Prehospital care providers and EMS should be prepared to care for multiple patients at the scene of a high-voltage or lightning-strike incident.26,43,73 Due to the possibility of a good prognosis with early CPR, standard traumatic triage protocols may not apply.110 Victims without signs of life should have first and immediate care. The triage priorities in cases of electrical and lightning exposure are different from standard traumatic scenarios.40,45 At the scene, patients with clear signs of life typically do well,and can wait a short period before receiving aid.38 Furthermore, clinical findings, such as fixed and dilated pupils, absent pulses, and apnea, are unreliable in this setting and should not be used clinically to stop resuscitation in the field. (See first section under ED Evaluation ó Acute Stabilization and Cardiopulmonary Resuscitation.)
Falls and subsequent blunt trauma are routinely associated with high-voltage contact and lightning strikes. These victims should be assessed and treated, assuming the presence of multisystem trauma. Proper cervical spine immobilization should be implemented. All immediate, life-threatening traumatic injuries are sought and managed during transport to the ED.
Finally, when emergency care providers are called to assess a person injured by electricity, they should take all complaints seriously. One study in the United Kingdom found that 25% of patients who were asymptomatic at the time of EMS call were admitted to the hospital for burn care, an associated traumatic injury, or cardiac monitoring.111 Furthermore, as some clinical symptoms may be delayed (neuropathy, cataracts, pain, etc), even clinically asymptomatic patients should be strongly encouraged to seek appropriate medical care. All electrical burns are classified as major burns optimally cared for in qualified burn centers.