2. ENVIRONMENTAL EMERGENCIES
2.2 ELECTROCUTION / LIGHTNING INJURIES
Electrical injuries are a relatively common, complex and potentially devastating form of trauma. The manifestations and severity of electrical trauma encompass a wide spectrum, ranging from a transient unpleasant sensation due to brief contact with low-intensity household current to instantaneous death and massive injury from high-voltage electrocution/lightning injury. Unlike thermal burns, electrical injuries commonly involve multiple body systems with the potential to pose difficult challenges regarding accurate assessment and proper management.
Therefore, injury due to electricity may include burns to the skin and deeper tissues, cardiac rhythm disturbances and associated injuries from falls and other trauma. The amperage, voltage, type of current (AC vs. DC) duration of contact, tissue resistance and current pathway through the body will determine the type and extent of injury. Higher voltage, greater current, longer contact and flow through the heart are associated with worse injury and worse outcome. In general, lightning exposure/contact may result in the most severe form of electrical injury.
ASSESSMENT / TREATMENT PRIORITIES
1. Assure scene safety, i.e. by ascertaining that the source of electricity is removed from the patient and the rescue area. Call appropriate public service agencies for assistance if needed.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs. Treat all life threatening conditions as they become identified.
6. Obtain appropriate history related to event (voltage source, time of contact, path of flow through body and unresponsiveness or seizures). Assess patient for entry and exit wounds, particularly under rings or other metal objects. Obtain Past Medical History, Medications, Drug Allergies, Substance abuse.
TREATMENT
BASIC PROCEDURES
1. Assure scene safety, i.e. by ascertaining that the source of electricity is removed from the patient and the rescue area. Call appropriate public service agencies for assistance if needed.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
6. If patient is in cardiopulmonary arrest:
a. Initiate CPR with supplemental oxygen
b. Apply AED/SAED to determine VF/VT, if AED/SAED credentialled.
7. Manage burn injuries and or entrance and exit wounds as indicated.
8. Activate ALS intercept, if deemed necessary and if available.
9. Initiate transport as soon as possible with or without ALS.
10. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Assure scene safety, i.e. by ascertaining that the source of electricity is removed from the patient and the rescue area. Call appropriate public service agencies for assistance if needed.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
6. If patient is in cardiopulmonary arrest:
a. Initiate CPR with supplemental oxygen
b. Apply AED/SAED to determine VF/VT, if AED/SAED credentialled.
7. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Initiate IV Normal Saline (KVO).
8. Manage burn injuries and or entrance and exit wounds as indicated. If extensive burns (moderate to severe) noted, manage patient according to Burn Protocol.
9. Contact Paramedic intercept, if deemed necessary and if available.
10. Initiate transport as soon as possible with or without Paramedics.
11. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Assure scene safety, i.e. by ascertaining that the source of electricity is removed from the patient and the rescue area. Call appropriate public service agencies for assistance if needed.
2. Maintain universal blood and body fluid precautions.
3. Maintain an open airway and assist ventilations as needed. Assume spinal and other potential traumatic injuries when appropriate and treat accordingly.
4. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
5. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
6. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Cardiac Monitor: manage dysrhythmia(s) per protocol.
c. Initiate IV Normal Saline.
7. Manage burn injuries and or entrance and exit wounds as indicated. Manage burn injuries and or entrance and exit wounds as indicated. If extensive burns (moderate to severe) noted, manage patient according to Burn Protocol.
8. Initiate transport as soon as possible.
9. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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