Six cases of collective lightning-induced arc explosion injuries: A case report

Currently, clinical studies on lightning injuries are mostly limited to single-patient cases, and there is still limited understanding of the mechanisms and clinical features of injuries that occur simultaneously among multiple individuals in a localized area. This article reports the environmental conditions, injuries, and treatment of six patients who suffered from arc explosion injuries caused by lightning within a 200-m radius. The incident occurred in late June on a rainy day at a coastal location (approximately 680 m elevation). Six patients were simultaneously injured by a lightning-induced electric arc explosion and were thrown several meters away from their original positions, resulting in a brief loss of consciousness and transient memory impairment. All six patients developed pulmonary contusion and hypokalemia, with elevated levels of inflammatory markers (e.g., hs-CRP) and leukocytosis with neutrophilia, as well as abnormal electrocardiogram (ECG) findings. Four patients had skin burns and tympanic-membrane perforations; the other two, who were wearing raincoats, did not have these injuries. The treatment regimens primarily included antibiotic therapy, hyperbaric oxygen, wound care, and other symptomatic supportive treatments. All patients improved and were discharged within eight days. This case series illustrates the environmental factors, injury mechanisms, and complex, multi-system clinical features of arc explosion injuries caused by lightning, emphasizing the importance of lightning protection measures.