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Some people who get directly struck by lightning and some more than once (starts at 00:25) survive while others die instantly or later on due to complications/injuries.

Looking at a wiki page for Lightning injuries

Lightning injuries are injuries caused by lightning strikes.

They result from three factors:

  • electrical damage.
  • intense heat.
  • the mechanical energy which these generate.

While sudden death is common because of the huge voltage of a lightning strike, survivors often fare better than victims of other electrical injuries caused by a more prolonged application of lesser voltage.

Lightning can strike or injure humans in four different ways but I'm going to focus on direct strikes.

Reported mortality rates range from 10–30 percent, depending on the source of data. Most people who are struck by lightning live to tell the story, but many suffer from long term injury or disability. Airforce medicine site

Is there a physiological reason why direct lightning strikes are not lethal for everyone or does it all come down to dumb luck?

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    $\begingroup$ There is a very wide range of energy in lightening strikes. $\endgroup$ – blacksmith37 Jun 5 at 15:57
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    $\begingroup$ To expand on @blacksmith37 comment: being "struck" by lightening doesn't necessarily mean a direct hit on your person. Even if lightening strikes several yards away you may suffer from electrical shock and be stunned from concussion. In general the further you are from ground zero the less likely you are to be injured, but even then the nature of the local terrain may strongly affect the resulting ground currents, which can be lethal. $\endgroup$ – Charles E. Grant Aug 15 at 16:51
  • $\begingroup$ Yeah "struck by lighting" covers a fairly wide range of occurrences, including different type of lighting and different types of strikes including direct and indirect. This is like asking why all burn victims do not die as if a first degree burn on the hand and a third degree burn across the entire body was the same thing. $\endgroup$ – John Aug 15 at 18:31
  • $\begingroup$ Specified question to direct strikes only. $\endgroup$ – Tom Aug 16 at 7:35
  • $\begingroup$ That youtube video looks like a hoax, though. The camera should have picked way more light based on the distance from the lens to the strikes. Different google search results suggest it may be fake too. $\endgroup$ – pawelek zzz Sep 15 at 10:03
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Is there a physiological reason why direct lightning strikes are not lethal for everyone or does it all come down to dumb luck?

To be lethal a lighting strike has to do enough damage to a critical organ that the injury is not survivable. Since electricity can take highly variable paths through a body, the amount of damage inflicted is also highly variable.

For example, current entering on the head and exiting on the foot stands a good chance of passing through both the brain and heart. This is likely to be a very severe injury. Conversely, current entering on the left hand and exiting on the left foot does not cross the body and may leave superficial burns but limited internal injuries.

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Lightning strikes the ground which then conducts to you.

By keeping minimal contact with the ground, you give the electricity less of a chance to conduct to you. And if your heels touch, this gives the electricity a shorter path to travel.

It is also important to avoid conductors, such as metal items.

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