Patients hit by lightening

[nypamedic43]

I'm never very good at posting new topics but here goes.

Yesterday, I went on a call for a person hit by lightening. We had some pretty big storms roll through here yesterday, lasting several hours. Strong winds up to 70 mph, hail, lots of rain and cloud to ground lightening.

We got the call about 1400 hours. The location was a farm, way up on top of a hill. When we arrive the fire dept is there and the patient is sitting on the back porch step, alert and oriented x 4 and a little jittery. I ask him what happened and this is the story:

When the first storm rolled through, around noon, he was standing in the doorway where he was now sitting. He heard a close lightening strike, flet a tingle and found himself 3 or 4 feet from where he started, up against an upright freezer. He stated he didnt lose consciousness but had a slight headache and upper epigastrum/lower chest pain. About an hour 45 minutes later, he noticed a NYSEG truck up on the corner, checking out the pole that had been struck. He non chalantly told the NYSEG worker that he had gotten hit with lightening from the strike that hit the pole. It apparently hit the pole, ran down the wires to the house and then into the house, where he was touching the door frame on the back porch. The patient then stated that the next thing he knew, he could hear sirens in the distance, coming closer and wondered where they might be going, When the fire dept pulled up in front of his house, he was kind of shocked. The NYSEG guy had called 911, which wasnt a bad thing.

I checked his hands and legs, chest and back and found no burns. He stated that the pain was a 3 or 4 on the pain scale but he really didnt want to go the hospital by ambulance, because he has no insurance and really no money to pay for it. We told him that that wasnt important, but he really needed to go to the ED. He kept refusing. SO I asked if it was ok to put the monitor on him just to check to make sure there wasnt a problem. He agreed.

The monitor showed a normal sinus rhythm and the 12 lead showed the same with no ectopy. Pulse was strong and regular, with a rate of 82 and respirations were non labored at 18. Blood pressure, considering the circumstances, was normal at 122/84. He still seemed nervous to me and when questioned, he admitted to smoking a bowl before we got there....hence the nervousness when he heard the sirens.

We advised him that he really should get checked out but he insisted that he didnt want to go by ambulance and his friend would take him down. He then stated that he was getting ready to go down when he heard the sirens.

He kept apologizing for dragging us all the way out into Gods country/ He said he didnt call and he didnt ask the NYSEG guy to call either. We told him it was fine and not to worry about it, but asked him again to come in to the ED with us. He again refused. Against my better judgement I signed him off as a refusal but told him that if anything changed, the pain got worse, he got short of breath, he had any tingling....to call us back. We were on scene for probably 30 minutes, getting the whole story and trying to convince him to come with us.

I guess if I had any questions at all, it would be.....How much time would you spend trying to convince a person that going to the ED by ambulance is in their best interest in a case like this?

[c9b5]

There's only so much you can do to convince him to go. If you had PD there, they may have been able to help - i.e. he goes with you or gets arrested for the pot. If he was A&O x3, and continued to refuse, there's nothing else for you to do. I would have made sure there was someone to stay with him for a few hours in case anything changed, though. If you're still worried, and you have a good relationship with the PD, have them do a welfare check a few hours later.

[Kiwiology]

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?

A competent patient always has the right to refuse and all patients are deemed competent until proven otherwise.

I am not sure but I think the fact the lightening hit the pole, travelled down the wires and then through the wooden door frame before coming into contact with the patient significantly attenuates the electrical force because it was grounded by a couple things before it hit him so its likely very different than if the lightening hit him directly or if he was standing in a puddle of water holding onto a metal object or something which is why he did not have any obvious electrical injury.

I think 20 minutes to a half hour is a reasonable time to spend at a scene with this guy but if he consistently (2-3x) tells me he doesn't want to go then fine I'm not going to try and convince him any more. The sales technique just ain't working.

[paramedicmike]

Lightening: to make light or lighter, illuminate, brighten,

to make less in weight,

when the head of the fetus enters the pelvis reducing pressure on the diaphragm allowing for easier breathing by a pregnant woman.

Lightning: a natural discharge of electrical energy usually occurring from cloud to cloud or cloud to ground.

Yes. I'm well aware I'm being "that guy" again. However, my initial response when I saw the title was to wonder just how much weight he lost and how this could be tied into an ambulance call.

On a certain level, I should say thanks for your misspelling as I learned a new definition for the word lightening (specifically the one about OB patients).

[nypamedic43]

Well damn....I didnt even notice the misspelling. I was just typing happily away, drinking my first cup of coffee of the day.

[island emt]

You arrived on scene and did a full & thorough assessment including a 12 lead ECG. You found no injuries and pt 's only complaint was a vague report of non specific pain.

You tried to convince him to be transported for further evaluation,l and determined him competent to refuse.

We can't force care, or transport on anyone against their will.

The only thing additional you might have tried if your spidey sense said he needed to be transported , would to be call the ER Doctor & have him/her speak to the Pt.

[nypamedic43]

I know that we can't force care on anyone and if they are alert and oriented they have the right to refuse. My question was : How long would you spend on scene trying to convince the patient to in the ambulance?

[Kiwiology]

Half an hour is not unreasonable to do an assessment, form a working diagnosis, establish the patient does not want to go and try to convince him otherwise. Once he was adamant he did not want to go despite our counsel I am not going to push the issue any further, pack up and do the obligatory "you can call back if you get worse" thing then that's it.

[Happiness]

I will do exactly the same things you did as in your assessment. I would say until your compfortable leaving the pt (this case is exceptional). Each case is different so, but I will normally spend between 15-20 minutes to try and convince the pt, but again there are those that I may only spend 5. hope that helps

[rock_shoes]

How much time I spend trying to convince someone to accept transport post assessment is directly related to how strongly my assessment makes me feel they should go for further medical treatment/assessment. You exercised due diligence and the patient chose to stay home against your advice. Case closed.

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