Introduction

Lightning is a massive electrostatic discharge caused by the circulation of warm moisture-filled air through unbalanced electric field in the atmosphere, accompanied by the loud sound of thunder. A typical cloud to ground lightning strike can be over 5 km long.1 A typical thunderstorm may have three or more strikes per minute at its peak.2 Lightning strikes 40–50 times a second worldwide, for a total of nearly 1.4 billion flashes per year.3 Cloud-to-ground (CG) lightning accounts for 25% of lightning globally. Lightning is not distributed evenly around the planet.4 About 70% of lightning occurs on land in the tropics, where most thunderstorms occur. The north and south poles and the areas over the oceans have the fewest lightning strikes. The place where lightning occurs most often is near the small village of Kifuka in the mountains of eastern Democratic Republic of the Congo5, where the elevation is around 975 meters (3,200 ft). On an average this region receives 158 lightning strikes per square kilometer a year.6 During thunderstorm the lightning flash/stroke discharge, many current peaks varying from 10,000-200,000 Amp occurring in fraction of a second affecting an area of about 30m distance.7 Because lightning can travel through air, plumbing systems, and land phone lines, it can struck people working in open fields or in their houses until 30 minutes after the final thunderclap is heard. Victims may present with minor injuries with no loss of consciousness to severe cardiopulmonary arrest or fatal injuries, however, the long-term effects on their lives and the lives of their family members can be devastating. Singh O. and Singh J. (2015)8 had concluded that Lightning is a common meteorological hazard in India.

Figure 1

Appearance of lightning in air

Epidemiology

About 240,000 incidents regarding lightning strikes happen each year.9 According to National Geographic, annually about 2,000 people are killed worldwide by lightning.10 According to the National Oceanic and Atmospheric Administration, over the last 20 years, the United States averaged 51 annual lightning strike fatalities, placing it in the second position, just behind floods for deadly weather.11 Singh O. and Singh J. (2015)8 had mentionedtop 10 fatality incidents of lightning recorded in India during the period 1979–2011are as follows-

Again Singh O. and Singh J. (2015) 8 after consideration of records of Indian Meteorological Dept. (IMD), Pune had mentioned that 5259 persons have been killed by lightning strikes in India during 1979-2011 and at the same time maximum number of lightning fatalities was observed in the states of Maharashtra (29%), followed by West Bengal (12%) and Uttar Pradesh (9%).

Aims & Objectives

Materials and Methods

The present cross sectional retrospective study was conducted in the department of Forensic Medicine & Toxicology at Late Shri Lakhiram Agrawal Memorial Govt. Medical College, Raigarh (CG). All the post-mortem records of lightning cases conducted at mortuary of KGH, Raigarh (CG) were considered for the research study. All cases other than lightning were excluded from the study. People of all age groups from both sexes were included in the study. The study was conducted from 1^st Jan 2018 to 31^st Dec 2019 (Two Years). All the data were collected and subjected to statistical analysis.

Photographs

Figure 2

Arborescent burn mark over chest

Figure 3

Singeing of scalp hair in lightning

Data Analysis

Table 2 During the study period out of 1109 autopsy cases, only 06 cases were death due to lightning, i.e. 0.54% of total autopsy cases.

The Table 3 shows that maximum cases were found in the age group of 31-40 years. The victims from both sexes were equally affected.

Table 4 According to the data all the cases were found in open spaces.

Table 5 It had been observed that maximum number of death cases occurred while working in farm land and while taken shelter under a tree or alike. Apart from that death of one victim was also reported when the victim was communicating in mobile phone and returning to home from market.

The Table 6 shows that maximum incidents had occurred during monsoon season (05 cases, 83.33%) and during evening hours. One case was also reported in afternoon.

Table 7 It had been observed that burn injuries due to lightning were found in different parts of the body of the victims. This suggests that almost all parts of body can be affected in lightning.

Table 8 In most of the cases (05 out of 06 cases) typical arborescent mark of lightning was observed in the body of victims. In 50% of the cases singeing of hair was present and in most of the cases, effects of lightning on clothing was absent. In one case SAH (Sub arachnoid haemorrhage) was also found.

Discussion

In our study maximum number of victims were in the age group of 31-40 years, which matches with the study of Gunethi BK, Singh UP (2015) 20 and Manukonda Rajeev Varma etal (2018). 22 It was found in one study that the female victims were predominant over male 19 but reverse finding 21 was also recorded in another study from the same state therefore finding of equal number of male and female deceased in our study is quite possible. In our study most of the cases occurred in open field, which matches with the study of Chao TC etal (1981). 24 Since there was no structural barrier to protect the victim from the aggression of lightning at open field, therefore all death occurred in partially sheltered and open areas. Again Chao TC etal (1981) 24 had mentioned that no death due to lightning occurred in well protected places. Communicating through mobile phone is working under the principle of electro-magnetic wave therefore while a person is communicating through mobile during lightning may bring dangerous episode for himself.

Most of the cases happened during monsoon season, which matches with the study of Gunethi BK, Singh UP (2015)20 and Gadge SJ and Shrigiriwar MB (2013).19 All cases in our study occurred between 12-6 PM, which is consistent with the findings of Gadge SJ and Shrigiriwar MB (2013)19 at Yavatmal, Maharashtra, therefore it is evident that lightning deaths are more common during working hours in day time. Arborescent mark is one of the critical finding in death due to lightning, which differentiates these cases from suspicious homicidal and other cases involving foul play. In majority of the cases no any specific internal finding was observed during post mortem examination. In only one case SAH was found.

Conclusion

Lightning is a naturally occurring global phenomenon and the incidents are always accidental in nature. Cardiopulmonary arrest is most common cause of death in such cases followed by ventricular fibrillation and thermal injuries. Although lightning injuries have a unique presentation in the form of arborescent mark on the body, but it can have unusual presentation in the body ranging from very specific finding to very little or no external or internal finding. In most cases victims die immediately after lightning effect, but in some cases person survives, which needs prompt resuscitative measures. Our study involves very little number of cases, which doesn’t clearly depict the actual picture of lightning deaths. Therefore it needs more sample size with meticulous and methodical approach in lightning related deaths. We are in concurrence with respect to safety measures pointed out in the study of Manukonda Rajeev Varma etal. (2018)22 and Chao TC etal. (1981).24

Confidentiality

Non disclosure of identity of the deceased and autopsy surgeon.

Source of Funding

None.

Conflict of Interest

None.