Introduction

Studies have estimated that 3% of all admissions to hospital burn units are for electrical trauma and most of these injuries are work-related. Based on data accumulated by the Edison Electric Institute, the majority of contact voltages for surviving electric utility linemen range from 1 to 10 kilovolts (kV), with the hand-to-hand circuit path being the most frequent path through the body. A ‘high-voltage’ electric shock can produce massive destruction of tissue and major physiologic imbalances. In electrical trauma victims, extensive injury to peripheral nerve and skeletal muscle is very common, with resultant upper extremity amputation rates as high as 65%.

The large electric fields produced by a ‘typical’ high-voltage shock can produce injury either from heat generated by electrical currents (joule heating), cell membrane electroporation or both. In the medical community, it is generally believed that the cellular injury is largely mediated by joule heating. The circumstances surrounding electrical shock accidents are so variable that it is nearly impossible to precisely determine the tissue exposure in the majority of cases. The amount of heat generated at a point along the current path depends on the quality and duration of contact, the contact voltage, the properties of the tissue and other variables. Usually, only the contact voltage is known accurately. But even that is not enough because the voltage across the body depends on clothing, shoes, gloves and whether the contact was mediated by an arc. As a result, the amount of heat generated in any one case is very difficult to estimate.