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Lightning injury triage — DIPIMC MCQ

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HardEnvironmental MedicineLightning injury triageDIPIMCDipIMC

A group is struck by lightning, leaving several casualties. One person appears lifeless and is not breathing, while others are moving and groaning. With limited responders, how should you prioritise?

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Correct answer: B — Prioritise the apparently lifeless casualty first

In a lightning strike, reverse triage applies: those in cardiac or respiratory arrest are prioritised for resuscitation, because lightning-induced arrest is often due to a transient respiratory or cardiac arrest from which recovery is possible if treated promptly. The conscious, groaning casualties are by definition perfusing and can wait. Treating in arrival order or abandoning the lifeless casualty misses salvageable arrests. Pearl: prompt ventilation and CPR for the apparently dead can be life-saving after a lightning strike.

Reference: Resuscitation Council UK Guidelines 2025 (Special Circumstances); JRCALC Clinical Guidelines