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Electrical injury

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"Electric shock" redirects here. For other uses, seeElectric Shock (disambiguation).
Electrical injury
Other namesElectrical shock
Lightning injurycaused by a nearbylightning strike.The slight branching redness (sometimes called aLichtenberg figure) travelling up the leg was caused by the effects of current.
SpecialtyEmergency medicine
ComplicationsBurns,rhabdomyolysis,cardiac arrest,bone fractures[1]
Frequency>30,000 per year (USA)[1]
Deaths~1,000 per year (USA)[1]

Anelectrical injury,(electric injury) orelectrical shock(electric shock) is damage sustained to theskinor internal organs on direct contact with anelectric current.[2][3]

The injury depends on thedensity of the current,tissue resistance and duration of contact.[4]Very small currents may be imperceptible or only produce a light tingling sensation. However, a shock caused by low and otherwise harmless current could startle an individual and cause injury due to jerking away or falling. A strong electric shock can often cause painfulmuscle spasmssevere enough todislocate jointsor even tobreak bones.The loss of muscle control is the reason that a person may be unable to release themselves from the electrical source; if this happens at a height as on apower linethey can be thrown off.[5][6]Larger currents can result in tissue damage and may triggerventricular fibrillationorcardiac arrest.[7]If death results from an electric shock thecause of deathis generally referred to aselectrocution.

Electric injury occurs upon contact of a body part withelectricitythat causes a sufficient current to pass through the person's tissues. Contact with energizedwiringor devices is the most common cause. In cases of exposure to highvoltages,such as on apower transmission tower,direct contact may not be necessary as the voltage may"jump" the air gapto the electrical device.[8]

Following an electrical injury from household current, if a person has no symptoms, no underlying heart problems, and is not pregnant further testing is not required.[9]Otherwise anelectrocardiogram,blood work to check the heart, and urine testing for signs of muscle breakdown may be performed.[9]

Management may involveresuscitation,pain medications, wound management, andheart rhythm monitoring.[9]Electrical injuries affect more than 30,000 people a year in theUnited Statesand result in about 1,000 deaths.[1]

Signs and symptoms[edit]

Burns[edit]

Second-degree burn after ahigh tension lineaccident

Heating due toresistancecan cause extensive and deepburns.When applied to the hand, electricity can cause involuntary muscle contraction, preventing the victim from untensing their hand muscles and releasing the wire, increasing the risk for serious burns.[10]Voltage levels of 500 to 1000 volts tend to cause internal burns due to the large energy (which is proportional to the duration multiplied by the square of the voltage divided by resistance or the square of the current multiplied by the resistance) available from the source. Damage due to current is through tissue heating and/or electroporation injury. For most cases of high-energy electrical trauma, the Joule heating in the deeper tissues along the extremity will reach damaging temperatures in a few seconds.[11]

Ventricular fibrillation[edit]

A domestic power supply voltage (110 or 230 V), 50 or 60 Hzalternating current(AC) through the chest for a duration longer than one second may induceventricular fibrillationat currents as low as 30 milliamperes (mA).[12][13]Withdirect current(DC), 90 to 130 mA are required at the same duration.[14]If the current has a direct pathway to the heart (e.g., via acardiac catheteror other kind ofelectrode), a much lower current of less than 1 mA (AC or DC) can cause fibrillation. If not immediately treated bydefibrillation,ventricular fibrillation is usually lethal, causingcardiac arrest,because all of theheart muscle fibresmove independently instead of in thecoordinated actionneeded for successfulcardiac cycleto pump blood and maintain circulation. Short single DC pulses induceVFdependent on the amount of charge (inmC) transferred to the body, which makes the amplitude of the electrical stimulus independent of the exact amount of current flowing through the body for very short pulse durations. DC shocks of short duration are usually better tolerated by the heart even at high currents and rarely induce ventricular fibrillation compared to lower currents with longer duration with both DC or AC. The amount of current can easily reach very high values asamperageis only of second order importance to fibrillation risk in the case of ultra short contact times with direct currents. But even if the charge itself is harmless, the amount of energy being discharged still can lead to thermal and chemical hazards if its value is high enough. One example of high current electric shock which may be usually harmless is anelectrostatic dischargeas experienced in everyday life on door handles, car doors etc. These currents can reach values up to 60 A without harmful effects on the heart as the duration is in the order of only severalns.Another example for dangerous electrostatic discharges even without flowing directly through the body are lightning strikes and high voltage arcs.

Mechanism[edit]

Mechanism of cardiac arrhythmias induced by electricity is not fully understood, but various biopsies have shownarrhythmogenic fociin patchymyocardial fibrosiswhich contained increased amount ofNa+ andK+ pumps,possibly associated with transient and localized changes insodium-potassium transportas well as their concentrations, resulting in changes inmembrane potential.[13][15]

Neurological effects[edit]

Electric current can cause interference with nervous control, especially over the heart and lungs.[citation needed]Electric shock which does not lead to death has been shown to causeneuropathyin some cases at the site where the current entered the body.[10]The neurologic symptoms of electrical injury may occur immediately, which traditionally have a higher likelihood for healing, though they may also be delayed by days to years.[10]The delayed neurologic consequences of electrical injury have a worseprognosis.[10]

When the path of electric current proceeds through the head, it appears that, with sufficient current applied, loss of consciousness almost always occurs swiftly. This is borne out by some limitedself-experimentationby early designers of theelectric chair[citation needed]and by research from the field ofanimal husbandry,whereelectric stunninghas been extensively studied.[16]

If ventricular fibrillation occurs (as above), the blood supply to the brain is diminished, which may causecerebral hypoxia(and its associated neurologic consequences).

Mental health[edit]

There are a variety of psychiatric effects that may occur as a result of electrical injuries. Behavioral changes can occur as well, even if the path of electric current did not proceed through the head.[10]Symptoms may include:[10]

  • Depression,including feelings of low self-esteem and guilt
  • Anxietyspectrum disorders, includingposttraumatic stress disorderand fear of electricity
  • Moodiness, including a lower threshold for frustration and "losing one's temper"
  • Memory loss, decreased attention span, and difficulty learning

Arc-flash hazards[edit]

Main article:Arc flash

OSHAfound that up to 80 percent of its electrical injuries involve thermal burns due to arcing faults.[17]Thearc flashin an electrical fault produces the same type of lightradiationfrom which electric welders protect themselves using face shields with dark glass, heavy leather gloves, and full-coverage clothing.[18]The heat produced may cause severe burns, especially on unprotected flesh. The arc blast produced by vaporizing metallic components can break bones and damage internal organs. The degree of hazard present at a particular location can be determined by a detailed analysis of the electrical system, and appropriate protection worn if the electrical work must be performed with the electricity on.

Pathophysiology[edit]

The minimum current a human can feel depends on the current type (ACorDC) as well asfrequencyfor AC. A person can sense electric current as low as 1mA(rms) for 60Hz AC and as low as 5mA for DC. At around 10mA, AC current passing through the arm of a 68-kilogram (150 lb) human can cause powerful muscle contractions; the victim is unable to voluntarily control muscles and cannot release an electrified object.[19]This is known as the "let go threshold" and is a criterion for shock hazard in electrical regulations.

The current may, if it is high enough, cause tissue damage orfibrillationwhich can cause cardiac arrest;more than 30 mA[12]of AC (rms, 60 Hz) or300–500 mAof DC at high voltage can cause fibrillation.[14][20]A sustained electric shock from AC at 120V,60 Hz is an especially dangerous source ofventricular fibrillationbecause it usually exceeds the let-go threshold, while not delivering enough initial energy to propel the person away from the source. However, the potential seriousness of the shock depends on paths through the body that the currents take.[14]If thevoltageis less than 200 V, then the human skin, more precisely thestratum corneum,is the main contributor to the impedance of the body in the case of amacroshock—the passing of current between two contact points on the skin. The characteristics of the skin are non-linear however. If the voltage is above 450–600 V, thendielectric breakdownof the skin occurs.[21]The protection offered by the skin is lowered byperspiration,and this is accelerated if electricity causes muscles to contract above the let-go threshold for a sustained period of time.[14]

If an electrical circuit is established by electrodes introduced in the body, bypassing the skin, then the potential for lethality is much higher if a circuit through the heart is established. This is known as amicroshock.Currents of only 10μA can be sufficient to cause fibrillation in this case with a probability of 0.2%.[22]

Body resistance[edit]

Voltage 5% 50% 95%
25V 1,750Ω 3,250 Ω 6,100 Ω
100 V 1,200 Ω 1,875 Ω 3,200 Ω
220 V 1,000 Ω 1,350 Ω 2,125 Ω
1000 V 700 Ω 1,050 Ω 1,500 Ω

The voltage necessary for electrocution depends on the current through the body and the duration of the current.Ohm's lawstates that the current drawn depends on the resistance of the body. The resistance ofhuman skinvaries from person to person and fluctuates between different times of day. TheNIOSHstates "Under dry conditions, the resistance offered by the human body may be as high as 100,000 ohms. Wet or broken skin may drop the body's resistance to 1,000 ohms," adding that "high-voltage electrical energy quickly breaks down human skin, reducing the human body's resistance to 500 ohms".[23]

TheInternational Electrotechnical Commissiongives the following values for the total body impedance of a hand to hand circuit for dry skin, large contact areas, 50 Hz AC currents (the columns contain the distribution of the impedance in the populationpercentile;for example at 100 V 50% of the population had an impedance of 1875Ω or less):[24]

Skin[edit]

The voltage-current characteristic of human skin is non-linear and depends on many factors such as intensity, duration, history, and frequency of the electrical stimulus. Sweat gland activity, temperature, and individual variation also influence the voltage-current characteristic of skin. In addition to non-linearity, skin impedance exhibits asymmetric and time varying properties. These properties can be modeled with reasonable accuracy.[25]Resistance measurements made at low voltage using a standardohmmeterdo not accurately represent the impedance of human skin over a significant range of conditions.

For sinusoidal electrical stimulation less than 10 volts, the skin voltage-current characteristic is quasilinear. Over time, electrical characteristics can become non-linear. The time required varies from seconds to minutes, depending on stimulus, electrode placement, and individual characteristics.

Between 10 volts and about 30 volts, skin exhibits non-linear but symmetric electrical characteristics. Above 20 volts, electrical characteristics are both non-linear and symmetric. Skin conductance can increase by several orders of magnitude in milliseconds. This should not be confused withdielectric breakdown,which occurs at hundreds of volts. For these reasons, current flow cannot be accurately calculated by simply applyingOhm's lawusing a fixed resistance model.

Point of entry[edit]

  • Macroshock:Current across intact skin and through the body. Current from arm to arm, or between an arm and a foot, is likely to traverse the heart, therefore it is much more dangerous than current between a leg and the ground. This type of shock by definition must pass into the body through the skin.
  • Microshock:Very small current source with a pathway directly connected to the heart tissue. The shock is required to be administered from inside the skin, directly to the heart i.e. a pacemaker lead, or a guide wire, conductive catheter etc. connected to a source of current. This is a largely theoretical hazard as modern devices used in these situations include protections against such currents.

Lethality[edit]

Electrocution[edit]

The earliest usage of the term "electrocution" cited by the Oxford English Dictionary was an 1889 newspaper reference to the method of execution then being considered.[26]Shortly thereafter, in 1892, the term was used inScienceto refer generically to death or injury caused by electricity.[26]

Factors in lethality of electric shock[edit]

Log-log graph of the effect of alternating currentIof durationTpassing from left hand to feet as defined inIEC60479–1.[27]
AC-1: imperceptible
AC-2: perceptible but no muscle reaction
AC-3: muscle contraction with reversible effects
AC-4: possible irreversible effects
AC-4.1: up to 5% probability of ventricular fibrillation
AC-4.2: 5–50% probability of fibrillation
AC-4.3: over 50% probability of fibrillation

The lethality of an electric shock is dependent on several variables:

  • Current: The higher the current, the more likely it is lethal. Since current is proportional to voltage when resistance is fixed (ohm's law), high voltage is an indirect risk for producing higher currents.
  • Duration: The longer the shock duration, the more likely it is lethal—safety switches may limit time of current flow. Short high-current pulses, as from capacitors, are usually less dangerous than longer-lasting low-current shocks.
  • Pathway: If current flows through vital organs, like the heart muscle, it is more likely to be lethal.
  • High voltage(over about 600 volts). In addition to greater current flow, high voltage may cause dielectric breakdown at the skin, thus lowering skin resistance and allowing further increased current flow.
  • Medical implants:Artificial cardiac pacemakersorimplantable cardioverter-defibrillators(ICD) are sensitive to very small currents.[28]
  • Pre-existing medical condition[29]
  • Age, body mass, and health status[30]
  • Sex: Women are more vulnerable to electric shock than men.[31]

Other issues affecting lethality arefrequency,which is an issue in causing cardiac arrest or muscular spasms. Very high frequency electric current causes tissue burning, but do not stimulate the nerves strongly enough to cause cardiac arrest (seeelectrosurgery). Also important is the pathway: if the current passes through the chest or head, there is an increased chance of death. From a main circuit or power distribution panel the damage is more likely to be internal, leading tocardiac arrest.[citation needed]Another factor is that cardiac tissue has achronaxie(response time) of about 3 milliseconds, so electricity at frequencies of higher than about 333 Hz requires more current to cause fibrillation than is required at lower frequencies.

The comparison between the dangers ofalternating currentat typical power transmission frequencies (i.e., 50 or 60 Hz), anddirect currenthas been a subject of debate ever since thewar of the currentsin the 1880s. Animal experiments conducted during this time suggested that alternating current was about twice as dangerous as direct current per unit of current flow (or per unit of applied voltage).

It is sometimes suggested that human lethality is most common withalternating currentat 100–250 volts; however, death has occurred below this range, with supplies as low as 42 volts.[32]Assuming a steady current flow (as opposed to a shock from a capacitor or fromstatic electricity), shocks above 2,700 volts are often fatal, with those above 11,000 volts being usually fatal, though exceptional cases have been noted. According to theGuinness Book of World Records,seventeen-year-old Brian Latasa survived a 230,000 volt shock on the tower of an ultra-high voltage line inGriffith Park,Los Angeles on November 9, 1967.[33]A news report of the event stated that he was "jolted through the air, and landed across the line", and though rescued by firemen, he sustained burns over 40% of his body and was completely paralyzed except for his eyelids.[34]The shock with the highest voltage reported survived was that of Harry F. McGrew, who came in contact with a 340,000 volt transmission line in Huntington Canyon, Utah.[35]

The severity and lethality of electric shocks generally depend on the duration and the amount of current passing through the human body. Frequency plays a role with AC and pulse DC. For example, a high frequency current has a higher ventricular fibrillation threshold than lower frequency. Also, shorter single pulses have higher thresholds than short pulses. Below 10 ms are usually believed to have a primarily charge dependent threshold and shock amplitude. Research shows that for very short electric pulse durations below 100 μs the threshold curve converges into a constant charge criterion independent of peak current or RMS values. Even though the for both muscle and nerve stimulation including the heart and the brain.[clarification needed]Heating is primarily determined by the amount of energy and is not related to stimulation. These definitions have been included into the IEC standard 60479-2 in opposite to IEC 60479-1 which addresses longer pulse durations above 10 ms for both DC and AC, which use a current over time duration curve based classification. These principles are used to determine the risks from capacitors, electric weapons, electric fences and other short pulsed low- and high-voltage electrical applications outside the medical field.

Prevention[edit]

Prevention of electrical injuries is one of the fundamental objectives of nationalelectrical codesfor permanently-installed electrical systems in buildings. Shock danger may be reduced by use of anextra-low voltageelectrical system that is unlikely to expose a human to dangerous levels of current. Specialisolated powersystems may be used in applications such as operating rooms, where electrical equipment must be used in proximity to a person unusually vulnerable to electrical shock. For electrical equipment used outdoors or in wet areas, aresidual current deviceorground fault circuit interruptermay provide protection from electrical current leakage.

Electrical devices have non-conductiveinsulationpreventing contact with energized wires or parts, or may have conductive metal enclosures connected to earthgroundso that users will not be exposed to dangerous voltage.Double insulateddevices have a separate insulation system, distinct from the insulation required for the function of the device, and intended for protection of the user from electrical shock.

People and animals can be protected by installing electrical equipment out of reach of passers-by, such as on electricaltransmission towers,or by installation in aelectrical roomonly accessible to authorized persons.Stray current leakageor electrical fault current may be diverted bybondingall conductive equipment enclosures together and to the earth.Current passing through the earthmay also provide a hazard of electrical shock, so a ground grid may be installed around installations such aselectrical substations.Lightning protection systemsare primarily installed to reduce property damage by lightning strikes, but may not entirely prevent electrical shock hazards. Persons outdoors during a lightning storm may be advised to takeprecautionsto avoid electrical shock.

Where installation, or maintenance of electrical equipment is required,interlockdevices may be used to ensure that all electrical sources are removed from the equipment before accessing normally energized parts. Administrative procedures such aslockout–tagoutare used to protect workers from accidentally re-energizing equipment under repair. Where accidental contact with energized components is still possible, or where adjustment of an energized system is absolutely necessary, workers may be trained to use insulated or non-conductive tools, andpersonal protective equipmentsuch as gloves, face shields, non-conductive boots, or cover-up mats. With proper training and equipment,live-line maintenanceis routinely safely carried out on electricaltransmission linesenergized at hundreds of thousands ofvolts.

Epidemiology[edit]

There were 550 reported electrocution deaths in the US in 1993, 2.1 deaths per million inhabitants. At that time, the incidence of electrocutions was decreasing.[36]Electrocutions in the workplace make up the majority of these fatalities. From 1980–1992, an average of 411 workers were killed each year by electrocution.[23]Workplace deaths caused by exposure to electricity in the U.S. increased by nearly 24% between 2015 and 2019, from 134 to 166. However, workplace electrical injuries dropped 23% between 2015 and 2019 from 2,480 to 1,900.[37]In 2019, the top 5 states with the most workplace electrical fatalities were: (1)Texas(608); (2)California(451); (3)Florida(306); (4)New York(273); and (5)Georgia(207).[38]

A recent study conducted by the National Coroners Information System (NCIS) in Australia[39]has revealed 321 closed case fatalities (and at least 39 case fatalities still under coronial investigation) that had been reported to Australian coroners where a person died from electrocution between July 2000 and October 2011.[40]

In Sweden, Denmark, Finland and Norway the number of electric deaths per million inhabitants was 0.6, 0.3, 0.3 and 0.2, respectively, in the years 2007–2011.[41]

In Nigeria, analysis ofNigerian Electricity Regulatory Commissiondata found 126 recorded electrocution deaths and 68 serious injuries in 2020 and the first half of 2021.[42]Most electrocutions are accidental and caused by faulty equipment or poor adherence to regulations. Some distribution companies in Nigeria have higher death rates than others; in 2017, there were 26 deaths on the Abuja grid, while the Ikeja grid caused only 2 deaths.[citation needed]

People who survive electrical trauma may develop a host of injuries including loss of consciousness, seizures, aphasia, visual disturbances, headaches, tinnitus, paresis, and memory disturbances.[43]Even without visible burns, electric shock survivors may be faced with long-term muscular pain and discomfort, exhaustion, headache, problems with peripheral nerve conduction and sensation, inadequate balance and coordination, among other symptoms. Electrical injury can lead to problems with neurocognitive function, affecting speed of mental processing, attention, concentration, and memory. The high frequency of psychological problems is well established and may be multifactorial.[43]As with any traumatic and life-threatening experience, electrical injury may result in post traumatic psychiatric disorders.[44]There exist several non-profit research institutes that coordinate rehabilitation strategies for electrical injury survivors by connecting them with clinicians that specialize in diagnosis and treatment of various traumas that arise as a result of electrical injury.[45][46]

Deliberate uses[edit]

Medical uses[edit]

Electric shock is also used as a medical therapy, under carefully controlled conditions:

Entertainment[edit]

Electrifying machine atMusée Mécaniquethat actually works with vibration[47]
YouTuberMehdi Sadaghdaris best known for demonstrating intentional electric shocks in his videos

Mild electric shocks are also used for entertainment, especially as apractical jokefor example in such devices as a shocking pen or ashocking gum.However devices such as ajoy buzzerand most other machines inamusement parkstoday only use vibration that feels somewhat like an electric shock to someone not expecting it.

Sexual uses[edit]

It is also used forsexual stimulation.This is usually done via devices that induceserotic electrostimulation.These devices may include aviolet wand,transcutaneous electrical nerve stimulation,electrical muscle stimulation,and made-for-play units.

Policing and personal defense[edit]

Electroshock weaponsareincapacitantweaponsused for subduing a person by administering electric shock to disrupt superficialmusclefunctions. One type is a conductive energy device (CED), an electroshock gun popularly known by the brand name "Taser",which fires projectiles that administer the shock through a thin, flexible wire. Although they are illegal for personal use in many jurisdictions, Tasers have been marketed to the general public.[48]Other electroshock weapons such as stun guns, stun batons ( "cattle prods" ), andelectroshock beltsadminister an electric shock by direct contact.

Electric fencesare barriers that use electric shocks to deter animals or people from crossing a boundary. The voltage of the shock may have effects ranging from uncomfortable, to painful or even lethal. Most electric fencing is used today foragricultural fencingand other forms of animal control purposes, though it is frequently used to enhance security of restricted areas, and there exist places where lethal voltages are used.

Torture[edit]

Electric shocks are used as a method oftorture,since the received voltage and current can be controlled with precision and used to cause pain and fear without always visibly harming the victim's body.

Electrical torture has been used in war and by repressive regimes since the 1930s.[49]The United States Army is known to have used electrical torture duringWorld War II.[50]During theAlgerian Warelectrical torture was used by French military forces.[51]Amnesty Internationalpublished a statement that Russian military forces inChechnyatortured local women with electric shocks by attaching wires onto their breasts.[52]

Theparrilla(Spanishfor 'grill') is a method oftorturewhereby the victim is strapped to a metal frame and subjected to electric shock.[53]It has been used in a number of contexts in South America. Theparrillawas commonly used atVilla Grimaldi,a prison complex maintained byDirección de Inteligencia Nacional,a part of thePinochetregime.[54]In the 1970s, during theDirty War,the parrilla was used in Argentina.[55]Francisco Tenório Júnior(known as Tenorinho), a Brazilian piano player, was subjected to the parrilla during themilitary dictatorship in Brazil.[56]

TheIslamic Statehas used electric shocks to torture and kill captives.[57][58][59]

Advocates for thementally illand somepsychiatristssuch asThomas Szaszhave asserted that electroconvulsive therapy (ECT) is torture when used without abona fidemedical benefit against recalcitrant or non-responsive patients.[60][61][62]

TheJudge Rotenberg CenterinCanton,Massachusettshas been condemned for torture by theUnited Nations special rapporteur on torturefor its use of electric shocks as punishment as part of itsbehavior modificationprogram.[63][64]

Japaneseserial killerFutoshi Matsunagaused electric shocks to control his victims.[65]

Capital punishment[edit]

Main article:Electric chair
Electric chairinSing Sing

Electric shock delivered by anelectric chairis sometimes used as an official means ofcapital punishmentin the United States, although its use has become rare from the 1990s onward due to the adoption oflethal injection.Although some original proponents of the electric chair considered it to be a more humane execution method thanhanging,shooting,poison gassing,etc., it has now generally been replaced by lethal injections in states that practice capital punishment. Modern reporting has claimed that it sometimes takes several shocks to be lethal, and that the condemned person may actually catch fire before death.

Other than in parts of the United States, only thePhilippinesreportedly has used this method, from 1926 to 1976. It was intermittently replaced by thefiring squad,until the death penalty was abolished in that country. Electrocution remains legal in 9 states (primary method inSouth Carolina,optional inAlabamaand Florida, optional if sentenced before a certain date inArkansas,KentuckyandTennessee,can only be used if other methods are found to be unconstitutional inLouisiana,MississippiandOklahoma) of the United States.[when?][66]

See also[edit]

References[edit]

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Cited sources[edit]

External links[edit]

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