Reverse triage for lightning-strike MCI
Reverse triage is essential in lightning-strike induced mass casualty incident (MCI) since those who appear dead may be easily resuscitated with good survival rates, so should be attended to first.
Patients sufferring from lightning strike may initially have fixed and dilated pupils (autonomic dysfunction) and cold mottled extremities from vasospasm. Asystole occurs from direct depolarization of the myocardium but typically spontaneous ROSC is achieved. Respiratory arrest from medullary paralysis can take longer to resolve and patients may develop a secondary hypoxic arrest.