Tropic lightning: myth or menace?

Lightning is one of the leading causes of death related to environmental disaster. Of all lightning fatalities documented between 2006 and 2012, leisure activities contributed the largest proportion of deaths, with water-associated, sports, and camping being the most common. Despite the prevalence of these activities throughout the islands, Hawai'i has had zero documented lightning fatalities since weather data tracking was initiated in 1959. There is a common misconception that lightning does not strike the ground in Hawai'i. This myth may contribute to a potentially dangerous false sense of security, and recognition of warning signs and risk factor modification remain the most important prevention strategies. Lightning damage occurs on a spectrum, from minor burns to multi-organ dysfunction. After injury, initial treatment should focus on "reverse triage" and immediate cardiopulmonary resuscitation when indicated, followed by transfer to a healthcare facility. Definitive treatment entails monitoring and management of potential sequelae, to include cardiovascular, neurologic, dermatologic, ophthalmologic, audiovestibular, and psychiatric complications.