Electricity accident

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Classification according to ICD-10
T75.4 Electric current damage
W85 Exposure to electrical wiring systems
W86 Exposure to other specified electrical currents
W87 Exposure to unspecified electrical current
ICD-10 online (WHO version 2019)

As electric injuries , electrical accident, also electric shock or electrocution a is injury by the action of the electric current refers to humans or animals. The extent of the damage is determined by several factors. The most common consequences of electrical accidents are chemical and thermal effects ( burns ), neurological effects, muscle irritation (e.g. muscle spasms , tetanic muscle contractions ) or muscle paralysis . The latter, in turn, can lead to life-threatening cardiac arrhythmias such as ventricular fibrillation as well as cardiac and circulatory arrest or respiratory paralysis with fatal outcome. Not to be underestimated are accidents caused indirectly, such as falls with considerable consequences. The following are decisive for the effects of an electrical accident:

  • the current strength per area (current density), which is set due to the circumstances described below in the article (especially voltage and resistance),
  • the type of current - alternating current or direct current ,
  • the frequency (only available with pulsating direct current or alternating current)
  • the state of health or age
  • the presence or absence of medical implants
  • the current path through the body (e.g. hand - hand; hand - foot, left, right)
  • the duration of the electric current
  • the size of the contact surfaces (for contact without voltage flashover)
  • the conductivity at the contact point (for contact without voltage flashover)
  • the step voltage (during thunderstorms or grounded power systems)
Warning sign W012 according to ISO 7010 : Warning of electrical voltage

Basics

A closed circuit is always required for electrical current to flow . At low voltage, direct contact with both poles of the voltage source is required. If a consumer (such as an electric motor) is only connected to one wire and thus only to a single electrical pole, the circuit is not closed and the consumer does not work because no current can flow.

If a person touches both lines of a voltage source at the same time, the circuit closes, causing current to flow through the person concerned. In the special case of an IT system , a single line can be touched without current flowing. Much more often, however, a conductor is earthed in power grids , which means that even in the low-voltage range, contact with a single conductor, depending on the earthing conditions, can lead to electric shock. Depending on the respective earthing system of the household electricity (such as the TT system or TN system ), the neutral conductor and the protective conductor may be touched safely if correctly installed , but not the external conductors (phase) carrying voltage to earth. If, however, there is only contact with the phase, i.e. without the protective conductor or neutral conductor involved, either a dangerous current flows through the human body via the earth or earthed objects or, if the location is isolated, a lower current flows, which can also be dangerous , about the body.

In the high-voltage area, however, there is a particular danger, since arcs can ignite when approaching, i.e. without direct contact with a conductor, and the unintentional flow of current occurs much faster than would be the case with low voltage. The distance below which this happens depends on the level of voltage and the ambient conditions. In air , these conditions include air pressure and humidity.

In the case of electrostatic discharges , the often large potential differences result in a charge equalization of differently charged objects. Smaller electrostatic discharges occurring in the household are usually harmless for healthy people, but more pronounced phenomena such as lightning can injure or kill people. Since high voltage is generated here too, an approximation is also sufficient for the formation of sparks .

Subdivision

Two sub-categories can be distinguished depending on the entry point of the electricity:

Macro shock

This type describes the most common electrical accidents in the true sense of the word. The current flows over the body surface through the intact skin. Since the skin resistance makes up the largest part of the body resistance , much lower currents flow with the same applied voltage than with a so-called micro shock.

Micro shock

With this type, the current flow takes place directly inside the body. This situation occurs, for example, when hospital patients have electrodes implanted beneath the skin. Due to the significantly lower resistance, even very small voltages can lead to dangerous currents. In addition, the inhomogeneities of the electrical resistance in the body can bundle the current, for example along the low-resistance blood vessels, and thus the heart or other sensitive parts of the body are exposed to particularly high current densities, which can easily lead to fatal consequences such as ventricular fibrillation.

Influencing factors

Path, type and strength of current

The decisive factor for the effects of the electric current, together with the duration of action, is the current density , i.e. current strength per area, through the body or individual tissues and organs, as well as the resulting heat development. The smaller the area through which the air flows, the lower the current strength or the shorter the exposure time must be so that no damage occurs. These circumstances are also essential to the extent and incidence of burns that Joule heat can cause. So there is the possibility that after a fatal electrical accident with a large contact area and low skin resistance, especially in the case of low-voltage accidents, no (external) current marks are visible on the body surface.

All and the following information about the magnitude of the current strengths are only valid if the current is distributed over the hand and skin in the body. If, for example, electrodes are implanted beneath the skin, the resistance drops massively, which means that sensitive organs can be damaged by much lower currents and even leakage currents pose a considerable risk. If the heart muscle is directly affected by the current flow, 0.02 mA or even 0.01 mA (with a contact area of ​​1.2 to 3.1 mm²) are sufficient  for ventricular fibrillation. Wet or damp skin also lowers the resistance, which means that more current gets into the body than with dry skin. In some cases, even lower currents apply to women and children. Wearers of medical implants or pacemakers are even more at risk. In addition, the values ​​vary greatly depending on the duration of exposure , the current path, frequency , area flowed through, body resistance, state of health or age , study and literature. A shorter path of the current, a larger area (smaller resistance -> more current) or a smaller area (higher resistance -> higher current density and thus greater warming and nerve irritation / pain) or a lower total body resistance can make lower currents than the specified life-threatening .

The value for the current that gets into the body results mainly from voltage and (body) resistance .

Alternating current

Alternating current is significantly more dangerous than direct current, four to five times as much, depending on the literature.

The perception threshold for electrical current varies greatly from person to person and is between 10 microamps and 4 milliamps with a contact area of ​​3 cm² and a frequency of 50  Hz , whereby women and children under 12 years of age are more sensitive than men.

The average child can let go of the power source between 3 and 5 milliamps, the average adult between 6 and 9 milliamps, with 6 milliamps for women and 9 milliamps for men. In the skeletal muscles, contractions are triggered by low-frequency alternating current from a strength of 10 milliamperes , sometimes even from 8 milliamperes (the so-called release threshold , dangerous area AC3 begins), which, due to the stronger development of the flexors, lead to a " Holding on ”to the live parts and thus lead to a longer exposure time. Even this strength of current can be fatal for children. Cardiac arrhythmias are already possible with currents of 25 milliamps. From 30–50 milliamperes, a contracture , that is, tension of the respiratory muscles and the diaphragm , can occur in the thoracic area and thus a respiratory arrest for the duration of the current flow. This can also happen if the flow of current affects the breathing center in the brain stem (e.g. typically in a lightning accident with head perfusion).
Alternating current at 50 Hz can, depending on the area of ​​activity, lead to ventricular fibrillation at a current strength of approx. 50 mA and more and if it is used for more than one second. The current path is decisive here: if current flows in the chest-back or chest-left hand area, ventricular fibrillation is already possible at 27 mA. If the hand flows towards the foot, ventricular fibrillation can be expected from 40 mA.

In the 50 to 80 milliamp range, unconsciousness and cardiac arrest can occur, and over 80 milliamps, unconsciousness and respiratory arrest can occur. Significant burns can occur from 100 milliamps. Even higher currents from around 10 amps lead to asystole and even more severe burns.

Direct current

The perceptibility threshold for direct current is around 2 mA.

Depending on the study and duration of exposure, currents from around 20 to 25 mA are dangerous.

Currents that exceed 40 mA can negatively affect the spread of excitation in the heart.

In accidents with direct current, currents of 130 mA or more are necessary to cause fatal injuries such as ventricular fibrillation.

Above 300 mA, unconsciousness is to be expected.

The transport of charge carriers represents a particular danger from direct current, as the electrolytic effect is particularly strong.

frequency

Alternating current and pulsating direct current (also called mixed current ) have a frequency. The higher the frequency, the higher the current flow. Most of the time, however, the specification refers to alternating current.

In addition, normal household network frequencies are in the range that stimulates the heart and nerves.

Alternating voltages with frequencies between 10 Hz and 500 Hz are particularly easy to excite and therefore dangerous for nerves, and 30 Hz to 150 Hz for the heart muscle.

At the frequency of 50  Hertz, which is common in Europe, the alternating current acts on the heart muscle 100 times per second, whereby the "vulnerable phase", which lasts around 15 to 20% of the total period of a heartbeat, is considered critical.

Skeletal muscles that contract quickly (white fibers) respond to frequencies in the range of 50 to 70 Hz, muscles that contract more slowly (red fibers) react better to frequencies of 30 Hz. In the range of 10 to 20 Hz, individual contractions are still perceived, above which one occurs Permanent contraction. If the frequency is over 100 Hz, it will slowly decrease.

There are different thresholds for irritation depending on the type of nerve. In the case of myelinated motor nerves, the excitatory effect occurs best at 50-100 Hz, in the case of non-myelinated C-fibers at 1–10 Hz.

At low frequencies of up to around 5 kHz, it is mainly the extracellular volume of the affected tissue that conducts, since the cell membranes, from an electrophysiological point of view, are capacitors with high resistance. With increasing frequency the resistance decreases, whereby at high frequencies above 1 MHz the entire volume serves as a conductor.

High frequencies from around 100 kHz only lead to lower frequencies ; those from around 300 kHz no longer lead to nerve stimulation , since the ionic conduction prevailing in them is unable to follow the rapid polarity changes. The thermal damage, which is dependent on the voltage-current strength relationship, can nevertheless occur and is desirable in HF surgery in order to stop bleeding.

tension

Although the effects of an electrical accident, as mentioned, depend on the current strength per body area and the duration of exposure, the voltage is mostly used as an indication of possible dangers, mainly due to Ohm's law . In addition, even when approaching non-insulated lines without contact, high voltage can lead to voltage flashover with the formation of arcs or, if there is insufficient or damaged insulation in power cables, to voltage breakdown. Thus, the information about the level of the voltage also serves to maintain the required safety distances to overhead lines at high voltage , which increase with increasing voltage.

The concrete value of the electric current flowing through the body results from the voltage and the body resistance (in the case of alternating voltage also the frequency) that the human or animal body forms. This is not constant and depends on various parameters. In practice, the sources of danger are mostly voltage sources . The higher the voltage (and frequency) or the lower the resistance, the more current flows through the body. Therefore, the level of the electrical voltage is usually used as a criterion for the classification of the danger, since the body resistance moves in certain known ranges.

For example, at a voltage of 230 volts and a body resistance of 1000 ohms, 230 milliamperes would enter the body. This calculation assumes, however, that the voltage source supplies a sufficient amount of current with an almost constant output voltage and thus can provide the required electrical power for an unlimited period of time . If the current intensity is limited - for example by the internal resistance of the voltage source - no current of 230 milliamps could flow even with higher or higher voltage, even with extremely low load resistance (long term), since the output voltage of the voltage source collapses. Many small electrostatic generators , which are often used for demonstration purposes, can, for example, generate high no-load voltages (200 kV), but (depending on the design) only deliver a low current of a maximum of 3 μA into the load and are therefore even with low (skin -) Resistance, harmless to healthy people who have not been provided with medical implants.

From the voltage information alone, therefore, no statement can be made about the hazard if other parameters are unknown. However, in the case of power lines used for energy transmission, high currents are almost always used for transmission in addition to higher voltages due to the continuously high output, which is a life-threatening combination for an electrical accident.

The following information regarding the dangerousness of the voltage therefore only applies if the voltage source can continuously supply the current given by the resistor and the current also flows through the skin resistance or body resistance. If other parts of the body are in contact, such as the tongue , the information on the level of tension does not apply. The extent of the effects increases with increasing voltage (with the same body resistance), as a higher current flows through the body.

Permissible contact voltage

According to the Association of Electrical, Electronic and Information Technologies , the maximum contact voltage in Germany must not exceed 50 V AC or 120 V DC. According to the Austrian Association for Electrical Engineering , the maximum contact voltage in Austria must not exceed 65 V AC or 120 V DC.

For electrical systems in agricultural and horticultural facilities (e.g. rooms for livestock), in the area of ​​rooms with a bathtub or shower and in medical technology, the contact voltage is set to a maximum of 25 V AC or 60 V DC. In area 0 of rooms with a bathtub or shower, the contact voltage must not exceed 12 V AC or 30 V DC. In the case of children's toys, the nominal voltage must not exceed 24 V direct voltage or the corresponding alternating voltage and the transformer for the protective low voltage must not form part of the toy.

Low voltage

With low voltage , alternating current leads to more pronounced damage than direct current; with high voltage , the opposite is true. The limit between high and low voltage in electrical engineering is 1000 volts alternating voltage or 1500 volts direct voltage, but for practical reasons a limit value of 500 volts is often used for everyday clinical use. This means that electrical accidents, for example in the subway area (nominal voltage there generally 750 V), are among the high-voltage accidents, as these are clinically different from the consequences of accidents caused by household electricity . However, it is often assumed that the effect of the current lasts for a few 100 ms.

High voltage

A high voltage accident mainly causes thermal damage to the tissue, i.e. burns . The effective currents are usually much higher than in low-voltage accidents and at the same time very hot arcing faults occur, which under certain circumstances can bypass the human body. For example, approaching a high-voltage line with 30 kilovolts, as is common in medium-voltage networks , leads to an electric arc and, assuming a body resistance of 5 kΩ, a current of around 6 amps briefly flows through the body. A thermal output of around 180 kilowatts occurs. This high output leads to an almost sudden evaporation of water-containing tissue in the area of ​​the current entry or exit point. So-called current marks appear in the tissue at the entry and exit points.

In the case of high-voltage conductors, when approaching them, H. even before direct contact, there is an arc fault, so that there is often no convulsive holding on to the conductor. The arc fault can be accompanied by a strong light effect (lightning) and a loud bang due to the thermal expansion of the air in the lightning channel. To avoid accidents when working in the vicinity of high-voltage parts, the safety clearances provided must be observed and the safety rules for "live work " must be observed.

If the person falls down from the electric shock, the current through the body is often cut off. At high voltages in the power supply networks of around 100 kilovolts, the current flow is so high when approaching that an electrical short circuit occurs and the network protection may respond. In this case consists in overhead lines the particularity that in the normal course of the automatic reclosing the line is again set under tension after a few seconds.

Despite the sometimes shorter exposure times, high-voltage accidents have a lower probability of survival for accident victims than low-voltage accidents.

resistance

For the total body resistance, the transition resistance ( electrical resistance ) at the point of entry of the current in the skin, the skin itself, the body resistance (the resistance that the individual body tissues oppose for themselves and in their entirety to the flow of current) and the transition resistance at the point of exit are decisive. The latter is often largely determined by the nature of the standing area (floor conditions) and the shoes worn.

The guideline value for the skin resistance is very variable and depends on the current path as well as the condition, this is in the range from below 100 Ω to well over 1000 Ω. The body resistance as well as that of the muscles is around 1000 Ω. For an adult and a current path from the right hand to the left or right foot, for example, values ​​between 500 Ω and 3 kΩ are measured. This value can be lower if the skin is touched over a large area, if the skin is thin (for example, in babies) and if the distance is shorter. Especially damp or wet skin (for example from soapy water or sweat ) causes a massive drop in skin resistance. If the total body resistance is measured with a multimeter and with a low measuring voltage, very high values, often over 1 MΩ, are displayed. However, this is strongly dependent on the applied voltage, frequency and humidity and can therefore be regarded as a varistor . Contact with high voltages causes a breakdown through the skin, so that only the body resistance applies. In addition, a higher resistance of the skin as well as a longer contact time in accordance with the law of electricity heat cause burns of the skin of varying severity. In the relevant literature, a body resistance of 1 kΩ to 2.4 kΩ is assumed. In the defibrillator , which is used to preserve life , the voltage is up to 750 volts and is applied between 1 and 20 ms. The contact resistance from the electrodes to the body is intentionally made particularly small. With an assumed average body resistance of 500 Ω, the current strength then reaches up to about 1.5 A.

Exposure time

Electric shocks cause damage, which depends on their duration. For example, electrostatic discharges (voltages up to over 15 kilovolts) generally only lead to shock reactions or secondary accidents, despite their high current strength of a few amperes, as their discharge duration is only less than a microsecond. With the electric fence energizer (impulses of a few kilovolts) this is used to keep animals away without harming them. Muscle contractions already occur in both cases, but these do not yet lead to dramatic, uncoordinated movements. However, shock reactions can lead to secondary accidents.

If the exposure time exceeds about 100 milliseconds, the limit current strength for ventricular fibrillation (risk of death), which is almost 500 mA from 20 ms to then , drops sharply until it is approximately 40 mA from about 1 s exposure time. Accordingly, the residual current circuit breakers used to avoid electric shocks trigger within 100 ms at a residual current of 30 mA. In the case of larger fault currents, the tripping time is shorter and is a minimum of around 20 ms - a value that offers protection even if someone connected to the earth touches a conductor carrying mains voltage. Residual current circuit breakers only offer protection against leakage currents to earth.

frequency

Burns from electrical accidents

In Germany between 36 and 100 people die each year (observation period 2000–2015) as a result of electrical accidents, around 90% of which are caused by low voltage and 10% by high voltage . About 30% of high and 3% of low voltage accidents result in death.

The Institute for Research into Electrical Accidents (BG ETF) at the Employer's Liability Insurance Association for Energy, Textile, and Electro Media Products ( BG ETEM ) in Cologne has been collecting statistical data on electrical accidents in Germany for decades, which, due to the large amount of data, also allows statements to be made about the frequency of death.

Current path
Total accidents		 of which
fatal 		rel. distribution Lethality
all in all fatal
Hand-hand 2891 82 77.3% 48.5% 2.84%
Hand foot 349 19th 9.2% 11.2% 5.44%
Hand-feet, hands-foot 294 18th 7.7% 10.7% 6.12%
Hands feet 106 20th 2.8% 11.8% 18.67%
shortened current paths upper body
(like hand-chest, or chest-back) 		108 30th 3.0% 17.8% 27.78%
all in all 3748 169 100% 100% 4.51%

The basis for the evaluation were the accidents at work due to electrical current reported at the Institute for Research on Electrical Accidents of the BGFE (from 2008: BG ETF) in the years 1969 to 1996. The data in the table only includes power accidents in the low voltage range from 130 volts to 400 volts with 50 Hertz alternating voltage, for which a minimum flow time of 300 milliseconds can be assumed.

A research group led by J. Jacobson determined the probabilities of the occurrence of ventricular fibrillation from animal experiments with pigs . The aim was to determine comparison factors in order to be able to transfer the measured data to humans. The following test conditions were passed:

  • Alternating current at 50 Hertz
  • Duration of action 75% of the heart pulse period
  • Longitudinal flow (right ear to left knee fold)
  • Body mass of pigs 15 kg to 25 kg
Flicker probability 1 % 5% 50% 95%
Current rms value in A 0.63 0.79 1.50 2.80

A correction factor of 2.8 was determined to transfer these current values ​​to the conditions in humans (right arm to left foot). This means that the effective values for the current in the table must be multiplied by 2.8. Conservatively (with a safety factor), this correction factor is only assumed to be 1.5.

In Switzerland , electric shock on overhead lines is the most common non-natural cause of death for storks, eagle owls and other large birds .

Sources of danger

Source of danger: defective power cord: the jacket is damaged, so the protective insulation is no longer provided

Common causes of electric shock are:

Special organ damage

The consequences of the electrical accident are also dependent on the electrical conductivity of the individual tissues or organs, which increases with the level of the electrolyte content.

The lower the electrical resistance, the more current flows through the affected region. Thus, the different electrical resistances of the individual tissues in the human body are largely responsible for the path that the majority of the electrical current takes. The nerve tissue and blood show the lowest resistance , followed by blood vessels , mucous membranes and muscle tissue . Skin, tendons, fatty tissue and bones, which have a significantly higher electrical resistance, follow in ascending order. Accordingly, with direct current and low-frequency currents, nerve tissue, as well as bleeding tissue or tissue and muscle tissue with good blood flow, are most likely to have the most current flowing through them. Nevertheless, a higher resistance such as skin is only conditionally better protection, because as soon as electricity flows through it, electrical energy is converted into heat, which causes burns and tissue is destroyed. Smaller parts of the body such as fingers and hands or small surfaces can also be irreversibly destroyed more quickly if the current is not diverted enough.

However, the extent and severity of the consequences of an electrical accident cannot be deduced from the damage to the body surface (such as the skin) alone.

Especially in accidents with high voltage currents, peripheral nerves are often damaged, in some cases even delayed. Since the flow of current through the hands and arms usually occurs in the low-voltage range, mainly the median , ulnar and radial nerves are affected by damage, with remission often occurring.

The following table provides an overview of the possible consequences of an electrical accident, depending on the influencing factors described , which can, but do not have to, occur both simultaneously and with a time delay, individually or in combination with different probability:

body part (s) through which electricity flows or affected u. a. possible symptom (s)
Body cells , tissues , organs (general) Cell destruction, with the formation of toxic protein decomposition products that can lead to kidney damage and symptoms of poisoning, acidosis , overheating, damage or lysis or increased permeability of the plasma membrane , (functional) disorders, damage to destruction of various tissues and organs ( lesions , necrosis ), changes in the Membrane potential , depolarization , liquefaction of the tissue, changes in metabolism, (internal) bleeding , shock, ( multiple ) organ failure, coagulation, denaturation , dehydration , hypoxia , carbonization, electrolyte disturbance , hyperkalaemia , hypocalcemia , ion shift, disturbance of stimulus generation and conduction
Skin , muscles, but also all other tissues light to severe (external and internal) burn injuries (grade 1-4, burn disease), among other things at the entry and exit points of the current (current marks ), but also severe muscle destruction (myolysis) or destruction of other tissues through internal burns ("boilings", Soft tissue injuries), with prolonged exposure including entire organs or the entire body, blistering , reddening of the skin, (burn) wounds , discoloration
Transitional epithelial tissue ,

Mucous membrane

Aphthae , erosions , ulcers
Muscles (general, all types) Paralysis or spasms of the skeletal muscles (simple / phasic and tetanic muscle contractions , muscle spasms ), which can cause muscle tears , tendon tears , dislocations and broken bones , as well as of the heart and respiratory muscles , myoglobinemia, compartment syndrome , weak to severe muscle pain , but also rhabdomyolysis , Muscular atrophy , myoclonia
heart Cardiac arrhythmias (can also longer delay hours after the accident occurring) such as ventricular fibrillation , atrial flutter and atrial fibrillation , premature beats , but also heart attack symptoms, bradycardia , hypertension , (sinus) tachycardia (this increase in blood pressure), ventricular flutter , (polymorphic) ventricular tachycardia , torsades de pointes , electromechanical dissociation , hypotension, AV block (Wenckebach period), temporary or permanent asystole ( cardiac arrest ) as well as (permanent) cardiac muscle damage (myocardial damage) up to (beginning) heart failure (acute or delayed), in individual cases ischemia with CK - rise and pericardial effusion , even troponin -increase, leg blocks (intraventricular spread disorder), syncope , coronary vasospasm (coronary vasospasm), intracoronary thrombus, bradycardia , heart attack and heart wall aneurysm
peripheral nerves Paresthesia (including of the nerve trunk), sensory disorders , reversible and irreversible loss or paralysis ( paralysis ) of sensory, motor and reflex functions, paresis, disorders of the autonomic nervous system, pain
Spinal cord more or less complete paraplegic syndrome , but also possibly amyotrophic lateral sclerosis , spinal trauma, spastic paresis, progressive deficits due to adhesive arachnoiditis, muscle atrophy
brain Unconsciousness ( coma ), impaired consciousness ( clouding of consciousness ), vigilance disorder , restlessness , memory disorders , thought disorder , seizures such as tonic clonic convulsions , pareses , dys- paresthesia , cerebral edema (resulting, for example: increase in intracranial pressure ), confusion , dizziness , headache, nausea , Amnesia , aphasia , vegetative dystonia , opisthotonus , root syndrome or, in the case of (too) high exposure to heat, permanent damage such as a cerebral lesion (e.g. hemiplegia , paraplegia, tetraparesis , Parkinson’s syndrome or epilepsy / epileptiform seizure), disorders of respiratory regulation , Paralysis or death from central paralysis of the respiratory center ( apnea ), cranial nerve failure , acute brain death , ashing and boiling of the tissue, cerebral necrosis, cerebral venous thrombi, cerebral haemorrhages (such as around the 3rd ventricle , on the floor of the 4th ventricle and on the Cortical marrow boundary), extrapyramidal dysfunction , cerebral dysfunction, neurological focus symptoms (dur ch scarring), (severe) neurological failures resulting in cyanosis , hyperhidrosis , hypertension , tremor , changes in brain metabolism, permanent damage, cerebellar atrophy
Meninges by thermal action: development of aseptic meningitis , arachnoiditis
Skullcap by heating the tissue and a sharp increase in pressure: detonation
blood Gas formation through electrolysis of the blood, increased LDH values
Blood vessels Spasms , thromboses , aneurysms , vascular ruptures, vascular necrosis (of the intima and media), hemorrhages , embolism ( fat embolism ), in coronary arteries coronary spasms with myocardial ischemia ("angina pectoris electrica"), in higher temperatures coagulation with thrombus formation, venous hyperemia ,
Area thorax and lungs Direct damage to the lungs, pneumothorax , respiratory insufficiency ( dyspnea ) due to tetany of the diaphragm, intercostal and auxiliary respiratory muscles up to respiratory arrest , peripheral respiratory paralysis, hypoventilation, dysfunction of the chest wall, exudative pleural effusion
Regions above or near the collarbones

or area of ​​the eyes

Cataract (cataracta electrica, also delayed), Kornealäsion, retinopathy (with edema ), Retinaläsion, papilledema , scotoma , Photokeratitis , damage to the optic nerve , optic neuropathy, visual disturbances, pigmentary changes, wide and fixed pupil (autonomic dysfunction), macular edema , retinal detachment , uveitis , ocular thrombosis, temporary or permanent blindness , chorioretinal atrophy , papilledema, hemorrhage , Makulaläsion
Hearing and balance system Inner ear damage , tympanic membrane perforation, burns (of the skin of the ear canal), transitory facial paralysis , lesions, dizziness , rupture of the Reissner membrane, bleeding with subsequent formation of a hematoma , fractures of the temporal bone , damage to the auditory balance nerve , hearing impairment ( tinnitus )
Abdomen area

Esophagus, stomach, intestines

Necrosis, damage to the intra-abdominal hollow organs ( perforation ), nausea , vomiting , paralytic ileus , intestinal motility
Kidneys acute tubular necrosis, kidney failure (e.g. due to myoglobinuria , hemoglobinuria , protein toxins, renal " crush syndrome ", or in the event of parenchymal damage), hypovolemia
Indirect effect: e.g. B. Bang or pressure wave (z. B. during a thunderstorm) can u. a. Internal bleeding , sudden hearing loss and tinnitus , bright electric arcs can damage the retina , and there is also a risk of secondary accidents such as B. A fall caused by shock, which can lead to head trauma if the head hits hard objects

Long-term consequences: physical consequential damage such as peripheral nerve lesions that can occur up to 3 years after the accident, as well as sensitivity disorders and (poly) neuropathies (in the event of lightning strikes), but also psychological such as sleep disorders, post-traumatic stressful situations, depression, psychoses, anxiety attacks, but also motor neuron diseases (motor system degeneration), tonic spinal cord seizures, extrapyrimidal movement disorders, atrophy of the lateral and spinal cords

activities

Measures at the scene of the accident

In general, the scheme of the rescue chain for first aid must also be observed here and it is essential to pay attention to self-protection when providing assistance and to warn outsiders so that no live parts are touched or there is a sufficient safety distance in the event of high voltage (set up barriers). In addition, flooded areas represent a further danger - this should be taken into account by both the house residents and the emergency services on site. Among other things, it is important to:

High voltage area

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In contrast to the low voltage which requires direct contact with the involved power lines for the current flow, are in non-insulated high-voltage system components such as power lines or overhead lines in the contactless approach flashovers with the formation of life-threatening arcs possible. Due to the high instantaneous power, the electric arc leads, in addition to the strong lighting effect and loud bang, to sudden evaporation of metallic contact material, which can lead to fires in the vicinity and burns on unprotected skin. Also at the insulation damaged high voltage cables are dangerous because voltage breakdowns can occur. For this reason, appropriate fire-resistant protective clothing with face protection such as a visor must be worn when working in the potential area of ​​impact of an electric arc .

U n to ... Distance for electrotechnical
instructed
persons 		Lay people
1 kV 0.5 m 1 m
30 kV 1.5 m 3 m
110 kV 2 m 3 m
220 kV 3 m 4 m
380 kV 4 m 5 m
500 kV 8 m
750 kV 11 m
1000 kV 14 m

To rescue the system, first ensure that it is de- energized . Systems and devices must first be disconnected from the power supply and then additionally grounded using a grounding rod or short -circuited using a short -circuiter in order to divert partial voltages and to prevent switched-off lines from remaining live, for example through inductive or capacitive coupling of neighboring operating wires. It should be noted that some energy technology systems with automatic restart are automatically reactivated after a short interruption due to the accident. The five safety rules must be followed in this order .

In the case of systems whose absence of voltage is not certain, a safety distance dependent on the voltage level, which increases with increasing voltage, must be observed. In addition, environmental factors such as weather conditions or ionization of air must be taken into account. Usual safety distances for people, which are observed by fire brigades, are given in the adjacent table.

There are separate safety distances for extinguishing any fires in live systems, which must be observed in systems that are live or not yet short-circuited. They also depend on the voltage, but also on the extinguishing agent used . If water is used, the above distances apply to a spray jet , to a full jet the distance increases to 6 meters at up to 110 kV, 7 meters at up to 220 kV and 8 meters at up to 400 kV.

Another source of danger for the rescuers is the step voltage that occurs when a live conductor touches the ground and current flows into the ground.

Low voltage area

Measures at the accident site in the event of low-voltage accidents

For rescue, exposed, live cables should be removed from the injured person with the help of dry and clean, non-conductive objects (e.g. long and thick broomstick made of plastic ), if necessary, bring the injured person out of the accident area using sufficiently electrically insulating aids such as safety gloves for electricians move away.

Even in the low-voltage area, the necessary safety distances must be observed when extinguishing work under voltage: The distance is one meter for a spray jet and five meters for a full jet. When extinguishing with portable fire extinguishers , a distance of one meter must be kept for a spray jet and only three meters for a full jet. [71]

In the case of unconscious patients, after the power supply has been switched off and (depending on the country-specific safety regulations ) any additional short-circuiting of the system, ensuring breathing and cardiovascular function has priority. If necessary, immediate cardiopulmonary resuscitation should be initiated. Trained rescue personnel defibrillate ventricular fibrillation . If available, a publicly accessible lay defibrillator is used.

In the case of responsive patients, burn injuries are only to be cooled initially, while maintaining normothermia, and covered with a low-germ, non-fluff wound pad. If water is used to cool any burns, it should therefore have room temperature, but under no circumstances a temperature below 15 ° C or even be ice-shaped, as this can lead to hypothermia on the one hand and, paradoxically, tissue damage on the other. The patient should not be left unattended, even if they are completely well, until heart damage has been ruled out. A 12-channel electrocardiogram is always required for this . Therefore, the alerted ambulance service usually transports them to the emergency room of a hospital. If changes in the electrocardiogram are detectable, a high-voltage accident has occurred or special risk factors exist, an observation with ECG monitoring is carried out for several hours.

The further measures depend on the severity of the burns. The thermal effect of the electric current leads to fluid loss in the body. Likewise, the charring of the affected tissue ( necrosis ) can lead to the development of toxins. There is a risk of sepsis resulting in death from bacterial infection of the damaged organs. In order to reduce damage to the kidneys, it is necessary to compensate for the loss of fluid with intravenous volume administration , for example sodium chloride infusion solution .

Diagnostics and monitoring

anamnese

The following points should be clarified:

  • physical complaints at the time of the event or during the course?
  • Chest pain, palpitations, shortness of breath?
  • Loss of consciousness, gaps in memory, abnormal sensations, dizziness?
  • Concomitant injuries (indirect consequences)?

Investigations

Monitoring High-voltage accidents are always subject to inpatient intensive care monitoring . In most cases, there are also relevant accompanying injuries such as burns. In the event of low-voltage accidents, monitor monitoring is required if the casualty was temporarily unconscious , arrhythmias were observed at the scene of the accident or during transport, or a suspicious 12-lead ECG is present. In- patient monitoring is only necessary if the medical history , physical examination or laboratory diagnostics reveal abnormal changes, a voltage above 500 V was the cause or there are serious underlying diseases of the cardiovascular system.

historical event

Illustration of a tragic electrical accident involving a line fitter in New York City in October 1889

The first electrical accident documented in writing is seen in the BGV as an event on November 4, 1879 in the Reichstag building in Berlin, in which an employee who wanted to demonstrate the function of the lamps to a group of people who were present got into the electrical circuit. He touched the two live contacts in the lamp base and fell to the floor. One of the people present made the suggestion to divert the harmful current, which should still be in the casualty, into the earth. To do this, the casualty was carried into the garden and his hands put into the earth. The "healing method" used at that time in the acute situation can be explained by the general lack of understanding of the context and does not represent a suitable reaction.

See also

literature

  • Gottfried Biegelmeier, Dieter Kieback, Gerhard Kiefer, Karl-Heinz Krefter: Protection in electrical systems. Volume 1: Dangers from Electric Current (=  VDE series of publications . Volume 80 ). 2nd Edition. VDE Verlag, Berlin / Offenbach 2003, ISBN 3-8007-2603-3 .
  • Gottfried Biegelmeier: Effects of the electric current on humans and farm animals. Electropathology textbook . VDE-Verlag, Berlin 1986, ISBN 3-8007-1452-3 .
  • Werner Hörmann, Bernd Schröder: Protection against electric shock in low-voltage systems - Commentary on DIN VDE 0100-410 (VDE 0100-410): 2007-06 (=  VDE series of publications . Volume 140 ). VDE-Verlag, Berlin, ISBN 978-3-8007-3190-9 .
  • Siegfried Altmann : An analysis of the "electrical accidents in the former GDR and today". VDE-Fachbericht 43. VDE-Verlag, Berlin / Offenbach 1993, pp. 5–17.
  • Siegfried Altmann: Investigations into fatal electrical accidents in the home and leisure area as well as in trade in the new federal states. VDE-Fachbericht 53. VDE-Verlag, Berlin / Offenbach 1998, pp. 115–135.

Norms

  • DIN IEC / TS 60479-1 ( VDE V 0140-479-1): 2007-05 Effects of electric current on people and farm animals - Part 1: General aspects
  • DIN V VDE V 0140-479-4 (VDE V 0140-479-4): 2005-10 Effects of electric current on people and farm animals - Part 1: Effects of lightning strikes on people and animals
  • DIN EN 61140 (VDE 0140-1): 2007-03 Protection against electric shock - common requirements for systems and equipment
  • DIN VDE 0100-410: 2007-06; Erection of low-voltage systems - Part 4-41: Protective measures; Protection against electric shock
  • DIN VDE 0100-540: 2012-06; Erection of low-voltage systems - Part 5-54: Selection and erection of electrical equipment - Earthing systems, protective conductors and protective equipotential bonding conductors

Web links

Commons : Electricity Accidents  - Collection of Pictures, Videos and Audio Files
Wikibooks: First Aid / Electric Shock  - Learning and Teaching Materials
Wiktionary: Electric shock  - explanations of meanings, word origins, synonyms, translations

Footnotes

  1. ↑ mainly in the case of electrical accidents in the low-voltage range up to around 400 V or 500 V (around 90% of electrical accidents). For accidents involving high voltage, see Influencing factors, voltage

Individual evidence

  1. ↑ a b c d Jens Scholz, Bernd W. Böttiger, Volker Dörges, Volker Wenzel, Peter Sefrin : Emergency Medicine . Georg Thieme Verlag, 2012, ISBN 978-3-13-158983-5 ( limited preview in Google Book Search [accessed on May 30, 2016]).
  2. ^ Bogdan Adamczyk: Foundations of Electromagnetic Compatibility: with Practical Applications . John Wiley & Sons, 2017, ISBN 978-1-119-12079-7 ( google.at [accessed September 22, 2018]).
  3. ^ Stefan Jellinek: Electropathology . Рипол Классик, 1903, ISBN 978-5-88178-805-6 ( limited preview in Google Book Search [accessed August 5, 2016]).
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    Note: The ascending part of the T wave indicates the so-called vulnerable phase of the heart's action. Here parts of the heart muscle (myocardium) cannot yet be influenced (refractory), while others are already excitable again. If a current surge occurs in this phase, ventricular fibrillation can occur and the heart may fail to pump completely.
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  41. ↑ a b DIN VDE 0100-410: 2007 section 701.55
  42. ↑ DIN VDE 0100-710_2012-10 section 710.414; for certain applications according to DIN EN 60601-1: 2013-12 (VDE 0750-1: 2013-12) or DIN 57753-1: 1983-02 also significantly less
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