Electrocution:

Approximately 1000 people in the UK are injured at work every year due to electrical injury, with around 25 of these people dying. This makes a call to an electrical incident uncommon, however, it does present potential challenges and considerations which you may not have thought of.

When dealing with electrical injuries there are several factors which can alter the level of injury. These include:

• The Voltage
• Whether it is Alternating (AC) or Direct (DC)
• The magnitude of the current
• The length of time exposed to the current
• The pathway that the current takes, i.e., it is more likely to be damaging if the current traverses’ major organs such as the heart
• If a person is wet, this can also affect the area of injury

An obvious concern when on scene is looking at safety, and ensuring all electrical feeds are off which may pose a danger to yourself/crew and the patient(s)/bystanders. For this, you may have to speak to several people at the site of the incident, and it will vary depending on the location/premises. For example, a home DIY project, turning off at the mains may eliminate the source, whereas at an industrial complex, an electrical engineer may be required to isolate the source. Be vigilant in the presence of electricity and always place your safety first and foremost, when working in a potentially dangerous place, it is up to you to conduct your own safety assessment and protect yourself even if that means waiting for specialist support.

Consider advice from the Fire Service, local electrical utility, safety representatives on site, or contact control to seek further advice.

Pathophysiology:

Electrical injuries can cause damage in multiple forms within the body. Damage occurs when the electricity energy passes through the body’s tissues, potentially resulting in:

• Cardiac arrhythmias and arrest – A voltage as low as 50 volts applied between two parts of the human body can cause a current to flow that can block the electrical signals between the brain and the muscles. Cardiac arrhythmias and arrest can occur from the effects of an electrical current on the cell membranes and smooth muscle as it flows through the heart. Further cardiac damage and ischaemia can occur due to spasm of the coronary artery.
• Burns – When an electrical current passes through the human body it heats the tissue along the length of the current flow. Electricity will usually follow the path of lowest resistance, presenting with an entry and exit burn. This means a potentially large amount of tissue, muscle, and organs being affected but with minor visible damage. Burns are more common with higher voltages but may occur from domestic electricity supplies if the current flows for more than a few fractions of a second.
• Trauma – People who receive an electric shock often get painful muscle spasms that can be strong enough to break bones or dislocate joints. This loss of muscle control often means the person cannot ‘let go’ or escape the electric shock. Secondary trauma can also be caused by the situation the person is in, for example, a fall or being thrown from the electrical device.
• Muscular Paralysis – May occur through high voltage contact affecting the central respiratory control system or respiratory muscles.
• Further considerations will be needed for pregnancy as it can be affected depending on the magnitude and duration of contact.