ELECTRICAL SHOCK

the perceptible and physical effect of an electrical current that enters the body. The shock may range from an unpleasant but harmless jolt of static electricity, received after one has walked over a thick carpet on a dry day, to a lethal discharge from a power line. The great majority of deaths occur from alternating current at house-current frequencies of 60 hertz (cycles per second) in North America and 50 hertz in Europe. Most of the deaths occur from contact with conductors at less than 500 volts. That is not to say that high voltages are less dangerous, but they are generally present only on apparatus and supply lines operated by utility companies, which attempt to ensure that only trained and authorized persons have access to them. The effects of electric shock on the human body depend on the current that flowsthe amperagerather than on the force of the current, or voltage. The electrical resistance of the human body is variable and may in fact alter considerably during the passage of an electric shock. Therefore, except in broad terms, applied voltage is not a consideration. This leads to difficulties in the investigation of accidents, for the electrical engineer is often able to state only the voltage applied, but the physician thinks in terms of the current that flowed. Another important consideration is the path that the current takes through the body. Looked at as an electrical conductor, the body behaves as a solution of electrolytes in a leathery container. The greatest current density therefore occurs along the axis joining the two points of contact. As the distance perpendicular to the line of current flow increases, the density of current rapidly falls off. Thus, those organs most likely to be affected are those that lie close to the direct path of the current. As the great majority of electrical fatalities are due to currents passing between an arm (usually the right) and the legs, the current passes through the chest and affects the organs within it. Except in those extremely unusual accidents in which the head makes one of the points of contact, the brain does not lie on or near the pathway of the current. An electric shock may directly cause death in three ways: paralysis of the breathing centre in the brain, paralysis of the heart, or ventricular fibrillation (uncontrolled, extremely rapid twitching of the heart muscle). It is generally believed that ventricular fibrillation is the most common cause of death in electric shock. Cardiopulmonary resuscitation (CPR) is the best emergency first-aid treatment for victims of electrical shock. It is a highly effective technique when applied by a well-trained person and can, in many cases, provide adequate short-term life support until more sophisticated treatment is available. Although the great majority of victims of electric shock, excluding those who have been burned, either die or recover completely, a very small number suffer from aftereffects, which may be temporary but are sometimes permanent. These may include cataract of the eye, a form of angina (attacks of pain beneath the breastbone), or various disorders of the nervous system. A variety of other conditions have been reported, but, in most cases, their exact relationship to the electrical accident is unclear or cannot be clinically substantiated.