Another loud clap of thunder, so loud he almost didn't hear the frantic knocking at the door. Before Adam could raise from his seat, two young boys stumbled in. They were soaking wet, pale in the face, and bewildered. Between breaths one boy tried to explain but Adam already knew the news was not good.
“Dude, Peter, wake up man, come on, you have to wake up!”
Peter opened his eyes to reveal a world unfamiliar. He knew he was with his Boy Scout troop. They had departed from the Crescent Meadow trailhead a few days before with the goal to summit Mount Whitney. The last thing he remembers was helping the scoutmaster build a shelter because of the storm.
Peter looked around. It was raining. The tall trees swayed in the strong wind and thunder shook the earth. James eyes were wide, his face blanketed white from fear. Beside him were two motionless bodies. Not bodies, friends, his friends. Were they breathing? Those who were conscious were scrambling about trying to grasp the situation. Their terrified faces illuminated by the flashes of lightning.
“Are you okay man? Are you hurt?” Asked James as he patted Peter down. He was looking for any signs of bleeding.
“Yeah. Yeah, I think I am okay. What happened?” His ears were ringing and he smelled a crispness about the air surrounding them.
“Lightning hit the tree we were using for the shelter. Oh man, it's bad, it's really bad.” James’ voice cracked.
“27, 28, 29, 30. Give two breaths.” Jonathan and Daniel, both 15 years old were now performing CPR on Robert, one of the many motionless bodies. He is only 13. Of their twelve person group, four were still unconscious, all receiving CPR.
Peter turned to face scoutmaster Doug. The seriousness of the situation was settling in, but Peter knew to remain calm. Others needed him. “We are okay, what should we do?”
“Go get help. The ranger station at Crabtree. Go boys, now!”
“Twelve? Twelve patients? How I am going to do this?” rang the panicked voice inside his head. Adam suddenly felt so small and helpless as the remoteness of his location set in. The 12 patients were one mile away at Sandy Meadows. That's 50 miles from the trailhead and 20 miles from the nearest road access, over steep and unforgiving terrain. The weather is deteriorating and daylight is slipping fast. These factors would be challenging to manage one patient in let alone twelve. A helicopter in this scenario is the only solution for the critically injured. But a helicopter will not fly in this storm and can not fly after sundown.
Adam drew a deep breath and exhaled his dread. He radioed dispatch, requesting a helicopter and back up medical support, but he wasn't hopeful. With limited medical supplies, one tank of oxygen, and a radio, Adam, Peter, and James set out for Sandy Meadows. The rain had stopped, all was quiet. Maybe the bird can fly after all.
“Okay”, he thought, “lightning injuries can vary. It's really unpredictable and depends on the amount of damage that may or not not be visible. Ugh. Common injuries are ruptured ear drums...” he knew that one. “...and...neurological issues, so that could mean paralysis, vision problems, etc. Burns, of course. Maybe even bone fractures and head injuries. And if victims are unconscious long enough with poor oxygen, there could be brain damage, abnormal and combative behavior, seizures.”
He felt a tightness in his chest, and took a deep breath in. “Stay calm. What else? There are so many patients. I need to triage. Oh wait, triage is different with lightning. I remember now.”
The image and words of Adam’s EMT instructor surfaced in his mind. Normally you should skip the those who are not breathing and have no pulse. But with lightning victims you should start CPR, the heart is stunned but has a higher chance of responding to resuscitation efforts if started immediately.
Nearing the scene, Adam counted more than 12 people. All was total chaos, other hikers had arrived to help. The scoutmasters were yelling orders, blowing whistles, and people were running back and forth. Only two were still unconscious and were still receiving CPR. A 13 year old boy and a 29 year old assistant scoutmaster.
Some of the other victims were altered in mentation, thrashing about, fighting their caregivers. One scoutmaster was screaming that he was paralyzed. Another patient also could not move his legs and complained of excruciating pain in his lower back, he drifted in and out of consciousness. Many of the young boys had burns on their butts and back.
Adam radioed dispatched. No response, only static. The storm must be interfering with the radios. He dismissed the thought that he was all alone to deal with this out of hell scenario.
“I have the instructions on the back of my first aid kit,” said James
“Good, setup a landing zone in case a helicopter is enroute. Then help with CPR. Make sure people are rotating through and not giving poor chest compressions because they are tried.”
Peter took one last look at Robert then ran after James to set up an LZ. Thirty minutes later the unmistakable sounds of the chopper blades broke through the clouds. It came as relief to Adam, but it was only temporary. Another storm was building. As soon as the skids touched the ground, the rain began to fall in torrents. Time only allowed for one park medic and advanced medical gear to be dropped off. No patients could be loaded as the weather continued to get worse. The helicopter left as quickly as it came. And in its wake returned the lightning.
The park medic, secretly to Adams relief, took charge of the scene. The medics main priority for this mass casualty incident is to maintain the big picture and to assure the most necessary care for each patient through the strategic delegation of available resources. At this time those resources included the several helpful bystanders, the limited medical equipment, the gear already on hand, and the eventual return of a helicopter. He instructed for CPR to continue for the two still unresponsive patients. With those patients being cared for, he then went on to triage the others. To make sense of the chaos, the medic had all ambulatory patients and bystanders move to a staging area at the edge of the meadow. This helped calm some up the victims as they no longer could see the resuscitation efforts of their friends. Another twenty minutes later the bird did indeed return again, but just as before was only able to drop off a medic and had to leave. Another dashed hope of survival.
Adam pushed hard and fast on the assistant scoutmasters stiff chest. The park medics assessed the airway to find it filled with blood and vomit. The assistant scoutmasters neck, chest and back were swollen. He had discoloration in the areas of his body closest to ground from blood settling in the tissue. He was dead. Adam stopped CPR.
The park medics moved on to the next patient receiving CPR, the young boy. Peter did not want Robert to be dead. He pumped harder. Between compressions he would utter words of encouragement, hoping Robert would hear them.
“Stop compressions, kid.” Said the park medic. “I feel a pulse. His heart is beating again. He is alive.” Peter was overwhelmed but work was still needed. Robert was still in critical condition and needed to get to a hospital as soon as possible. It was nearly half past six pm, and the weather was still threatening. The radios were silent due to the storm interference. Communication to dispatch was not possible.
An advanced airway device was placed. Peter helped ventilate Robert. At least now there was plenty of oxygen. Other bystanders assisted in placing Robert in a sleeping bag to keep his body warm and built a shelter for an overnight stay. His pulse was faster now but he remained unresponsive. Night would come soon, there was uncertainty if he could pull through the long dark hours ahead.
Adams radio suddenly screeched. It was unintelligible garble from dispatch. Then as clear as day a voice rang true. The heavens had opened, the storm lifted enough to allow not one but four helicopters to land at Sandy Meadows. All patients, including Robert and the assistants scoutmaster’s body, were air evacuated enroute to the hospital by 8:30 pm.
Robert died two days later in the intensive care unit. All 10 survivors made a full recovery physically, but not emotionally. The events that took place at Sandy Meadow left a permanent mark. Adams reflects often on that day. Was there something he could have been differently? Could the Boy Scouts have done something to avoid the injuries from the strike?
- Direct Strike - lightning directly striking a person before striking anything else
- Contact Injury - when someone is touching an object that is struck by lightning,
- Side Splash - when lightning current arches from one object or person, hitting another person
- Ground Current - when lightning strikes the Earth and travels through the ground to a victim
Lightning injuries can vary from catastrophically deadly to almost nothing at all. The extent of damage depends on various factors like how much electricity entered the body, where it entered or exited the body, the path it took, and so on. We will not know this information but common lightning injuries include ruptured eardrums, burns, entrance and exit wounds, temporary loss of consciousness, cardiopulmonary arrest and Lichtenberg figures. Lichtenberg figures are red feather-like marks on the surface of the skin. These marks are superficial and will resolve on their own.
Other lightning strike injuries can include neurological damage, eye injuries and cataract development, hearing loss, fractures, cardiac damage, head injuries, spinal injuries and psychological issues. Symptoms can have a delayed onset and may disappear completely over time.
Sudden death from lightning is caused by cardiac and respiratory arrest.
Again, lightning injuries can vary and therefore you must be ready to treat a variety of problems. But of course the priorities remain the airway, breathing and circulation (the ABC’s). Those that are not familiar with the ABC’s, it means we want to be sure that the person can breathe, nothing is blocking air from entering the mouth and into the lungs, and there is no heavy bleeding. Anything wrong with the ABC’s is usually life threatening.
As mentioned earlier, cardiac arrest is common in lightning strike victims. Thankfully, the survival rate with CPR is much higher in these patients. Therefore, reverse triage should be used when there are multiple lightning strike patients.
But remember, your safety is first, so if necessary, remove victims to a safer location before initiating treatment.
Any person struck by lightning has a potential for a traumatic head injury, so try not move the victim unnecessarily. Be sure to search the victim’s body from head to toe. Look for entrance and exit wounds, burns, red markings, and abnormal swelling.
The last topic to discuss is prevention.
Always look up the weather forecast before departing on your trip. It is typically good to plan to be done by 2pm if you are in the mountains during the summer since most storms occur in the afternoon.
The most dangerous areas to be for lightning are on ridge tops, summits, wide open spaces, or near isolated tall structures like trees or cell towers. Deep caves, dense forest, and ravines offer more protection from lightning. And yes, lightning does strike in one place more than once. Always wait 30 minutes after the last clap of thunder before continuing activity.
As with all of our Case Stories, this one was based off a true story. You can find the original write up here. The information about lightning is from our online wilderness safety school and is also included in our online WFA, WFR, and WEMT recert courses. You can find the full lecture here.
We hope you learned something from this moving Case Story. Stay safe!