title: A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.
abstract: Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued.
authors.affiliation: University of California, San Francisco, Fresno Medical Education Program, Fresno, CA. Electronic address: sspano@gmail.com.
authors.forename: Susanne J
authors.initials: SJ
authors.lastname: Spano
authors.affiliation: University of California, San Francisco, Fresno Medical Education Program, Fresno, CA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Campagne
authors.affiliation: University of California, San Francisco, Fresno Medical Education Program, Fresno, CA.
authors.forename: Geoff
authors.initials: G
authors.lastname: Stroh
authors.affiliation: University of California, San Francisco, Fresno Medical Education Program, Fresno, CA.
authors.forename: Marc
authors.initials: M
authors.lastname: Shalit
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D004632:Emergency Medical Services; D017809:Fatal Outcome; D006801:Humans; D015168:Lightning Injuries / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000068316:Parks, Recreational; D016896:Treatment Outcome; D055813:Wilderness Medicine
keywords: National Park Service; helicopter EMS transport; lightning; multicasualty incident; parkmedic; wilderness rescue