Lightning injuries occur through several distinct mechanisms. Here's a breakdown of the four you listed:
1. Direct Contact (Direct Strike)
The lightning bolt directly strikes the person. This is actually the least common mechanism but carries the highest mortality. The full current passes through the body, causing cardiac arrest, respiratory failure, and severe burns at entry/exit points.
2. Superheated Air (Flash/Flashover)
Lightning superheats the surrounding air to approximately 30,000 K (5x hotter than the sun's surface). This creates an intense radiant heat flash that can cause superficial burns, eye injury (flash blindness, cataracts), and ignite clothing. Interestingly, most lightning current actually "flashes over" the outside of the body rather than passing through it - this is why mortality from lightning is lower than expected given the voltages involved.
3. Expanded/Repelled Air (Blast Effect)
The rapid superheating causes explosive expansion of air outward from the strike channel. This creates a supersonic shock wave (the thunder). This blast wave can cause barotrauma - ruptured eardrums (the most common blast injury in lightning survivors), pulmonary contusion, and bowel injuries similar to other blast mechanisms.
4. Sledgehammer Effect (Compressed Air Blow)
This is the mechanical concussive force created by the compressed air that is pushed outward ahead of the return stroke current. It acts like a physical blow, capable of throwing victims significant distances, causing blunt trauma, fractures, head injuries, and spinal injuries. This is why lightning victims are often found some distance from where they were standing.
Additional mechanisms not listed but worth knowing:
- Ground current (step voltage) - the most common cause of lightning injury, where current spreads radially from the strike point along the ground
- Side flash (splash) - current jumps from a struck object (tree, pole) to a nearby person
- Contact voltage - person is touching an object that is struck
- Upward streamer - the leader discharge from the body itself before the strike completes
The sledgehammer/compressed air effect and the superheated air mechanisms explain why victims can sustain significant trauma even without a direct strike.