Senate Finally Passes New ‘Forever’ GI Bill

(THIS ARTICLE IS COURTESY OF TASK AND PURPOSE)

 

Senate Finally Passes New ‘Forever’ GI Bill, Sends It On To Trump

First Published On August 2, 2017

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At the eleventh hour before it recessed for the summer, the Senate finally got around to some real business: passing a sweeping GI Bill upgrade that extends benefits to more veterans and gives them more time to use those bennies.

RELATED: A NEW LIFETIME GI BILL IS LIKELY TO BECOME LAW. HERE’S HOW IT WILL IMPACT VETS »

The bill — dubbed “the forever GI Bill” by supporters — had been approved unanimously by the House, but its fortunes in the Senate were uncertain after the deliberating body approved a slapdash extension of its voting session into August to consider a bevy of government appointments and a full slate of bills.

The Senate just passed by unanimous consent a sweeping set of changes/expansion to the post-9/11 GI Bill. Heads to Trump’s desk. Story TK.

the new GI Bill

“The passage of the Forever GI Bill shows just how much can be accomplished when military and veterans organizations join forces,” said John Rowan, National President of Vietnam Veterans of America, in a statement.

The new bill, which heads to President Donald Trump’s desk and is expected to be signed into law swiftly, was the product of months of round tables and negotiations between veterans service organizations, non-profits, and politicians across both sides of the aisle.

After years working on this bill we finally have it passed. Thanks to the hundreds of people who were part of helping pass the New GI Bill!

“This was a truly bipartisan effort led by some amazing organizations and leaders within Congress, all committed to ensuring veterans and their families have the opportunity for a college education post-military service,” said Jared Lyon, president and CEO of Student Veterans of America, in a statement. “I could not be more proud of the team effort that went into making this a reality. This is what collaboration looks like, and this is what leadership looks like.”

Adam Weinstein is a Navy vet and senior editor for Task & Purpose. His work has appeared in Esquire, GQ, Gawker, and the New York Times. Follow Adam Weinstein on Twitter @AdamWeinstein
 [email protected]
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Veterans Overwhelmingly Favor Medical Marijuana

(THIS ARTICLE IS COURTESY OF ‘TASK & PURPOSE’)

 

Veterans Overwhelmingly Favor Medical Marijuana. When Will VA And Lawmakers Get On Board?

First Published on 

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An overwhelming majority of U.S. military veterans and veteran caregivers support the legalization of marijuana for medical purposes, according to a new national poll by Five Corner Strategies conducted on behalf of the American Legion — and veterans aren’t going to stop until the Department of Veterans Affairs starts taking medical marijuana research seriously.

The poll found that while 82% of respondents supported the legalization of medical cannabis, a whopping 92% supported expanded research into the medical benefits of the drug. And that attitude cuts across political boundaries: 88% of respondents who self-identified as “conservative” and 90% of self-identified “liberals” supported a federal legalization effort.

Medical cannabis is currently only legal in 29 states and the District of Columbia; yet, it is unlawful for VA doctors to prescribe it since marijuana remains a Schedule 1 substance — forcing vets to use medical cannabis at their own risk or not at all. Further, shortfalls in funding, restrictive eligibility criteria for a recently approved federal study specific to vets, and little support from the VA has prevented any policies from moving forward in Washington, despite a growing acceptance of marijuana to mitigate pain and mental-health issues.

RELATED: LAWMAKERS ARE URGING THE VA TO TAKE MEDICAL MARIJUANA FOR VETERANS SERIOUSLY »

According to the American Legion’s new poll, one in five veterans surveyed consume marijuana “to alleviate a medical or physical condition.” Ironically, the majority of those using medicinal pot are over the age of 60, despite support for the practice declining among older respondents, where 100% of 18-30-year-old respondents favored federally legalized medical marijuana, only 79% of sexagenarians agreed.

Following the release of the poll, conducted by national PulsePoint IVR on 802 self-identified veterans (513 respondents) and veteran caregivers (289) between Oct. 8 and Oct. 10, 2017, on Capitol Hill on Nov. 2, the American Legion, in conjunction with members of the House Committee on Veterans Affairs, called upon Secretary of Veterans Affairs David Shulkin to push for new research despite an increasingly obstinate approach to legalization by Attorney General Jeff Sessions.

“In order to keep veterans safe, we need to listen then,” Rep. Mark Takano, a Democrat from California and vice ranking member on the House Committee on Veterans Affairs, told the assembled crowd. “When a majority of veterans say medical cannabis has the potential to provide relief, we need to listen to them … If the VA’s research confirms that medical cannabis can be effective, it can have a transformative effect of veterans care while preventing veterans from lipping into the trap of opioid addiction.”

veterans medical marijuana research

The poll is the culmination of a growing push to change the federal government’s approach to veterans and medical marijuana. In a Oct. 26 letter to Shulkin, lawmakers on the House Committee on Veterans Affairs called on the VA to initiate renewed research into the medical benefits of legal cannabis, citing both a rising chorus of veterans advocacy organizations like the American Legion and the opioid epidemic that the Trump administration declared a national health emergency the same day.

While the VA has done little to move the needle on medical marijuana research, Shulkin has personally said he’s open to exploring alternative therapies, including medicinal weed, if they benefit veterans and their care.

“We are acutely aware of the work that’s going on around the country, particularly in states that have legalized medical marijuana,” Shulkin toldTask & Purpose in a June 12 interview. “And we are observing very closely work that’s being done that may be helping veterans, and we are open to any ideas and therapies that may be effective.”

VA Secretary David Shulkin on Medical Marijuana For Vets
In an exclusive sit-down interview with Task & Purpose June 12, Veterans Affairs Secretary David Shulkin made clear his department would pursue any emerging therapy with promise for disabled or troubled veterans — including medical marijuana. Here’s what he said.

National attitudes toward marijuana legalization have come a long way in recent years: According to an Oct. 25 Gallup poll conducted around the same time as the American Legion survey, a majority of registered Republicans are in support of marijuana legalization for the first time in a half-century. But even with public support for recreational marijuana legalization at an all-time high, only 64% are in favor of ending the federal prohibition on the substance — well below the levels of support detailed among veterans and military families in recent surveys.

While many veterans and doctors are already working to circumvent the VA’s existing medical marijuana policies, as Task & Purpose reported in October, it’s those changing attitudes among military and VA officials that will shape the course of medical marijuana research.

RELATED: HOW VETS AND THEIR DOCTORS ARE GETTING AROUND THE VA’S MEDICAL MARIJUANA POLICY »

“As we researched, we came across veterans who said that the only reason they were alive today and didn’t commit suicide was because they found medical cannabis,” Lou Celli, the American Legion’s national director of veterans affairs and rehabilitation, said on Nov. 2. “But you and I know we can’t change policy based on anecdotes. We need facts in order to have a meaningful discussion. And in order to get evidence and facts, we must do clinical research.”

WATCH NEXT:

VA Secretary Shulkin: ‘I’ll Have The Veterans’ Backs’
In an exclusive interview with Task & Purpose June 12, VA Secretary David M. Shulkin emphasized the importance of keeping a strong VA — and not privatizing all its services — to foster deeper trust between service members and the nation they serve.

 

Jared Keller is a senior editor at Task & Purpose and contributing editor at Pacific Standard. Follow Jared Keller on Twitter @JaredBKeller
 [email protected]

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(LIGHTNING FACTS) These Are Some Of The Many Facts VA Doctors At The Veterans Administration Hospitals Ignore And Deny!

(THIS ARTICLE IS COURTESY OF THE ‘LIGHTNING INJURY RESEARCH PROGRAM’, NOAA, AND MD./PROFESSOR MARY ANN COOPER, UNIVERSITY OF ILLINOIS AT CHICAGO)

Medical Aspects of Lightning

 

How Big A Problem Is This? Statistics

Lightning has been the second largest storm killer in the U.S. for the last 40 years, exceeded only by floods. A lightning strike can result in a cardiac arrest (heart stopping) at the time of the injury, although some victims may appear to have a delayed death a few days later if they are resuscitated but have suffered irreversible brain damage.

According to Storm Data, a National Weather Service publication, the U.S. averages 73 reported lightning fatalities per year. Due to under reporting, the figures are more realistically about 100 deaths per year. Only about 10% of people who are struck by lightning are killed, leaving 90% with various degrees of disability.

ODDS OF BECOMING A LIGHTNING VICTIM
U.S. 2000 Census population 280,000,000
Odds of being struck by lightning in a given year
(reported deaths + injuries)
1/700,000
Odds of being struck by lightning in a given year
(estimated total deaths + injuries)
1/240,000
Odds of being struck in your lifetime (Est. 80 years) 1/3000
Odds you will be affected by someone being struck
(Ten people affected for every one struck)
1/300

Who Gets Injured

While about one-third of all injuries occur during work, workers compensation companies are often reluctant to acknowledge the injury or pay related medical expenses. About another third of injuries occur during recreational or sports activities. The last third occurs in diverse situation, including injuries to those inside buildings.

How Do Lightning Injuries Affect People?

While any death is a blow to a family, eventually the family readjusts and goes on. However, for those who have a relative who suffers significant disability from lightning, life changes forever and the dreams of that family and the survivor may be markedly altered. The family income may be tremendously decreased if the survivor was one of the breadwinners, or the spouse or another family member may have to quit work to care for the survivor if the disability is great enough.

While about one-third of all injuries occur during work, workers compensation companies are often reluctant to acknowledge the injury or pay their medical expenses. About another third of injuries occur during recreational or sports activities. The last third occurs in diverse situation, including injuries to those inside buildings.  Many injuries in each of these groups can be prevented with proper education, well conceived lightning protection systems that protect the people as well as the equipment being used or �shelters� where the survivor may seek safety, and lightning safety plans for coaches, parents, and referees at sporting events. While lightning safety and injury prevention is an individual responsibility and decision for adults, adults are ALWAYS responsible for the children in their care, particularly if it is an outdoor sports activity such as soccer, t-ball, camping, etc.

Unlike high voltage electrical injuries where massive internal tissue damage may occur, lightning seldom causes substantial burns. In fact, most of the burns are caused by other objects (rainwater, sweat, metal coins and necklaces, etc) being heated up and causing the burn rather than caused by the lightning itself.

Lightning tends to be a nervous system injury and may affect any or all parts of the nervous system: the brain, the autonomic nervous system, and the peripheral nervous system.  When the brain is affected, the person often has difficulty with short-term memory, coding new information and accessing old information, multitasking, distractibility, irritability and personality change. A great quote sums it up perfectly:

“Patients have difficulty in all areas that require them to analyze more items of information than they can handle simultaneously. They present (appear) as slow because it takes longer for smaller than normal chunks of information to be processed. They present as distractible because they do not have the spare capacity to monitor irrelevant stimuli at the same time as they are attending to the relevant stimulus. They present as forgetful because while they are concentrating on point A, they do not have the processing space to think about point B simultaneously. They present as inattentive because when the amount of information that they are given exceeds their capacities, they cannot take it all in.”

Early on, survivors may complain of intense headaches, tinnitus (ringing in the ears), dizziness, nausea, vomiting and other �post-concussion� types of symptoms.  Survivors may also experience difficulty sleeping, sometimes sleeping excessively acutely after the injury but changing during the next few weeks to inability to sleep more than two or three hours at a time. A few may develop persistent seizure-like activity several weeks to months after the injury.  Unfortunately, standard EEG�s do not always pick up injury in the areas that lightning most often affects leading to a diagnosis of �pseudo-seizures�.

Personality Changes / Self-Isolation

Many may suffer personality changes because of frontal lobe damage and become quite irritable and easy to anger. The person who �wakes up� after the injury often does not have the ability to express what is wrong with them, may not recognize much of it or deny it, becomes embarrassed when they cannot carry on a conversation, work at their previous job, or do the same activities that they used to handle. As a result, many self-isolate, withdrawing from church, friends, family and other activities. Friends, family and co-workers who see the same external person, may not understand why the survivor is so different. Friends soon stop coming by or asking them to participate in activities. Families who are not committed to each other break up.

Obviously, depression becomes a big problem for people who have changed so much and lost so much.  Suicide is something that almost all severely injured people have thought about at one time or another.  Occasionally, those who do not have access to medical care or who do not understand what is happening may self-medicate with alcohol and other drugs, particularly those who have previously sought solace with these compounds.  It is very important that the family and friends of the survivor maintain supportive contact even though it requires an adjustment in their relationship with the survivor.  An injury such as this is an injury to the family, not just to the person hit.

Fatigue

Survivors often complain of easy fatigability, becoming exhausted after only a few hours of work. This may be because every task that they used to automatically do without thinking now requires intense concentration to accomplish. Many return to work but find that they cannot multitask and do all of the activities that are required at their job.

Medical Testing

There are two kinds of medical tests:

  • Anatomic ones that take a simple picture (x-ray) or measurement (blood count)
  • Functional ones that show how something is working (PET, neuro-psychological testing, intelligence testing)

Sometimes function can be ascribed to the anatomic tests but often it cannot so that it is often fallacious on the basis of a normal static picture to ascribe normal function.  The mental changes that the lightning survivor has are functional (how the brain works) changes, not anatomic ones so that anatomic tests such as the CT scan and MRI are usually normal. More functional scans such as PET and SPECT may show changes but are hard to obtain due to their relative infrequency in medical centers. To use an analogy:  if an electric shock were sent through a computer, the outside case would probably look okay (similar to a photo or x-rays of the person), the computer boards on the inside would probably look okay and not be fused nor melted (CT, MRI for the person), but when you boot up the computer it would have difficulty accessing files, making calculations, printing, etc. similar to a person with brain injury who has short-term memory problems, difficulty accessing and coding information, difficulty organizing output,

A functional test of how a person�s brain is working that is seldom thought of by most non-neurologists is called neuropsychological testing.  These tests are administered by a qualified neuropsychologist familiar with the literature in this area, not by a psychiatrist, and consist of a 6-8 hour battery of pen and paper tests including memory, IQ, organizational ability, and other �how the parts of the brain are working� kinds of tests.  Survivors of lightning and electrical injury usually have a characteristic pattern of deficits.  This type of testing is expensive and not necessary for most but can sometimes be helpful when litigation is involved and there is a doubt about the cause of a person�s injury.

Delayed Problems

Another common, often delayed problem for some survivors is pain, also a difficult problem to quantify and manage and one that does not always present initially in the full-blown pattern that it may have later. The pain may not only present as the chronic intense headaches mentioned above but may be in the back (perhaps from compression and disc injury from the intense muscle contractions which may throw a person several yards at the time of the injury), or in an extremity. Many may have nerve entrapment syndromes. A small number may eventually develop classic RSD. (Reflex Sympathetic Dystrophy, Sympathetically Mediated Pain Syndrome, causalgia)

Sometimes the functional tests that are ordered are testing the wrong thing an electromyogram (EMG) measures only the largest nerve fibers, the motor fibers, which are seldom affected by lightning injury.  Smaller pain-carrying nerve fibers are not tested by EMG so that a �normal EMG� means little when ordered for someone with pain.  Likewise, the standard EEG does primarily surface readings of the brain and misses seizure activity in several deeper regions.  EEG�s may not pick up only 50% of temporal lobe seizures (some personality, organizing ability) and miss 120% of hypothalamic seizures.4

Lack of libido and impotence are often reported. Other common and not so common complaints involve the digestive system, the endocrine (hormonal) system, and the immune system, some of which are currently being studied. It is not clear if these are directly due to lightning injury, to medication side effects, or to other incidental causes unrelated to lightning.

Help Exists – Lightning Strike and Electric Shock Survivors, International, Support Group

An organization that has been of tremendous help to survivors, their families, their physicians and other professionals is Lightning Strike and Electric Shock Survivors, International (LSESSI), a support group formed in 1989 by a gentleman who was injured in 1969 who became tired of no one recognizing or knowing what to do for those with lightning injury. LSESSI has printed materials, offers tremendous support, networks survivors with others in their area, and provides an annual meeting where survivors come together for support as well as for lectures from professionals who work with lightning and electrical survivors and their families. LSESSI can be reached at 912-346-4708, [email protected], http://www.lightning-strike.org/index.html, or at P.O. Box 1156, Jacksonville, North Carolina 28541-1156.

Four Factors Necessary for Recovery

The four most important factors in overcoming disability from lightning injury (or from any illness or major injury for that matter) are:

  1. A supportive family/friends network.
  2. The person or family becoming their own best advocate and learning as much as they can about their disability.
  3. A physician (regardless of specialty) who is willing to listen, read, learn and work with the survivor and their family.
  4. A sense of humor.

 

Prevention

Far more important than treating survivors is preventing lightning injury.

National Lightning Safety Awareness Week

Prevention is the KEY.

 

REFERENCES

 

  1. Holle RL, Lopez RE, Curran EB: Distributions of Lightning-Caused Casualties and Damages Since 1959 in the United States, 11 Conference on Applied Climatology, American Meteorological Society, January 1999
  2. Cooper MA: Lightning Injuries: Prognostic Signs for Death, Ann Emerg Med 9:134, 1980
  3. Lopez RE, Holle RL, Heitkamp TA, Boyson M, Cherington M, Langford K: The Underreporting of Lightning Lnjuries and Deaths in Colorado. Bull Amer Meteor Soc, 74:2171-78, 1993.
  4. Cooper MA, Andrews CJ, Holle RL, Lopez RE: Lightning Injuries, Ch 3, Auerbach P (Ed):  Wilderness Medicine, 4th Edition, CV Mosby, 2001.
  5. Cherington Paper
  6. Life After Shock I, Life After Shock II, collections of stories of lightning and electric shock survivors and how it has changed their lives, Lightning Strike and Electric Shock Survivors, Intntl, Morris Publishing, Nebraska,1996/2000.
  7. Heitkamp, Holle, Lopez
  8. Holle, R.L., R.E. L�pez, and C. Zimmermann, 1999: Updated Recommendations for Lightning Safety-1998.  Bull Amer Meteor Soc, 80:2035-2041
  9. Cherington M, Cooper MA: eds, Seminars in Neurology, Vols 3&4, 1995, two issues on electrical and lightning injuries
  10. Primeau M, Engelstetter G, Bares K: Behavioral Consequences of Lightning and Electrical Injury, Sem Neurol, 15(3):279-285, 1995.
  11. Pliskin NH, Capelli-Schelpfeffer M, Law RT, Malina AC et al: Neuropsychological Symptom Presentation after Electrical Injury, J Trauma 44(4):709-15, 1998
  12. Heilbronner RL, Pliskin NH:Psychological issues in the neurorehabilitation of electrical injuries, NeuroRehabilitation 13:127-32, 1999.
  13. Groenwald D:Cumulative and Persisting Effects of Concussion on Attention and Cognition, 154 (sorry, no further info on this reference is available to us)

U.S. Veterans Administration Information On Benefits For Veterans

(THIS ARTICLE IS COURTESY OF THE VETERANS ADMINISTRATION)

 

Veterans Benefits Administration <[email protected]> Unsubscribe

2:51 PM (2 hours ago)

 

matrix 

Dear VA Beneficiary, 

Do you know all of the VA benefits that you may eligible for based on your service connected disability rating, receipt of a non-service connected benefit, or special circumstance? To help you find them, we created charts to show you what benefits you may be eligible for based on your current situation.

Have a service connected disability rating from 0-100%? Use the Service Connected Matrix to find more benefits that you may be eligible to receive.   

Not service connected? Are you getting VA pension or Aid and Attendance or Housebound benefits? Use the Non Service Connected Matrix to discover benefits that you may be eligible to receive.

Also, check out the Circumstance Matrix to see if any of the listed circumstances apply to you.  

We want to make sure everyone is aware of all of their benefits! 

Thank you for your service!

 

Sincerely,

Veterans Benefits Administration

Veterans Affairs Officials Defend Plans To Strip Benefits From Elderly Veterans To Save VA Money

(THIS ARTICLE IS COURTESY OF THE ‘MILITARY TIMES’)

WASHINGTON — Veterans Affairs officials on Wednesday defended plans to strip tens of thousands of dollars in unemployment benefits from elderly veterans as responsible reforms to the department’s growing budget, but opponents promised to fight the idea.

Included in President Donald Trump’s $186.5 billion VA budget for fiscal 2018 — a nearly 6 percent boost in discretionary spending from this year — are plans to dramatically cut the department’s Individual Unemployability program.

Up to 225,000 veterans over the age of 60, at least 7,000 of whom are over 80, could be impacted by the change.

Under current rules, the IU program awards payouts at the 100 percent disabled rate to veterans who cannot find work due to service-connected injuries, even if actual rating is less than that.

Administration officials want to stop those payouts once veterans are eligible for Social Security retirement benefits, arguing those individuals should no longer qualify for unemployment benefits. Veterans who cannot collect Social Security would be exempt.

“There are always hard decisions that have to be made,” VA Secretary David Shulkin said following a House Veterans’ Affairs Committee budget hearing on Wednesday. “Sometimes that means you have to adjust current programs to support the growth of other benefits. That’s what we’re seeing here.

“I don’t think we can continue to only expand services and not look at the ones we are delivering … I think people can understand paying veterans who are above age 80 unemployment benefits isn’t what makes sense to the average American.”

For veterans who aren’t already retirement age, the change could largely be offset by their new Social Security payouts.

But for veterans already receiving both, it will mean a sudden loss of a significant income source. The IU payouts can total more than $22,000 a year.

Shulkin said the move, which is expected to save $3.2 billion next year alone, is proof that “we’re trying to refine our approaches to use our resources efficiently.”

Military Times

Trump’s 2018 military pay raise is smaller than expected

But advocates called it an unconscionable attack on older veterans.

“The budget plan unveiled yesterday completely abandons many of the most severely disabled veterans of the Vietnam generation and could make thousands of elderly veterans homeless,” said John Rowan, national president of Vietnam Veterans of America.

“We’re extremely alarmed by this budget proposal, because this is the opposite of what President Trump promised veterans.”

VVA officials said they spent have spent the last day since the budget announcement fielding panicked calls from veterans dependent on the program, wondering how they’ll make ends meet.

VFW National Commander Brian Duffy said his membership likes many parts of the budget “we are absolutely against forcing wounded, ill and injured veterans to pay for improvements elsewhere within the VA.” AMVETS released a statement Wednesday demanding the IU provision be dropped, labeling it “stealing” benefits from veterans.

Administration officials have also proposed rounding down cost-of-living adjustments to veterans benefits next year, a practice that would take no more than $12 from an individual vet in annual payouts but could save the government $20 million next year.

White House officials said those changes and other benefits trims are needed to offset the cost of other program expansions, in particular plans to expand and revamp the VA Choice Card program, which allows veterans to more easily receive private-sector medical care at the government’s expense.

Republican lawmakers on the House committee did not mention the benefits proposals in their budget questions for Shulkin, but several Democrats blasted the ideas. Ranking member Tim Walz, D-Minn., said called the plans “a pretty strong repudiation of what (veterans) have earned.”

Rep. Mark Takano, D-Calif., said the idea risks “plunging them into poverty.”

Shulkin said he is open to alternatives, but also wary of increasing VA spending without “making sure our current programs are being utilized in the appropriate way.”

Lawmakers will use the White House budget plan as a baseline to offer their own funding proposals in coming weeks, with the goal of finalizing a department budget before the end of the current fiscal year in September.

Leo Shane III covers Congress, Veterans Affairs and the White House for Military Times. He can be reached at [email protected]

(LIGHTNING FACTS) These Are Some Of The Many Facts VA Doctors At The Veterans Administration Hospitals Ignore And Deny!

(THIS ARTICLE IS COURTESY OF THE ‘LIGHTNING INJURY RESEARCH PROGRAM’, NOAA, AND MD./PROFESSOR MARY ANN COOPER, UNIVERSITY OF ILLINOIS AT CHICAGO)

Medical Aspects of Lightning

 

How Big A Problem Is This? Statistics

Lightning has been the second largest storm killer in the U.S. for the last 40 years, exceeded only by floods. A lightning strike can result in a cardiac arrest (heart stopping) at the time of the injury, although some victims may appear to have a delayed death a few days later if they are resuscitated but have suffered irreversible brain damage.

According to Storm Data, a National Weather Service publication, the U.S. averages 73 reported lightning fatalities per year. Due to under reporting, the figures are more realistically about 100 deaths per year. Only about 10% of people who are struck by lightning are killed, leaving 90% with various degrees of disability.

ODDS OF BECOMING A LIGHTNING VICTIM
U.S. 2000 Census population 280,000,000
Odds of being struck by lightning in a given year
(reported deaths + injuries)
1/700,000
Odds of being struck by lightning in a given year
(estimated total deaths + injuries)
1/240,000
Odds of being struck in your lifetime (Est. 80 years) 1/3000
Odds you will be affected by someone being struck
(Ten people affected for every one struck)
1/300

Who Gets Injured

While about one-third of all injuries occur during work, workers compensation companies are often reluctant to acknowledge the injury or pay related medical expenses. About another third of injuries occur during recreational or sports activities. The last third occurs in diverse situation, including injuries to those inside buildings.

How Do Lightning Injuries Affect People?

While any death is a blow to a family, eventually the family readjusts and goes on. However, for those who have a relative who suffers significant disability from lightning, life changes forever and the dreams of that family and the survivor may be markedly altered. The family income may be tremendously decreased if the survivor was one of the breadwinners, or the spouse or another family member may have to quit work to care for the survivor if the disability is great enough.

While about one-third of all injuries occur during work, workers compensation companies are often reluctant to acknowledge the injury or pay their medical expenses. About another third of injuries occur during recreational or sports activities. The last third occurs in diverse situation, including injuries to those inside buildings.  Many injuries in each of these groups can be prevented with proper education, well conceived lightning protection systems that protect the people as well as the equipment being used or �shelters� where the survivor may seek safety, and lightning safety plans for coaches, parents, and referees at sporting events. While lightning safety and injury prevention is an individual responsibility and decision for adults, adults are ALWAYS responsible for the children in their care, particularly if it is an outdoor sports activity such as soccer, t-ball, camping, etc.

Unlike high voltage electrical injuries where massive internal tissue damage may occur, lightning seldom causes substantial burns. In fact, most of the burns are caused by other objects (rainwater, sweat, metal coins and necklaces, etc) being heated up and causing the burn rather than caused by the lightning itself.

Lightning tends to be a nervous system injury and may affect any or all parts of the nervous system: the brain, the autonomic nervous system, and the peripheral nervous system.  When the brain is affected, the person often has difficulty with short-term memory, coding new information and accessing old information, multitasking, distractibility, irritability and personality change. A great quote sums it up perfectly:

“Patients have difficulty in all areas that require them to analyze more items of information than they can handle simultaneously. They present (appear) as slow because it takes longer for smaller than normal chunks of information to be processed. They present as distractible because they do not have the spare capacity to monitor irrelevant stimuli at the same time as they are attending to the relevant stimulus. They present as forgetful because while they are concentrating on point A, they do not have the processing space to think about point B simultaneously. They present as inattentive because when the amount of information that they are given exceeds their capacities, they cannot take it all in.”

Early on, survivors may complain of intense headaches, tinnitus (ringing in the ears), dizziness, nausea, vomiting and other �post-concussion� types of symptoms.  Survivors may also experience difficulty sleeping, sometimes sleeping excessively acutely after the injury but changing during the next few weeks to inability to sleep more than two or three hours at a time. A few may develop persistent seizure-like activity several weeks to months after the injury.  Unfortunately, standard EEG�s do not always pick up injury in the areas that lightning most often affects leading to a diagnosis of �pseudo-seizures�.

Personality Changes / Self-Isolation

Many may suffer personality changes because of frontal lobe damage and become quite irritable and easy to anger. The person who �wakes up� after the injury often does not have the ability to express what is wrong with them, may not recognize much of it or deny it, becomes embarrassed when they cannot carry on a conversation, work at their previous job, or do the same activities that they used to handle. As a result, many self-isolate, withdrawing from church, friends, family and other activities. Friends, family and co-workers who see the same external person, may not understand why the survivor is so different. Friends soon stop coming by or asking them to participate in activities. Families who are not committed to each other break up.

Obviously, depression becomes a big problem for people who have changed so much and lost so much.  Suicide is something that almost all severely injured people have thought about at one time or another.  Occasionally, those who do not have access to medical care or who do not understand what is happening may self-medicate with alcohol and other drugs, particularly those who have previously sought solace with these compounds.  It is very important that the family and friends of the survivor maintain supportive contact even though it requires an adjustment in their relationship with the survivor.  An injury such as this is an injury to the family, not just to the person hit.

Fatigue

Survivors often complain of easy fatigability, becoming exhausted after only a few hours of work. This may be because every task that they used to automatically do without thinking now requires intense concentration to accomplish. Many return to work but find that they cannot multitask and do all of the activities that are required at their job.

Medical Testing

There are two kinds of medical tests:

  • Anatomic ones that take a simple picture (x-ray) or measurement (blood count)
  • Functional ones that show how something is working (PET, neuro-psychological testing, intelligence testing)

Sometimes function can be ascribed to the anatomic tests but often it cannot so that it is often fallacious on the basis of a normal static picture to ascribe normal function.  The mental changes that the lightning survivor has are functional (how the brain works) changes, not anatomic ones so that anatomic tests such as the CT scan and MRI are usually normal. More functional scans such as PET and SPECT may show changes but are hard to obtain due to their relative infrequency in medical centers. To use an analogy:  if an electric shock were sent through a computer, the outside case would probably look okay (similar to a photo or x-rays of the person), the computer boards on the inside would probably look okay and not be fused nor melted (CT, MRI for the person), but when you boot up the computer it would have difficulty accessing files, making calculations, printing, etc. similar to a person with brain injury who has short-term memory problems, difficulty accessing and coding information, difficulty organizing output,

A functional test of how a person�s brain is working that is seldom thought of by most non-neurologists is called neuropsychological testing.  These tests are administered by a qualified neuropsychologist familiar with the literature in this area, not by a psychiatrist, and consist of a 6-8 hour battery of pen and paper tests including memory, IQ, organizational ability, and other �how the parts of the brain are working� kinds of tests.  Survivors of lightning and electrical injury usually have a characteristic pattern of deficits.  This type of testing is expensive and not necessary for most but can sometimes be helpful when litigation is involved and there is a doubt about the cause of a person�s injury.

Delayed Problems

Another common, often delayed problem for some survivors is pain, also a difficult problem to quantify and manage and one that does not always present initially in the full-blown pattern that it may have later. The pain may not only present as the chronic intense headaches mentioned above but may be in the back (perhaps from compression and disc injury from the intense muscle contractions which may throw a person several yards at the time of the injury), or in an extremity. Many may have nerve entrapment syndromes. A small number may eventually develop classic RSD. (Reflex Sympathetic Dystrophy, Sympathetically Mediated Pain Syndrome, causalgia)

Sometimes the functional tests that are ordered are testing the wrong thing an electromyogram (EMG) measures only the largest nerve fibers, the motor fibers, which are seldom affected by lightning injury.  Smaller pain-carrying nerve fibers are not tested by EMG so that a �normal EMG� means little when ordered for someone with pain.  Likewise, the standard EEG does primarily surface readings of the brain and misses seizure activity in several deeper regions.  EEG�s may not pick up only 50% of temporal lobe seizures (some personality, organizing ability) and miss 120% of hypothalamic seizures.4

Lack of libido and impotence are often reported. Other common and not so common complaints involve the digestive system, the endocrine (hormonal) system, and the immune system, some of which are currently being studied. It is not clear if these are directly due to lightning injury, to medication side effects, or to other incidental causes unrelated to lightning.

Help Exists – Lightning Strike and Electric Shock Survivors, International, Support Group

An organization that has been of tremendous help to survivors, their families, their physicians and other professionals is Lightning Strike and Electric Shock Survivors, International (LSESSI), a support group formed in 1989 by a gentleman who was injured in 1969 who became tired of no one recognizing or knowing what to do for those with lightning injury. LSESSI has printed materials, offers tremendous support, networks survivors with others in their area, and provides an annual meeting where survivors come together for support as well as for lectures from professionals who work with lightning and electrical survivors and their families. LSESSI can be reached at 912-346-4708, [email protected], http://www.lightning-strike.org/index.html, or at P.O. Box 1156, Jacksonville, North Carolina 28541-1156.

Four Factors Necessary for Recovery

The four most important factors in overcoming disability from lightning injury (or from any illness or major injury for that matter) are:

  1. A supportive family/friends network.
  2. The person or family becoming their own best advocate and learning as much as they can about their disability.
  3. A physician (regardless of specialty) who is willing to listen, read, learn and work with the survivor and their family.
  4. A sense of humor.

 

Prevention

Far more important than treating survivors is preventing lightning injury.

National Lightning Safety Awareness Week

Prevention is the KEY.

 

REFERENCES

 

  1. Holle RL, Lopez RE, Curran EB: Distributions of Lightning-Caused Casualties and Damages Since 1959 in the United States, 11 Conference on Applied Climatology, American Meteorological Society, January 1999
  2. Cooper MA: Lightning Injuries: Prognostic Signs for Death, Ann Emerg Med 9:134, 1980
  3. Lopez RE, Holle RL, Heitkamp TA, Boyson M, Cherington M, Langford K: The Underreporting of Lightning Lnjuries and Deaths in Colorado. Bull Amer Meteor Soc, 74:2171-78, 1993.
  4. Cooper MA, Andrews CJ, Holle RL, Lopez RE: Lightning Injuries, Ch 3, Auerbach P (Ed):  Wilderness Medicine, 4th Edition, CV Mosby, 2001.
  5. Cherington Paper
  6. Life After Shock I, Life After Shock II, collections of stories of lightning and electric shock survivors and how it has changed their lives, Lightning Strike and Electric Shock Survivors, Intntl, Morris Publishing, Nebraska,1996/2000.
  7. Heitkamp, Holle, Lopez
  8. Holle, R.L., R.E. L�pez, and C. Zimmermann, 1999: Updated Recommendations for Lightning Safety-1998.  Bull Amer Meteor Soc, 80:2035-2041
  9. Cherington M, Cooper MA: eds, Seminars in Neurology, Vols 3&4, 1995, two issues on electrical and lightning injuries
  10. Primeau M, Engelstetter G, Bares K: Behavioral Consequences of Lightning and Electrical Injury, Sem Neurol, 15(3):279-285, 1995.
  11. Pliskin NH, Capelli-Schelpfeffer M, Law RT, Malina AC et al: Neuropsychological Symptom Presentation after Electrical Injury, J Trauma 44(4):709-15, 1998
  12. Heilbronner RL, Pliskin NH:Psychological issues in the neurorehabilitation of electrical injuries, NeuroRehabilitation 13:127-32, 1999.
  13. Groenwald D:Cumulative and Persisting Effects of Concussion on Attention and Cognition, 154 (sorry, no further info on this reference is available to us)
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