Quick Answer
After a lightning strike, reassess neurological function by checking for level of consciousness, pupillary response, and motor function, and providing CPR if necessary. A person struck by lightning is at high risk for cardiac arrest and should be treated as a priority. The American Red Cross recommends checking for breathing and pulse every 2 minutes.
Initial Assessment and CPR
When rescuing someone struck by lightning, prioritize their airway, breathing, and circulation (ABCs). Clear the airway of any obstructions, then check for breathing and pulse. If the person is not breathing or has no pulse, begin cardiopulmonary resuscitation (CPR) with 30 chest compressions followed by 2 rescue breaths. Continue CPR until emergency medical services (EMS) arrive, but do not delay calling for help. For a child or infant, use one-third the adult compression depth and two-thirds the rate.
Neurological Assessment
Perform a rapid neurological assessment by checking the person’s level of consciousness using the Glasgow Coma Scale (GCS). A score of 13 or higher indicates a good outcome, while scores below 8 suggest severe brain injury. Check pupillary response by shining a light in each eye; normal response is a constricted pupil. Test motor function by assessing muscle strength and reflexes in the extremities. If the person shows no response or has severe deficits, suspect neurological damage.
Burn Treatment and Prevention
Lightning strikes can cause severe burns from electrical discharge, which can be hidden beneath clothing. Remove wet clothing and jewelry before treating burns with cool water (not ice) and a topical antibiotic ointment. Do not apply ice or burn creams, as they can cause further damage. To prevent electrical shock, stay away from downed power lines and avoid contact with metal objects during a thunderstorm. If a downed power line is near a person struck by lightning, do not approach the scene until it is deemed safe by emergency responders.
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