Patients hit by lightening

[mobey]

Anecdotally, I have had lightning hit a lightning rod a hundred feet from me, and it knocked me off my feet. With no entry/exit burns I doubt this guy was actually zapped directly, or if he was, by the time the electricity hit him, it was low enough voltage/amperage to not do significant harm.

In patients with no insurance, I do scare them into driving or hitching a ride to the ER. This preticular case, I would probably inform him that although he looks ok on the outside, he may have a "cooked" organ inside.

But then again,..... I have been accused of being too abraisive at times.

Sounds like you did good.

[Chief1C]

To him having no insurance and no money to pay for the bills you and hospital send him is rather important so I can understand why he did not want to come with you. As an aside, if you do not transport him does he get like a lesser bill or something?

I never consider whether someone can pay, or cannot pay when they call. Because as the billing agent, I always have the option to write someone off. I would rather them get to A hospital, any hospital; than die from circumstances beyond immediate control. Most health systems allow one to set up a payment plan. If I bill someone $1200, and they say they'll either not pay; or they can pay $5 a week till it's paid off - I'll take the $5 a week. I'm sure many hospitals would too. I get my forms signed after we get to the ER, I don't ask them about insurance before we treat them; and if they refuse, there is no bill. If they refuse with ALS, we end up footing a $75 bill. However, it's so rare for ALS to meet us on scene - maybe once every three or four years, that we do not pass that off to the patient. (that is unless it's like a wreck that takes a half hour to cut someone out, then ALS might meet us on scene).

That storm was nasty when it passed through here, the NOAA Alarm literally JUST went off, when a strike hit directly behind the station. I felt the hair on the back of my neck stand up, then heard the boom. But it only lasted a few minutes, the rain was worse, flooded the streets. South and to the west they had really bad damage, fires, etc. from it.

Edited July 10, 2012 by 1 C

[Richard B the EMT]

I question if the person was actually hit by the electrical energy of a lightning strike, or thrown by the concussion of the thunder. Someone commented being knocked over by a thunder blast at 100 foot range, so this could have been similar.

I live less than 3 miles from a former shore defence gun battery (Battery "Harris", at Fort Tilden, NY), that had 2 16 inch diameter inside bore guns. Grandma used to tell me, when the guns were test fired during the 1930s and 1940s, even that far from the guns, pictures fell from the walls, and windows cracked, from the concussion.

However, it seems, from the description, that the patient was fully and properly evaluated. By the standards and protocols I follow, an RMA (Refused Medical Assistance) could then be obtained.

[Kiwiology]

I am no physics professor or electrician but it sounds like they were hit by electrical force that was greatly attenuated because it had travelled through the power pole, wires and wooden door frame and they would have been grounded against the floor ratherthan being hit by the full force of the lightining itself

[nypamedic43]

What concerned me was the the fact that he said he was thrown backwards into the freezer, about 5 feet, give or take. I truly think that he was hit with the force of the lightning (how's that Mike lol) that had been lessened in force by the distance it traveled down the line and into the grounded house.

I didn't even take his inability to pay into consideration. If his EKG had shown anything but a NSR, I would have insisted that he go with us and would have gotten PD involved. However, he did end up going down with his friend and was released a couple of hours later.

These new protocols are a pain right in the arse. There is very little wiggle room anymore. A person that has been vomiting for 2 hours gets worked up....WITH a 12lead. I'm not sure how this is all going to pan out in the long run really. While they have expanded the protocols...they have also placed restrictions on those protocols. I'm not real keen on performing a pericardial centesis in any capacity. They have given us the skill but you have to be certified with the medical director in order to do it. Facilitated intubation is the same way and it has to be a 2 medic crew. We still are in a "mother may I" role. It's kind of frustrating.

[Kiwiology]

The 30 seconds it takes to acquire a 12 lead ECG isnt the end of the world

[rock_shoes]

It isn't a terrible idea to do a 12 lead on patients who have prolonged periods of N/V/D. They could easily end up with an electrolyte imbalance that will show up on ECG.

Sent from my SGH-T989D using Tapatalk 2

[DwayneEMTP]

... If his EKG had shown anything but a NSR, I would have insisted that he go with us and would have gotten PD involved...

Wait, alert and oriented with a relatively clean EKG and he retains the right to refuse. Alert and oriented with EKG changes and he somehow relinquishes that right?

I don't understand...

I just got into a major pissing contest with my company because they ordered me to go to the hospital, that I would have had to pay for and then, likely, be reimbursed. I refused, my medical director was angry, my 'voice on the phone' supervisor was angry, everyone wanted 'what was best for me' but no one wanted to pay the bill. What they really wanted was to be obeyed, and for me to spend my money to cover their asses. I believe that this is what's happening many times that we try and talk people into going to the ER.

In my case, as, possibly, with yours, we can't try and force people to the ER 'for their own good' while trying to pretend that it's not really just US costing THEM a ton of money to cover OUR asses.

(No worries on my account. I'm fine. Am going to post about it later.)

[chbare]

I was involved in a lightning related mass casualty incident while supporting a field artillery unit during a storm. I also decided not to seek treatment mainly because of the number of casualties that required ground evac out of a remote training area because flight resources were unavailable due to weather.

That aside, I would have serious issues about forcing an alert, oriented and informed patient to go to the hospital.

Edit: totally unrelated, but I hate when volts, amps and so on are used without proper context.

Edited July 13, 2012 by chbare

[mobey]

Edit: totally unrelated, but I hate when volts, amps and so on are used without proper context.

Buddy, I love that you commented on this.

When I first wrote my post I just said "volts", fully aware that I do not really know enough about electricity to be using tthe terms. I thought to myself.... better soften that a little because Chris will call you out. Hence, I wrote Voltage/Amps.

Thank you for living up to your neurotic label