Emergency responders encounter one quintessential fact: the unpredictability of problems they encounter.
Most often, all they may know is that someone needs help. Such was the case when our receptionist transferred a call to me at a rural clinic. The parents of an 18-year-old girl had heard an unusual noise, a strange scream or groan, and found her lying on the cellar floor – unresponsive. The family’s home was six miles from the clinic and from an ambulance more than 20.
After calling our visiting fourth-year medical student and grabbing an emergency kit, including mask and Ambu bag for assisting respiration, we headed out. Our little Chevy Malibu could really wind out and stir the dust – but I backed off, recalling that half of lawsuits against ambulance services are the result of traffic accidents.
Our patient was lying on her back on a damp cellar floor but now able to speak. A quick survey showed no respiratory difficulty or abnormal vital signs. She began telling us what had happened. Barefoot, she had descended to the house’s second refrigerator – a clunky, old one with a metal-handled door pull. Grasping the handle, she had immediate pain in her hand and arm. She recalled being unable to let go, frozen to it, the current causing muscle spasms and tightening her grip. Fainting away and collapsing to the floor broke the contact and saved her life. It was a year before the woman, a restaurant server, could heft a heavy tray with her affected arm.
Electrical injuries, most commonly from alternating current (110-220 volts AC), are classified as electrocutions, electrical shocks and electrical burns. Those electrocuted are DRT, dead right there, from respiratory or cardiac arrest (or both). For others, immediate CPR is recommended, and the risk of cardiac arrest may extend up to 12-plus hours post-shock. The girl described above is classic for electrical shock – no further elaboration needed. Electrical burns are devastating. Heat generated by the path taken by electricity varies with the resistance of different tissues, and deeper, unseen injuries are usually far worse than those visible. Children (pets, too) who bite or chew into lamp or appliance cords can suffer horrible burns to lips and gums.
About 1,000 people are killed by electricity in the United States annually, usually children younger than age 6 and young adults. Not surprisingly, most electrical accidents occur in the home or the workplace. I remember a worker autopsied after dropping dead at work, presumably a heart attack. Tiny spots of burn-marks on the soles of his feet spoke otherwise – he drilled into a wall and the juice he contacted exited through his feet and boot nails to ground, DRT.
Although the construction industry comprises only about 8 percent of the U.S. workforce, it accounts for almost half of workplace injuries, highest of any industry sector. The construction industry also has the highest number of electrical fatalities of any industry with about 300 annually (plus 4,000 electrical injuries). The most frequent causes are: contact with overhead power lines, wiring, transformers or other electrical components.
With electricity, one mistake is often one too many.
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.
