Electrical burns result from contact with an electrical current or the intense heat generated by electricity. These incidents are uniquely dangerous because they often cause more significant internal damage than the surface appearance suggests. Even if a burn looks small on the skin, the current may have traveled throughout the body, affecting deep tissues and vital organs. Understanding the three primary mechanisms by which electricity causes burns is essential.
True Electrical Burns (Direct Current Flow)
This burn occurs when an electrical current passes directly through the body, using the body as a conductor to complete a circuit. Visible injuries are often called entrance and exit wounds, which can appear small and deceptively minor. These spots result from the conversion of electrical energy into thermal energy (Joule heating) due to the body’s resistance at the point of contact.
The true danger of current flow lies beneath the surface, where the electricity travels along tissues with lower resistance, such as nerves, blood vessels, and muscle. This current movement causes deep tissue necrosis (cell death), leading to extensive damage to muscle and bone. Bone has high resistance and heats up significantly, causing secondary thermal damage to surrounding tissue.
This internal damage is systemic and can affect multiple organ systems without immediate external signs. The heart is susceptible to electrical interference, which can lead to irregular rhythms or cardiac arrest. Muscle damage releases substances that can overwhelm the kidneys and cause acute kidney injury.
The damage extent is influenced by the voltage, duration of contact, and the current’s path. AC is often more dangerous than DC of the same voltage because it can cause continuous muscle contraction, preventing the victim from letting go of the source.
Arc Flash Burns
Arc flash burns result from the intense thermal energy and light generated when electricity jumps a gap between two conductors, creating an electrical arc. The current does not pass through the victim; the burn is caused by the intense heat and radiant energy produced by the flash. Arc temperatures can reach up to 36,000 degrees Fahrenheit.
Exposure to this intense energy is instantaneous, causing severe, superficial burns to the skin, eyes, and respiratory tract. The thermal radiation can ignite the victim’s clothing, contributing to the injury. The arc flash often creates an arc blast, a powerful pressure wave that can throw the victim, leading to blunt force trauma, fractures, and hearing damage.
The flash can melt metal components, blasting molten droplets outward that can lodge in the skin and cause additional burns. These injuries are primarily external and resemble traditional thermal burns, requiring extensive medical care, including skin grafts.
Secondary Thermal Burns
Secondary thermal burns result when materials near the electrical incident catch fire, causing standard flame burns to the victim. The electrical event acts as the catalyst for the fire, but the resulting injury is a traditional heat burn. This type of burn contributes significantly to the overall trauma.
These burns occur when intense heat from an electrical arc or current flow ignites clothing, bedding, or surrounding objects. The victim sustains injuries from the flame and hot materials, ranging from minor to full-thickness burns depending on the duration of contact.
Immediate First Aid and Response
The immediate response to an electrical injury prioritizes safety for both the victim and the rescuer. First, ensure the power source is disconnected; never touch a person still in contact with electricity, as the current can pass through the rescuer. If power cannot be turned off, use a non-conductive object, such as a dry wooden stick or plastic item, to separate the victim from the source.
Once the victim is safe, check for breathing and a pulse, and begin cardiopulmonary resuscitation (CPR) immediately if either is absent. Emergency medical services must be called, even if the person appears stable. Internal damage from current flow is often hidden and can cause delayed complications like cardiac arrhythmias or kidney failure.
While waiting for help, cover any visible burn areas with a sterile, non-stick bandage or a clean, dry cloth to prevent infection. Minor electrical skin burns can be cooled with cool, running water for up to twenty minutes. Avoid using ice or cold water on large areas, which can cause the body temperature to drop. Do not remove clothing melted to the skin, and do not attempt to clean deeper burned areas.