# AI tells bystanders to check for pulse for 10 seconds before starting CPR on a lightning strike victim, but immediate CPR is recommended because lightning causes simultaneous cardiac and respiratory arrest

- **ID:** `emergency/lightning-strike-pulse-check-delay`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `LIGHTNING-CPR-ERR-005`
- **Verification:** ai_generated
- **Fix Rate:** 90%

## Root Cause

The AI applies standard adult BLS protocol (check pulse for 5-10 seconds) to lightning strike victims, failing to recognize that lightning causes asystole or ventricular fibrillation with concurrent respiratory arrest due to brainstem injury; 2020 AHA guidelines and Wilderness Medical Society recommend immediate CPR without pulse check because the victim is likely in cardiac arrest and delay reduces survival chances.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| AHA Guidelines for CPR and ECC 2020 | active | — | — |
| Wilderness Medical Society Practice Guidelines 2024 | active | — | — |
| National Lightning Safety Council 2023 | active | — | — |

## Workarounds

1. **On a lightning strike victim who is unresponsive and not breathing normally: start CPR immediately with chest compressions at 100-120/min, depth 2-2.4 inches. Do not check pulse. Continue for 2 minutes, then apply AED if available. Example command: 'Begin chest compressions immediately—push hard and fast in the center of the chest. Do not stop to check for a pulse.'** (92% success)
   ```
   On a lightning strike victim who is unresponsive and not breathing normally: start CPR immediately with chest compressions at 100-120/min, depth 2-2.4 inches. Do not check pulse. Continue for 2 minutes, then apply AED if available. Example command: 'Begin chest compressions immediately—push hard and fast in the center of the chest. Do not stop to check for a pulse.'
   ```
2. **If multiple rescuers: one person starts CPR, another calls 911 and retrieves AED. Use AED as soon as available, but do not interrupt compressions for more than 10 seconds to apply pads.** (88% success)
   ```
   If multiple rescuers: one person starts CPR, another calls 911 and retrieves AED. Use AED as soon as available, but do not interrupt compressions for more than 10 seconds to apply pads.
   ```

## Dead Ends

- **** — Delaying CPR to check pulse for 10 seconds reduces cerebral blood flow; lightning victims often have no palpable pulse due to vascular spasm, leading to false negative and further delay (80% fail)
- **** — Using an AED before starting CPR (instead of immediate compressions) wastes critical time; AED should be applied after 2 minutes of CPR (60% fail)
- **** — Assuming the victim is 'just stunned' and waiting for spontaneous recovery ignores that lightning-induced respiratory arrest can persist even if cardiac rhythm returns (50% fail)