Electrical injury

Electrical injury
Specialty	Emergency medicine

An electric shock occurs upon contact of a human body with any source of voltage high enough to cause sufficient current through the skin, muscles or hair. The minimum current a human can feel is thought to be about 1 milliampere (mA). The current may cause tissue damage or fibrillation if it is sufficiently high. Death caused by an electric shock is referred to as electrocution. Generally, currents approaching 100 mA are lethal if they pass through sensitive portions of the body.

Shock effects

Burns

Heating due to resistance can cause extensive and deep burns. 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 current multiplied by resistance) available from the source. Damage due to current is through tissue heating.

Ventricular Fibrillation

A domestic power supply voltage (110 or 230 V), 50 or 60-Hz AC current through the chest for a fraction of a second may induce ventricular fibrillation at currents as low as 60 mA. With DC, 300 to 500 mA is required. If the current has a direct pathway to the heart (e.g., via a cardiac catheter or other kind of electrode), a much lower current of less than 1 mA (AC or DC) can cause fibrillation. If not immediately treated by defibrillation, fibrillations are usually lethal because all the heart muscle cells move independently instead of in the coordinated pulses needed to pump blood to maintain circulation. Above 200 mA, muscle contractions are so strong that the heart muscles cannot move at all.

Neurological effects

Current can cause interference with nervous control, especially over the heart and lungs. Repeated or severe electric shock which does not lead to death has been shown to cause neuropathy. Recent research has found that functional differences in neural activation during spatial working memory and implicit learning oculomotor tasks have been identified in electrical shock victims .

When the current path is through the head, it appears that, with sufficient current, loss of consciousness almost always occurs swiftly. (This is borne out by some limited self-experimentation by early designers of the electric chair and by research from the field of animal husbandry, where electric stunning has been extensively studied.)

Arc-flash hazards

One major corporation found that up to 80 percent of its electrical injuries involve thermal burns due to arcing faults. The arc flash in an electrical fault produces the same type of light radiation from which electric welders protect themselves using face shields with dark glass, heavy leather gloves, and full-coverage clothing. The heat produced may cause severe burns, especially on unprotected flesh. The blast produced by vaporizing metallic components can break bones and irreparably 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.

Issues affecting lethality

Other issues affecting lethality are frequency, which is an issue in causing cardiac arrest or muscular spasms, and 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 to cardiac arrest.

The comparison between the dangers of alternating current and direct current has been a subject of debate ever since the War of Currents in the 1880s. DC tends to cause continuous muscular contractions that make the victim hold on to a live conductor, thereby increasing the risk of deep tissue burns. On the other hand, mains-magnitude AC tends to interfere more with the heart's electrical pacemaker, leading to an increased risk of fibrillation. AC at higher frequencies holds a different mixture of hazards, such as RF burns and the possibility of tissue damage with no immediate sensation of pain. Generally, higher frequency AC current tends to run along the skin rather than penetrating and touching vital organs such as the heart due to the skin effect. While there will be severe burn damage at higher voltages, it is normally not fatal.

It is sometimes suggested that human lethality is most common with alternating current at 100–250 volts; however, death has occurred below this range, with supplies as low as 32 volts. Danger increase dramatically with voltages over 250 volts. Shocks above 2700 volts are often fatal, with those above 11000 volts being usually fatal. Shocks with voltages over 40,000 volts are generally invariably fatal. However, Harry F. Mcgrew came into direct contact with a 340,000 volt transmission line in Huntington Canyon, Utah, and survived. According to Guinness Book Of World Records, this is the largest known electric shock that was survived. Brian Litasa also came into contact with a 230,000 volt line in Los Angeles's Griffith Park and survived. Normally contact with currents of this magnitude cause near instantaneous evaporation of the body.

Electrical discharge from lightning tends to travel over the surface of the body causing burns and may cause respiratory arrest.

Skin Resistance

The voltage necessary for electrocution depends on the current through the body and the duration of the current. Using Ohm's law, Voltage = Current × Resistance, we see that the current drawn depends on the resistance of the body. The resistance of our skin varies from person to person and fluctuates between different times of day. In general, dry skin is a poor conductor that may have a resistance of around 100,000 Ω, while broken or wet skin may have a resistance of around 1,000 Ω.

Point of entry

• 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: Direct current path to the heart tissue, the shock is required to be administered from inside the skin, i.e. a malfunctioning pacemaker, or ungrounded catheter etc.

Electrocution statistics

There were 550 electrocutions in the US in 1993, which translates to 2.1 deaths per million inhabitants. At that time, the incidence of electrocutions was decreasing. 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.

Deliberate uses

Medical uses

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

• Electroconvulsive therapy or ECT is a psychiatric therapy for mental illness. The objective of the therapy is to induce a seizure for therapeutic effect. There is no sensation of shock because the patient is anesthetized. The therapy was originally conceived of after it was observed that depressed patients who also suffered from epilepsy experienced some remission after a spontaneous seizure. The first attempts at deliberately inducing seizure as therapy used not electricity but chemicals; however electricity provided finer control for delivering the minimum stimulus needed. Ideally some other method of inducing seizure would be used, as the electricity may be associated with some of the negative side effects of ECT including amnesia. ECT is generally administered three times a week for about 8-12 treatments.
• As a treatment for fibrillation or irregular heart rhythms: see defibrillator and cardioversion.
• As a method of pain relief: see Transcutaneous Electrical Nerve Stimulator (more commonly referred to as a TENS unit).
• As an aversive punishment for conditioning of mentally handicapped patients with severe behavioral issues. This method is highly controversial and is employed at only one institution in the United States, the Judge Rotenberg Educational Center; The institute also uses electric shock punishments on non-handicapped children with behavioral problems, and whether this constitutes legitimate medical treatment versus abusive discipline is the subject of ongoing litigation.

Law enforcement and personal defence

Electroshock weapons are incapacitant weapons used for subduing a person by administering electric shock to disrupt superficial muscle functions. 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. Other electroshock weapons such as stun guns, stun batons ("cattle prods"), and electroshock belts administer an electric shock by direct contact.

Although they are illegal for personal use in many jurisdictions, Tasers have been marketed to the general public. A line of pink Tasers are specifically being marketed for women. The Taser website states "Who says safety can't be stylish?" in reference to its "latest designer TASER C2 colors" and patterns, which include leopard print patterns and a range of colors.

Torture

Electric shocks have been used as a method of torture, since the received voltage and amperage can be controlled with precision and used to cause pain while avoiding obvious evidence on the victim's body. Such torture usually uses electrodes attached to parts of the victim's body. Another method of electrical torture is stunning with an electroshock gun such as a cattle prod or a taser (provided a sufficiently high voltage and non-lethal current is used in the former case).

The US Army is known to have used electrical torture during World War II. Amnesty International published an official statement that Russian military forces in Chechnya tortured local women with electric shocks by connecting electric wires to their bra straps. Japanese serial killer Futoshi Matsunaga used electric shocks for controlling his victims.

Advocates for the mentally ill and some psychiatrists such as Thomas Szasz have asserted that electroconvulsive therapy is torture when used without a bona fide medical benefit against recalcitrant or non-responsive patients. See above for ECT as medical therapy. These same arguments and oppositions apply to the use of extremely painful shocks as punishment for behavior modification, a practice that is openly used only at the Judge Rotenberg Institute.

Capital punishment

Main article: Electric chair

Electric shock delivered by an electric chair is sometimes used as an official means of capital punishment in the United States, although its use has become rare in recent times. Although some original proponents of the electric chair considered it to be a more humane and modern execution method than hanging, shooting, poison gassing, etc., it has now generally been replaced by lethal injections in countries 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 the process is complete. The brain is always severely damaged and inactivated.

Other than in parts of the United States, only the Philippines reportedly has used this method, and only for a few years. It is legal in at least 10 states of USA.

See also

• Static electricity
• Electromagnetism
• Transcutaneous electrical nerve stimulation
• Milgram experiment

External links

• National Institute for Occupation Safety & Health: Worker Deaths by Electrocution a CDC study.
• Physiological effects of electricity
• Test for electrical safety
• Electrical injury (Merck Manual)
• Electric Shock Hazards (Hyperphysics)
• Electric Shock: a more technical perspective
• Construction Safety Association of Ontario: Electrocution ... article with case studies
• Protection against electric shocks: physiological effects and protection rules
• Theodore Bernstein's (Senior Member- IEEE) Electrical Shock Hazards and Safety Standards
• Electric Shock Calculator