Lightning-Associated Injuries and Deaths Among Military Personnel - US, 1998-2001

Morbidity and Mortality Weekly Report. 2002;51(38) 

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After flooding, lightning is the second leading cause of weather-related death in the United States; approximately 300 injuries and 100 deaths are associated annually with lightning strikes in the United States.[1,2,3,4] To characterize lightning-associated injuries and deaths among U.S. Armed Forces personnel, the U.S. Army and CDC analyzed data from the Defense Medical Surveillance System (DMSS). This report summarizes the results of that analysis, which indicate that the highest lightning-related injury rates during 1998-2001 occurred among male U.S. military members who were aged <40 years, single, with a high school education or less, stationed near the Gulf of Mexico or the East Coast, and in the U.S. Army. The findings suggest that the risk for lightning-associated injury depends primarily on the frequency, timing, duration, and nature of outdoor exposure to thunderstorms. Military personnel should be aware of severe weather onset and take reasonable precautions to protect themselves and their companions from exposure to lightning.

DMSS maintains hospitalization and ambulatory clinic visit data on U.S. Armed Forces personnel (both active-duty and reserve) and links health data with personnel data (e.g., age, race, sex, education, occupational specialty, and duty station). This analysis considered lightning-associated injuries or deaths among active-duty and reserve military personnel that occurred during 1998-2001. A lightning-associated injury or death was defined as a hospitalization or ambulatory clinic visit in the 50 states and the District of Columbia that was assigned a primary or secondary diagnosis of "effects from lightning, shock from lightning, or struck by lightning" according to the International Classification of Diseases, Ninth Clinical Modification (ICD-9-CM) code 994.0. Because isolated cloud-to-ground lightning strikes could not be distinguished from multiple lightning strikes at the same time and location, it was assumed that two or more lightning-associated injuries or deaths at the same time and location were caused by a single lightning strike. Descriptive statistics were analyzed, including event date, location, percentage of strikes causing injury resulting in hospitalization or death, casualties per strike, and military status (i.e., active or reserve) of affected persons. Because accurate denominator data were not available for reserve personnel, lightning casualty rates and relations of selected demographic factors to those rates were calculated for active-duty personnel only. Military personnel comprise a highly mobile population, and many duty assignments last for <1 year; therefore, lightning-associated casualty rates were expressed as casualties per 100,000 person years. Rate ratios and 95% confidence intervals (CIs) were based on Poisson regression. The descriptive nature of this report precluded calculating adjusted estimates.

During 1998-2001, a total of 142 lightning strikes caused 350 service member injuries and one service member death at U.S. military installations in the United States (Figure); 64 (18.0%) persons required hospitalization. The majority (123 [86.6%]) of lightning strikes injured either one or two persons; 12 (8.5%) strikes injured three to nine persons; and seven (4.9%) strikes injured ≥10 persons, including one that injured 44 persons during an outdoor training exercise. Three fourths (106 [74.6%]) of lightning strikes occurred during May-September, with a peak (71 [50.0%]) during July-August. Lightning strikes occurred more often near the coasts, particularly in southern and eastern areas. Active-duty personnel constituted the majority (246 [70.1%]) of lightning-associated casualties. Overall, the lightning strike casualty rate was 5.8 per 100,000 person years ( Table 1 ). By state, Louisiana (39.6), Georgia (25.2), and Oklahoma (23.5) had the highest rates. Comparisons among age groups showed a strong inverse relation between age and risk for lightning-associated injury ( Table 2 ). Men were 3.3 times more likely than women to be struck by lightning. Service members with a high school education or less and those in combat-related occupations (e.g., infantry or artillery) were at higher risk than their counterparts. Among the services, the Army had the highest lightning casualty rate (9.5), and the Navy had the lowest (1.4); the Army-to-Navy rate ratio was 7.0 (95% CI=4.4-11.7).

Reported by: MJ Silverberg, PhD, A Frommelt, MPH, JL Lange, PhD, JF Brundage, MD, MV Rubertone, MD, BH Jones, MD, Army Medical Surveillance Activity, US Army Center for Health Promotion and Preventive Medicine. BS Winterton, DVM, EIS Officer, CDC.

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