a. General Effects.

Electric current passing through the body can cause severe injury to body tissues.

How much tissue damage occurs depends on the strength of the electric current passing through the body and the length of time the patient was exposed to the current.

Electricity is a fundamental part of our environment. Man-made electricity provides us with conveniences such as air-conditioning and pleasures such as VCRs and television. Electricity in nature gives us the beauty of the aurora borealis and lightning.

However, electricity can also be dangerous. When it goes through the body, electricity is converted to heat that burns tissues in its path. High-voltage electrical current can arc, generating so much electricity that it burns a person standing nearby. Current passing through vital body organs can cause respiratory or cardiac arrest with fatal results.

b. Determination of the Severity of an Electrical Burn.

The severity of a patient’s burns is critical to the order of care he will receive, the type of care, and the order of transport.

For an electrical burn patient, an accurate history of the accident should include the following elements.

(1) Voltage and amperage of the current.

(2) Amount of time the patient was exposed to the electricity.

(3) Amount of moisture on the patient.

(4) Amount of his body surface that came in contact with the current.

(5) Amount of insulation worn by the patient.

(6) Area of the body through which the current passed.

(7) Type of current (AC or DC).

c. Signs and Symptoms of Electrocution.

A person who has had an electrical accident may have the following signs and symptoms.

(1) Burns on the skin surface where the energy entered and exited the body.

(2) Dazed and confused condition.

(3) Problems with sight.

(4) Paralysis (from disrupted nerve pathways).

(5) Irritable or restless, whether conscious or unconscious.

(6) Weak, irregular, or absent pulse.

(7) Irregular heartbeat or cardiac arrest.

(8) Blood pressure elevated or low with signs and symptoms of shock.

(9) Shallow, irregular, or absent breathing (tongue may swell and obstruct airway).

(10) Multiple fractured bones and dislocations from intense muscular contractions or from falling.

(11) Seizures.

d. Effects on the Body.

Electric current can have a variety of effects on the body.

Some damage can be seen immediately while other effects may not become apparent until later (after 24 hours). Examples of delayed effects include damage to the spinal cord and cataracts. Generally, the body is affected in the ways listed below.

(1) Broken bones and bruises. Alternating current, more dangerous than direct current, may cause muscular contractions that throw the victim clear of the point of contact. In the fall, however, he may sustain injuries such as bruises or broken bones.

(2) More muscular contraction damage. Muscular contractions may cause blood pressure to skyrocket suddenly. The contractions may cause the patient to have minute spots of brain hemorrhage, hemorrhage of organs, and eye disorders. One or both eyes may be bloodshot.

(3) Temporary paralysis. The patient may experience temporary paralysis. This may be the result of extensive neurological damage from the electric current passing through the cells of the body. Paralysis may cause the patient’s respirations to stop.

(4) Heart. Effects of an electrical shock on the heart range from temporary fibrillation to complete cardiac arrest or permanent tissue damage. If electric current passes through the heart, death may occur immediately due to ventricular fibrillation or the temporary suspension of breathing (apnea). Cardiopulmonary arrest is the most  frequent cause of death at the scene.

(5) Kidneys, spinal cord, and brain. Kidneys, spinal cord, and brain are often severely damaged.

(6) Entry wound/exit wound. The entry wound is the place where electricity entered the body. The exit wound is where electricity left the body. The entry wound is usually a blood-deprived, whitish-yellow, coagulated area. Sometimes this wound will be charred or depressed with well-defined edges. The exit wound normally looks as if the electric current exploded as it left the body.

(7) Skin. Skin damage may vary from small circular spots to large areas of charred destruction.

(8) Blood vessels. Blood vessels supplying the skin are often destroyed. Blood clots may be seen for some distance surrounding the original wound. A limb that initially seems to be only minimally damaged may become deprived of blood in a few days and, finally, become gangrenous.

(9) Late-appearing complications. Additional complications that may not appear immediately include the following:

(a) Nerve damage.

(b) Severe pain along nerve channels.

(c) Spinal cord lesions and injuries.

(d) Cardiac abnormalities.

(e) Rapid heartbeat for several weeks.

(f) Pulmonary infection.

(g) Death of muscle tissue.

(h) Muscle lesions.

(i) Delayed hemorrhage.

(j) Gastric or duodenal ulcers.

(k) Bleeding in the gastrointestinal tract.

(l) Acute kidney failure.

(10) Pregnancy. In a pregnant woman, the fetus is susceptible to electric current since the placenta and amniotic fluid provide little resistance. Even a minor shock can be serious to a fetus. Any pregnant woman who has sustained a shock, no matter how small, must be transported to the hospital.

e. Protecting Yourself During Rescue.

Be very careful when you attempt to help a victim of electrical current. Sites of electrical accidents are very hazardous! To protect yourself, follow these guidelines.

(1) Look. Look for downed wires whenever the accident involves a vehicle which has struck a power pole.

NOTE: To determine whether a downed wire might be hidden in the grass or brush, carefully look at the next pole down the line. Count the number of power lines at the cross arm. There should be the same number of lines at the top cross arm of the damaged pole as at the top cross arm of the next pole. If there are not, inspect the area closely for downed power lines.

(2) Avoid downed wires. Never attempt to move downed wires.

(3) Radio for help. Radio for help from the power company immediately upon entering the scene of a downed power line.

(4) Downed line across vehicle. If a downed power line is lying across a wrecked vehicle, do not touch the vehicle–even if the victims inside are seriously injured. If the victims are conscious, tell them not to leave the vehicle. If they touch the ground and the car at the same time, the electric current may kill them.

(5) Downed line not on vehicle. If a downed power line is in the area but is not near or touching the vehicle, proceed as usual with extrication of the persons inside.

(6) Downed line sparking/flipping. If a downed power line is sparking and flipping around, use extreme caution. If the fire department is on the scene, try to throw a folded salvage cover or fire hose on the wire. As a last resort, try to roll a spare tire over the line, but do not touch the tire as it rolls.

(7) Downed household current line. If the downed wire is for a household current, you can handle the wire safely in dry weather if you wear rubber gloves or use a folded dry sheet or wooden stick. Do not attempt to move even a household current line if the weather is humid.

CAUTION: Remember, truly dangerous wiring is always placed at the top of the pole.

(8) Downed TV/telephone line. If the downed lines are television or telephone lines, you can handle them safely with gloved hands, even if the lines are slightly moist.

(9) Doubt about downed line. When in doubt, do not touch a downed line. Never assume that a downed line is dead unless the power company confirms this as fact.

(10) Low voltage. Relatively low voltages such as 120 volt household current can cause extensive injury to a person. The patient may look as if he has sustained just a minor injury. Therefore, be careful when you approach a patient at a site where the injury might have been caused by electricity.

NOTE: If you have a possible pool-drowning patient, check quickly in the water for electrical cords or hazards. Before you enter the water to remove the patient, brush lightly against the water. If you feel a tingle, turn off all the power at the main switch before you enter the water.

(11) Scene evaluation. Make a visual sweep of the accident scene before you attempt to treat the patient. Look for power cords and what they are attached to. Especially, look for power cords that may be routed to a tool the patient may still be holding.

(12) Plugged appliance. Pull the plug of any appliance which you believe may have shocked the patient.

f. Treatment for an Electrical Injury Patient.

Emergency treatment begins with separating the patient from the electric current source, quick assessment of vital functions, and emergency measures such as cardiopulmonary resuscitation and defibrillation. Remember, it is vitally important in treating electrical burn casualties to maintain the patient’s airway and to monitor his cardiac status. Follow the procedure given below.

(1) First, protect yourself and the patient. Be sure you are both in a safe zone, an area free from active electric current.

(2) Immobilize the patient’s spine, if possible, before you move him.

(3) Start cardiopulmonary resuscitation (CPR) immediately, if indicated.

(4) Maintain the patient’s airway.

(5) Evaluate and treat any burns. Cool burn sites and apply moist, sterile dressings.

(6) Treat the patient for shock and administer oxygen.

(7) Monitor the patient’s cardiac status.

(8) Force the patient to lie down and keep quiet. Maintain his body temperature.

(9) Give IV fluids.

(10) Transport the patient immediately.

NOTE: Perform a urinary catheterization. Tissue death may cause the urine to be cherry-red to black colored.