Most lightning-strike victims survive. Roughly 90 percent live; the protocol that produces that survival rate requires fast cardiac response from bystanders. The lightning-at-the-field protocol covers the prevention; this piece covers the rare moment when prevention failed.
If you are reading this in real time with a struck victim, call 911 immediately and start cardiopulmonary resuscitation (CPR) if the victim is not breathing.
The mechanism.
Lightning is a massive electrical discharge that can affect the body through:
Direct strike. Rare. Lightning hits the person directly.
Side flash. Most common. Lightning hits a nearby object and jumps to the person.
Ground current. Lightning hits the ground and travels outward through soil.
Conductive contact. Person touching metal that conducts the strike.
Streamer. Person was the upward streamer that met the downward leader.
The energy passes through the body in milliseconds. The body is not “electrified” afterward; the victim is safe to touch and treat immediately.
The immediate effects.
Cardiac arrest is the most-common immediate cause of lightning-strike death. The electrical discharge depolarizes the heart, stopping coordinated rhythm. Without immediate CPR, the victim does not survive.
The good news: the heart often restarts on its own within minutes. Bystander CPR maintains circulation during that window.
Respiratory arrest can outlast the cardiac arrest. The brainstem respiratory centers can be paralyzed for minutes. Even if the heart restarts, the victim may need rescue breathing.
Loss of consciousness is common, often brief.
Burns are typically less severe than other electrical injuries because the duration is so short, but can be substantial in direct-strike or side-flash cases. The “Lichtenberg figures” (fern-like skin patterns) sometimes appear and are characteristic.
Blunt trauma from being thrown by the muscular contraction of the strike. Falls, hitting equipment or structures, sometimes spinal injury.
Eye injuries. Lightning can produce cataracts (sometimes developing later), retinal damage, and direct burns.
Ear injuries. The shock wave can rupture the eardrum.
Confusion, amnesia for the event.
The immediate protocol.
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Call 911. State “lightning strike” so dispatch sends spinal-precaution equipment along with cardiac monitoring.
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Approach the victim. Lightning-strike victims do not retain electrical charge. They are safe to touch immediately.
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Move the victim to safety if there is ongoing lightning risk. The strike often hits the same area again. If the area is still under storm activity, careful movement to safer location is appropriate, balanced against the cervical-spine risk.
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Check for breathing and pulse.
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If no breathing or pulse, start CPR immediately. Continue until emergency medical services (EMS) arrives or the victim recovers spontaneous circulation.
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If breathing but unconscious, position on side (recovery position) unless cervical spine injury is suspected from the fall. If spine injury suspected, stabilize head and maintain neutral position.
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Address burns if present, but cardiac and respiratory care comes first.
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Monitor for additional victims. Lightning strikes often affect groups. Other people who fell or were near the strike point may have been affected with less obvious symptoms.
The triage rule for multi-victim strikes.
When lightning hits a group, conventional triage is sometimes reversed. The victims who appear deceased (unresponsive, not breathing) get priority because they are most-likely to be in cardiac arrest from the strike itself and are the ones who can be saved with immediate CPR.
The victims who appear conscious are likely to survive without immediate intervention.
This is the opposite of typical trauma triage and is the published recommendation for lightning-strike multi-victim scenarios per ACEP and Wilderness Medical Society guidance.
The AED question.
An automated external defibrillator (AED) should be used as soon as available. The 90-second AED standard applies. Most modern AEDs work as expected on lightning-strike cardiac arrest if the rhythm is shockable.
For programs in outdoor venues, an on-site AED is essential during storm season. Programs that practice in lightning-prone regions without one are operating below the published standard.
The 24-hour and longer follow-up.
Even with apparent recovery, lightning-strike victims need ER evaluation. The reasons:
Delayed cardiac arrhythmias are documented.
Delayed neurological effects can appear over hours.
Internal burns from current passage may not be visible externally.
Spinal injury from the fall may not be apparent without imaging.
ER evaluation typically includes cardiac monitoring, neurological assessment, sometimes imaging, and observation.
The long-term injury patterns.
Some lightning-strike survivors develop persistent symptoms that emerge over months. The pattern is documented in the medical literature:
Cognitive symptoms (memory issues, attention difficulty, processing speed reduction).
Mood changes (depression, anxiety, irritability).
Chronic pain (often neuropathic).
Sleep disruption.
Visual changes (delayed cataracts).
Hearing changes (delayed effects from blast injury).
These often improve over 1 to 2 years but can be persistent for some survivors. Pediatric neurology and rehabilitation referrals can help.
For families with a lightning-strike survivor, awareness that some effects develop later matters. The kid who seems fine immediately after a strike may develop symptoms weeks or months later.
For programs.
The emergency action plan (EAP) should include lightning-strike protocol specifically, distinct from the general lightning-warning protocol.
A practiced response. Programs that have run tabletop lightning-strike scenarios respond faster.
AED on site, CPR-trained adults, address for 911 readily available.
Communication plan for parents of struck and other-affected athletes.
For the witness who freezes.
Lightning strikes are rare and dramatic. The witness who watches it happen and is paralyzed is the witness who does not save the victim.
The training that prevents this is general first-aid and CPR training. The person who has practiced compressions on a manikin can do them on a real victim under stress.
For coaches, the case for CPR/AED certification is direct.
The honest read. Lightning-strike fatalities in youth sports are rare and largely preventable through the prevention protocol (the 30/30 rule, the 30-minute resumption rule, the substantial-shelter standard). When the prevention fails, the survival rate depends on bystander CPR and AED use in the first minutes. The kids who survive lightning strikes are usually the kids whose surrounding adults knew the protocol.
For programs in lightning-prone regions, the conversation about both prevention and response is part of the standard. For families, the awareness that lightning-strike survivors need ER evaluation even when they appear fine matters.
If you are reading this in active response to a strike, call 911, start CPR, use the AED. The protocol is what saves lives in this scenario.