When Lightning Strikes: What Happens to the Body
Being struck by lightning is one of those childhood fears grouped with sinking into quicksand or disappearing into the Bermuda Triangle. But unlike the others—fears we quickly outgrow once we realize they’re unlikely—lightning remains uncomfortably close to reality. Although strikes are rare, they happen far more often than most people think.
What makes lightning so frightening is its unpredictability. According to the CDC, roughly 40 million lightning strikes hit the ground in the United States each year. And while nearly 90% of lightning strike victims survive, the danger remains real: from 2006 to 2021, 444 people in the U.S. died from lightning strikes.
Where Lightning Strikes—and Why
Certain environmental factors make an area more prone to lightning: heat, elevation, and conductivity.
- Heat helps generate thunderstorms.
- Height offers the shortest path from cloud to ground.
- Conductive materials—like metals, wet surfaces, or certain types of rock—facilitate the flow of electricity.
This is why states such as Florida, Texas, Colorado, North Carolina, Alabama, Arizona, Georgia, Missouri, New Jersey, and Pennsylvania report the most lightning-related injuries and deaths: they combine some or all of these risk factors. Geography also matters—regions near the equator, mountains, or large bodies of water naturally experience more thunderstorms.
A famous example: the Empire State Building, which is struck about 25 times per year simply because of its height.
But even if we know which regions are high-risk, the exact path of a lightning bolt is impossible to predict. For this reason, safety guidelines emphasize staying indoors, avoiding metal pipes, plumbing, and electrical appliances during storms. Seeking shelter under a tree, despite being instinctive, can expose victims to side flashes, ground current, conduction, or the less common but still dangerous phenomenon known as streamers.
What Lightning Can Do to the Human Body
If someone is struck by lightning, several mechanisms, not just the kinetic impact, cause injury. Lightning injuries can be grouped into four main components:
1. Light Component
Primarily affects the eyes and can lead to:
- Keratitis
- Cataracts
- Uveitis
- Retinal detachment
- Papillitis
- Macular hole formation
These injuries can emerge immediately or develop over time.
2. Heat Component
The intense heat from the strike can cause:
- Superficial skin burns
- Linear burns along sweat or skin fold lines
- Scorched hair or clothing
- A distinct burning smell
3. Electrical Component
This is the most complex and often the most dangerous.
Visible Effects:
- Lichtenberg figures (fern-like skin markings), more noticeable on lighter skin.
Cardiac Effects:
- Arrhythmias
- Cardiac arrest
- Ischemic ECG changes
- Underlying coronary obstruction
Neurological Effects:
- Cerebral salt-wasting syndrome (leading to hyponatremia, dehydration, and risk of brain swelling)
- Seizures
- Depression
- Neurocognitive dysfunction
4. Blast (Barotrauma) Component
This is the most recently proposed sixth mechanism of lightning injury, referring to the rapid explosive expansion of air around the lightning channel. When lightning superheats the surrounding air, it creates a shockwave similar to a blast. This sudden pressure change can cause significant internal and external injuries, particularly to air-filled structures.
Ear and Hearing Effects:
- Tympanic membrane perforation
- Hearing loss
- Vestibular dysfunction (balance disturbances, dizziness, vertigo)
- External ear canal burns
Although this component is still being explored in research, barotrauma likely explains many of the auditory injuries seen in lightning strike survivors.
Other Internal or Delayed Complications
Some injuries aren’t immediately visible. These can be localized to one organ system or systemic, appearing early or long after the strike.
Respiratory complications (rare but possible):
- Pulmonary edema
- Pulmonary contusion
- ARDS
- Pulmonary hemorrhage
Renal complications:
- Acute tubular necrosis due to ischemia
Psychological and neuropsychiatric consequences:
- PTSD
- Anxiety and depression
- Panic attacks
- Sleep disturbances
- Cognitive difficulties (memory, concentration)
These long-term effects are often overlooked but can significantly affect survivors’ quality of life.
Why Systematic Care Matters
Because lightning can damage multiple organ systems at once, survivors require systematic evaluation by healthcare professionals following Advanced Trauma Life Support (ATLS) principles.
If you encounter a lightning victim outdoors during a storm:
1. Move them to safety, only if it’s safe for you.
- Lightning can strike the same spot twice.
2. Begin CPR if needed.
A lightning victim does not retain an electrical charge, so it is safe to touch them once the current has passed. Start CPR if they:
- Have no pulse or a very weak pulse
- Are not breathing or are breathing abnormally
- Are unresponsive
Immediate resuscitation greatly improves survival.