Pocket the Cellphone and Beware the Lightning

HARROW, England, June 23 - People who chat away on a cellphone in the open as a thunderstorm approaches ominously should hang up and run for shelter, physicians here warned.

In a letter to the BMJ, the erstwhile British Medical Journal, the physicians described the case of a 15-year-old girl who was struck by lightning while she was using a cellphone in a large London park during a storm.

"The girl has no recollection of events because she had an asystolic cardiac arrest," wrote Swinda Esprit, M.D., and colleagues of the Northwick Park Hospital here.

"She was successfully resuscitated, but one year later she was a wheelchair user with complex physical, cognitive, and emotional problems, as well as a persistent perforation of the left tympanic membrane with associated conductive hearing loss on the side she was holding the mobile phone."

Unlike a high-voltage electrical shock, which can send current coursing through the body and cause death by cardiac arrest, a lightning strike usually results in a phenomenon known as "flashover," in which an electrical charge such as a lightning strike diffuses over the surface of the skin, which has a high level of electrical resistance. In some cases, however, the energy may find its way through an orifice such as an ear, the mouth, or the nose.

In the case of the girl described in the BMJ, the cellphone pressed to her ear, which was made of electrically conductive materials such as metal and wiring, appears to have acted as a conduit allowing the lightning energy to enter her body, resulting in the significant morbidity and disability she experienced, Dr. Esprit and colleagues suggested.

"To our knowledge, no similar cases have been reported in the medical literature," they wrote.

But press reports in China, Korea, and Malaysia cited three other cases, all fatal, of cellphone users who were struck by lightning outdoors during a thunderstorm, the British physicians wrote.

"This rare phenomenon is a public health issue, and education is necessary to highlight the risk of using mobile phones outdoors during stormy weather to prevent future fatal consequences from lightning strike injuries related to mobile phones," they continued.

According to lightning injury expert Mary Ann Cooper, M.D., of the University of Illinois at Chicago, lightning strikes account for only about 10% of storm-related fatalities.

"While death is devastating, the family eventually can go on," she told an audience at the National Weather Association annual meeting in 1998. "Far more pervasive changes to the family may occur if the survivor is disabled."

Just as a brief electrical shock can restore a stopped or chaotically beating heart to a normal sinus rhythm, a lightning strike-the biggest electrical shock there is-can stop the heart dead in its tracks, sending it into ventricular asystole, Dr. Cooper has written. And even when the heart recovers there may be prolonged respiratory arrest that can cause a second episode of a cardiac arrest.

But for every 10 people who die from a lightning strike, there are 90 who are jolted but survive, which is near miraculous considering that a typical lightning bolt can be five miles long, 50,000 degrees Celsius hot, and pack a more than 100-million volt wallop.

Still, for many survivors of lightning strikes, the consequences can be severe, debilitating, and lifelong.

"Early on, survivors may complain of intense headaches, ringing in the ears, dizziness, nausea, vomiting and other post-concussion types of symptoms," according to a National Weather Service fact sheet. "Survivors may also experience difficulty sleeping, sometimes sleeping excessively at first and then only two or three hours at a time. A few may develop seizure-like activity several weeks to months after the injury."

Lightning-induced damage to the frontal lobes can transform a normally cheerful and easygoing type into an irritable, quick-to-anger personality.

"People who wake up after the injury often do not have the ability to express what is wrong with them, may not recognize much, become embarrassed when they cannot carry on a conversation, work at their previous job, or do the activities that they used to handle," the National Weather Service adds. "As a result, many isolate themselves, withdrawing from church, friends, family and other activities. Friends, family and co-workers who see the same external person, may not understand why the survivor is so different. Friends soon stop coming by or asking them to participate in activities. Families who are not committed to each other break up."

On examination, lightning-strike survivors may have little or no evidence of damage on anatomical tests such as CT or MRI scans, but functional diagnostics such as PET and SPECT scanning may show evidence of neurologic changes.

Extensive neurocognitive or neuropsychological testing measuring memory, IQ, and organizational skills are more useful, because they may reveal specific deficit patterns common among lightning-strike survivors, according to Dr. Cooper.

"Another common, often delayed, problem for some survivors is pain, also difficult to quantify and manage," she wrote in a fact sheet available on the National Oceanic and Atmospheric Administration's web site.

"The pain may not be from chronic intense headaches but may be in the back (perhaps from compression and disc injury from the intense muscle contractions which may throw a person several yards at the time of the injury), or in an extremity," she wrote. "Some may have nerve entrapment syndromes and a small number may eventually develop sympathetically mediated pain syndrome."