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Electrocution: Prehospital Care of Electrical Burns

Cable Exposed Electrocution

Electrical injuries are fairly uncommon but when they occur, electric burns can be devastating to the human body. This article will talk about the causes of electrocution and special considerations emergency medical personnel should take when treating patients with these injuries. An electrical injury has unique signs and symptoms and will require a different treatment protocol than other types of burn injuries.


Electrical Burn Injuries

First responders are dispatched to an unconscious 24-year-old male who is the possible victim of electrocution by lightning. They arrive on-scene and find the male awake and sitting up with a female nearby. The female approaches the EMS crew and notifies them that she called 911. She was inside and saw lightning hit the tree next to the man and then he fell to the ground.


Thunderstorm Electricity Strikes TreeThe male patient is awake, confused and having difficulty hearing the first responder’s questions. His respiratory rate is 14, pulse is tachycardic at 107, weak and irregular. His blood pressure is 118/62. ECG shows sinus tachycardia at 112.


The man complains of difficulty hearing, skin tenderness, pain in his legs and tingling in his arms. First responders find pulses present to all extremities with skin redness on his chest and arms. They also find redness forming down his left leg in a branching pattern.


He appears to be the victim of an electrical burn injury from a lightning splash, rather than a direct hit. For this reason, EMS continues cardiac monitoring, places him on oxygen, establishes an IV at TKO, and reassess en-route to the emergency department (ED).


What is an Electrical Burn?

In order to be great at providing emergency treatment for an electrical burn injury, you need to know a little bit about electricity, how it works, and how it travels through the body.


This article won’t get too specific about how electricity works, except when it relates to patient electric burns and how to treat an electrical injury. Electrocution patients are unique because Emergency Medical Services (EMS) will need to take special precautions for patients who may appear to only have a minor burn on their finger.

This section will answer the commonly asked question:

What is an electrical burn?


First, here are some synonyms for the term electrical burn.

Electric shock – electric burn – electrocution – electrical injury – shock injury – electrocuted


To learn “what is an electrical burn” it helps to define electrocuted, discuss low and high voltage injuries and learn the four main types of electrical injuries.


Electrocution Definition:  

Pain, serious injury or death caused by an electric current passing through the body. Electrocution also describes non-fatal injuries which are caused by electricity.

However, electrocution can be used for intentionally causing injury or death by electroshock, as with executions.


What are the four main types of electrical injuries?

Here we will discuss the different types of electrical burn injuries. These do not include low voltage or high voltage injuries. Both of these electrical burn categories are discussed below along with links to electrical burn photos.


Four Main Types of Electrical Injuries

The four main types of electrical injuries are arc burn (aka True burn), flash burn, flame burn and oral burn. Lightning is also sometimes given it’s own classification.


Arc Burns (aka True Burn) – These types of electrical injuries are the result of electricity traveling from an area of high resistance to low resistance. (Information on resistance in the human body can be found in the pathophysiology section below.) Arc burns penetrate into the tissues of the body and cause severe electrical burns internally.


A person coming in contact with a high voltage power source can form an electric arc, but direct contact with the power source isn’t needed to receive an arc burn. Arc burns can cause a tremendous blast of pressure and throw patient’s with force into other objects. This is the most common of the four main types of electrical injuries.


Also, temperatures as high as 4000 degrees celsius can be produced in the area around the arc burn. Generally, electrical burn injuries will occur on the patient at the locations where the arc strikes the patient’s body.


Flash Burns – These types of electrical injuries are directly related to arc burns. Flash burns are caused when the heat from a nearby electrical arc travels across the patient’s skin. Temperatures can get as high as 5000 degrees celsius, but with flash burns the electric current doesn’t penetrate into the body.


These electrical burns typically occur on the surface of the body causing large areas of partial thickness burn injuries to the skin. To clarify, the same patient can suffer from severe electrical burns with internal injuries from arc burns and  external flash burn injuries.


Flame Burns – Other electric burns can cause objects to ignite and create a flame, which burns the patient. These types of electrical injuries are a result of arc, flash or oral burns. For example if a patient’s clothing is ignited during an arc or flash burn, the injuries from the clothing fire are a result of flame burns.


These are similar to every other thermal burn and will be treated as thermal burns, but it’s important for medical personnel to know the original source of the fire was electrical in nature. It’s common for patients with flame burns to need treatments for other electrical burns.


Oral Burn – This type of electrical injury is more common in children and pets. Oral burns are usually caused by biting and sucking on power or extension cords. Electric shock injury occurs when electricity travels from one side of the mouth to the other. This type of electrical injury causes swelling, pain, deformity and the patient may complain of burning around lips.


As EMS it’s important to note that after the pediatric patient bites an electrical cord, they will likely have edema and a small burn at the corner of their mouth, without any bleeding.


However, it’s possible for these burns to involve occult injury to the labial artery. Eschar (dead tissue) will often form in two to three days, which can interfere with the labial artery. Later, in two to three weeks the eschar will begin to fall off and the child can experience severe bleeding that needs to be corrected with surgery.

Boy power cord electrocution
Children are at risk for oral burns due to chewing on power cords.


For this reason, children with these seemingly minor electric burns should be monitored closely and need to get prompt follow-up care from the Emergency Department (ED) or a physician. It’s likely they will need an emergency referral to a burn specialist or plastic surgeon. You can go to https://www.ncbi.nlm.nih.gov for more information on complications of oral burns in children. 


Category of Electrical Burns

An electrical burn injury can be separated into two electrical burn categories – low voltage injury and high voltage injury. Current, resistance, and voltage all play a role in how severe electrical burns will be, but voltage will be the focus for patient care and emergency response.


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