury but may potentially overlay any of them [5, 40, 68]. People may also be thrown by opisthotonic contractions and experience musculoskeletal injuries as would be expected [5, 66].

As noted in Section 3, in developed countries, nearly 90% of those injured by lightning survive but are often left with disabling sequelae [5, 10, 11, 16, 55, 67]. The percentage of survivors in developing countries may be considerably smaller where people are exposed 24/7/365, may be affected by keraunoparalysis in unsafe structures that catch on fire, and cannot access high-quality medical and rehabilitative care. A large range of injuries has been reported including damage to the ears, eyes, skin, heart, and brain. For a more complete and referenced discussion, see Cooper et al. in Auerbach [5]. The proximate cause of death is cardiac arrest and anoxic brain injury at the time of the strike, even if a partially successful resuscitation delays the legal pronouncement for a few days [5, 11, 74]. Later, deaths may be due to suicide as survivors become despondent when they cannot find help for their brain injury and other sequelae, may not be able to return to work and lose their homes, or lose the support of their friends and family due to personality changes and other stressors [75, 76]. Others may self-medicate with alcohol, drugs, or herbs

People tend to take their experience with common household electricity and scale it up, predicting that lightning must cause horrible burns [5, 66]*.* They may even have heard of the destructive injuries caused by high-voltage injuries. However, in developed countries, lightning burns tend to be superficial and insignificant compared to the neurologic injuries that are suffered. Less than ½ of lightning survivors surveyed by the Lightning Strike and Electric Shock Survivors, International (LSESSI) support group several years ago had damage of any kind to their skin [16, 74–76]. Given the majority of injuries are not direct strikes or direct injuries but from mechanisms where the strength of the strike has been mitigated by dissipation across longer distances or other factors (ground current, contact injury, upward streamer), this is a reasonable finding. However, the lack of burns will often result in physician

skepticism and legal disputes with worker insurance denial [5, 57, 75, 76].

Long term, lightning survivors may suffer temporary or permanent neurological sequelae including chronic pain syndromes and cognitive damage similar to those reported in the now widely recognized post-concussive syndrome with attention deficit, memory problems, learning difficulty, frontal lobe damage causing irritability and personality changes, and loss of multitasking and executive function, all resulting in inability to return to their previous level of employment [5, 16, 75, 76]. Blunt injury from being thrown may also cause musculoskeletal pain [5, 68]. As with other brain injured people, frustration, impatience, instant rage, and other personality changes may drive away family members, further compromising the

Disability may significantly affect a family's socioeconomic status if the survivor is unable to return to work or needs chronic care [5, 16, 40, 49, 57, 75, 76]. A further setback to the victim's family, particularly in developing countries such as those in Africa, is a common belief that a family affected by lightning injury is "cursed" or was punished for bad behavior such as beating their wives or children. The community may shun the entire family so that they have little choice but to leave their community, home, and employment to start over in a new community where their

**118**

survivor's recovery [5, 16, 75, 76].

tragedy is unknown [5, 30, 40].

Currently there is no way to reverse or decrease the damage cascade that is set in motion when the injury first occurs. The Lightning Strike and Electric Shock Survivors, International is a support group that has helped hundreds of survivors and their families to find help and knowledge about their injuries [16, 47, 75, 76]. Treatment is standard for pain syndromes, anoxic brain injury, eighth nerve tinnitus and balance problems, and cognitive disability. Unfortunately, this type of care is expensive and seldom available in developing countries. In the developed world, some survivors may return to work, but it may be in a different field or with lesser responsibility and income.

As in most injuries and illnesses, prevention is far better than caring for those injured by lightning. In developed countries, lightning injury prevention through public education is simple and cost-effective [17, 18, 60, 62, 77]. However decreasing lightning injuries in developing countries is a much more complex task than in countries where lightning-safe structures and vehicles are common and almost universally close at hand.
