In differentiating electrical injury from lightning injury, what is the best discriminator?

In differentiating between electrical injury and lightning injury, the presence of deep burns serves as the best discriminator. Electrical injuries typically produce significant and sometimes deep tissue damage due to the passage of electrical current through the body, often resulting in characteristic pattern burns that can penetrate to deeper layers of skin and tissues.

In contrast, lightning injuries can lead to a range of effects, but the burns associated with lightning strikes tend to be more superficial because they primarily result from the rapid thermal effects of an electrical discharge rather than current flow through the body. Lightning can cause other injuries such as blast effects, but deep burns specifically are more indicative of injuries from lower voltage, direct current sources typical of common electrical accidents.

While loss of consciousness, cardiac arrest, and fractures or dislocations may occur in both types of injuries, these are not definitive discriminators. Because deep burns are a hallmark of electrical injuries and less common with lightning injuries, they provide crucial diagnostic information in emergency settings.