When lightning strikes: reducing the risk of injury to high-altitude trekkers during thunderstormsResponse to Letter

To the Editor-in-Chief: We read with interest the review on hypoxia-related altitude illnesses.1 We would like to draw attention to the often overlooked dangers posed by lightning at altitude. The recent tragic death of an elite mountaineer on Mount Kilimanjaro2 highlights the importance of educating travellers about this phenomenon. The overall ratio of lightning injuries to deaths is 10:1, with a 76% chance of sequelae in survivors.3 Most lightning deaths are due to cardiorespiratory arrest. Neurologic sequelae include amnesia, paraesthesiae and traumatic spinal injury. Tympanic membrane rupture occurs in 50% of survivors.4 When thunder is heard, trekkers should seek shelter in a building with plumbing and electrical wiring or in a fully enclosed metal vehicle. Ungrounded structures such as huts and tents increase the risk of being struck.5 As electrically grounded shelter is often unavailable, thunder at altitude should compel the trekker to avoid high-risk areas such as ridgelines and summits, and to avoid tall objects such as isolated trees and …