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{{Short description|Burn to the skin caused by electricity}}
[[File:Electrical burn on hand.jpg|thumb|Electrical burn on hand]]
An '''electrical burn''' is a [[burn]] that results from [[electricity]] passing through the body causing rapid injury. Approximately 1000 deaths per year due to electrical injuries are reported in the United States, with a mortality rate of 3-5%.<ref name="WB9">{{EMedicine|article|770179|Electrical Injuries in Emergency Medicine}}</ref><ref>{{Cite journal|last=Nasoori|first=A|date=2017|title=Maggot debridement therapy for an electrical burn injury with instructions for the use of Lucilia sericata larvae|url=https://www.researchgate.net/publication/321856095|journal= Journal of Wound Care|volume=26|issue=12|pages=734–741|doi=10.12968/jowc.2017.26.12.734|pmid=29244970}}</ref> Electrical burns differ from [[Thermal burn|thermal]] or [[Chemical burn|chemical]] burns in that they cause much more [[subdermal]] damage.<ref name="WB7">“Electrocution Burns.” Burn Survivor Resource Center. n.p. n.d. Web. 29 September 2011. <http://www.burnsurvivor.com/injury_examples_electrocution.html {{Webarchive|url=https://web.archive.org/web/20111030080057/http://www.burnsurvivor.com/injury_examples_electrocution.html |date=2011-10-30 }}>.</ref> They can exclusively cause surface damage, but more often tissues deeper underneath the skin have been severely damaged. As a result, electrical burns are difficult to accurately diagnose, and many people underestimate the severity of their burn. In extreme cases, electricity can cause [[Electric shock|shock]] to the brain, strain to the heart, and injury to other organs.<ref name="WB1">Health Care Advisor: Burn Treatment Self Help Guide. n.p. n.d.. Web. 29 September 2011.<http://www.burnremedies.com/Electrical.html {{Webarchive|url=https://web.archive.org/web/20111102063636/http://www.burnremedies.com/Electrical.html |date=2011-11-02 }}>.</ref>

For a burn to be classified as electrical, electricity must be the direct cause. For example, burning a finger on a hot electric [[Clothes iron|steam iron]] would be thermal, not electrical. According to [[Joule's first law]]: electricity passing through [[Electrical resistance and conductance|resistance]] creates heat, so there is no [[Electric current|current]] entering the body in this type of burn. Likewise, a fire that is ruled to be "electrical" in origin, does not necessarily  mean that any injuries or deaths are due to electrical burns. Unless someone was injured at the exact moment that the fire began, it is unlikely that any ''electrical'' burns would occur.

==Causes ==
Electrical burns can be caused by a variety of ways such as touching or grasping electrically live objects, [[short-circuiting]], inserting fingers into electrical sockets, and falling into electrified water. [[Lightning strike]]s are also a cause of electrical burns, but this is a less common event.<ref name="WBebi">“Electrical Burn Injuries.” Department of Surgery, Government Medical College, Miraj and General Hospital, Sangli, Maharashtra, India. 17 August 2003. Web. 29 September 2011. <http://www.medbc.com/annals/review/vol_17/num_1/text/vol17n1p9.asp>.</ref>
With the advances in technology, electrical injuries are becoming more common and are the fourth leading cause of work-related traumatic death.<ref name="Wbei">{{EMedicine|article|433682|Electrical Injuries}}</ref> One third of all electrical traumas and most [[high-voltage]] injuries are job related, and more than 50% of these injuries result from power line contact.<ref name="Wbei"/>

Electrical burns can be classified into six categories, and any combination of these categories may be present on an electrical burn victim:
*'''Low-voltage burn'''. A burn produced by contact with a power source of 500 volts or less is classified as a low-voltage burn. The current at this voltage is not enough to cause tissue damage along its path except at the contact site. This type of burn may be mild, superficial, or severe depending on the contact time.<ref name="WB3">“Electrical Burns.” Burnsurgery.org. n.p. n.d. Web. 29 September 2011. <http://www.burnsurgery.org/Modules/initial_mgmt/sec_7.htm>.</ref>
*'''High voltage burn'''. This burn is very severe as the victim makes direct contact with the high voltage supply and the damage runs its course throughout the body. Exterior injuries are misleading as most of the damage occurs underneath the skin. In this case, subdermal tissues are severely damaged.<ref name="r1"/>
*'''Arc burn'''. This type of burn occurs when electrical energy passes from a high-resistance area to a low-resistance area.<ref name="WB4"/> No contact is required with an [[Electric arc|arc]] burn as the electricity ionizes air particles to complete the circuit. The heat generated can be as high as {{cvt|4,000|C|sigfig=2}}{{hsp}}{{mdash}}{{hsp}}hotter than the boiling points of several metals and certainly hot enough to ignite a victim's clothing. A form of explosion dissipates excess energy from the arc.<ref name="WB3"/> In addition, a high-current arc can produce a [[Longitudinal wave|pressure wave]] blast in excess of {{convert|1000|psi}} of pressure. This can throw the victim and cause severe injuries.<ref name="WBbif">{{cite web |title=Burn Injury Facts: Arc Flash/ Blast |work=Hazard Prevention |date=April 2006 |pages=1–2 |url=http://www.lni.wa.gov/safety/research/files/arcflashhazardreport.pdf |access-date=2015-07-08 |archive-date=2019-09-26 |archive-url=https://web.archive.org/web/20190926123308/http://www.lni.wa.gov/safety/research/files/arcflashhazardreport.pdf |url-status=dead }}</ref>
*'''Flash burn'''. Flash burns are caused by electrical arcs that pass over the skin. The intense heat and light of an arc flash can cause severe burns in a fraction of a second. Although the burns can cover a large area of skin, they are largely superficial and the tissues beneath the skin are generally undamaged and unaffected. This typically occurs when the [[frequency]] of the [[Alternating current|AC current]] is significantly higher than the 50 or 60&nbsp;Hz used in land-based [[electrical distribution]] systems (such as in [[aircraft]]).<ref name="WB4"/>
*'''Flame burn'''. Flame burns are caused by contact with objects that were ignited by an electrical source when associated with flash and arc burns.<ref name="WB4"/>
* '''Oral burns'''. This is caused by biting or sucking on electrical cords, and it most commonly happens to children.<ref name="r2">{{cite journal |last1=Toon |first1=Michael Howard |last2=Maybauer |first2=Dirk Manfred |last3=Arceneaux |first3=Lisa L. |last4=Fraser |first4=John Francis |last5=Meyer |first5=Walter |last6=Runge |first6=Antoinette |last7=Maybauer |first7=Marc Oliver |title=Children with burn injuries-assessment of trauma, neglect, violence and abuse |journal=Journal of Injury and Violence Research |volume=3 |issue=2 |pages=98–110 |year=2011 |pmid=21498973 |pmc=3134932 |doi=10.5249/jivr.v3i2.91 }}</ref> Electric current typically passes from one side of the child's mouth to the other, possibly causing deformity.

==Pathophysiology==
Four electrical factors determine the severity of the damage caused by electrical burns: [[voltage]], [[Electric current|current]], [[Electrical resistance|resistance]], and [[Alternating current#AC power supply frequencies|frequency]]. The severity of the burn also depends on the pathway the [[Electric current|current]] takes through the body.<ref name="WB2">“Electrical Burns: Causes and Treatment.”  n.d. Web. 29 September 2014. <http://legal-lookout.com/injury-information/electrical-burns/>.</ref> Generally, the pathway of the current will follow the course of the least resistant tissues: firstly blood vessels, nerves, and muscle, then skin, tendon, fat, and bone.<ref name="r1">Docking, P. “Electrical Burn Injuries.” [[Accident and emergency nursing]] 7.2 (1999): 70-76. Print.</ref> Most commonly, electric injuries primarily damage the outer limbs, but more critical portions of the body may be affected as well causing severe complications.<ref name="r5">{{cite journal |last1=Xu |first1=Xuezhang |last2=Zhu |first2=Weiping |last3=Wu |first3=Yali |title=Experience of the Treatment of Severe Electric Burns on Special Parts of the Body |journal=Annals of the New York Academy of Sciences |volume=888 |issue= 1|pages=121–30 |year=1999 |pmid=10842626 |doi=10.1111/j.1749-6632.1999.tb07949.x |bibcode=1999NYASA.888..121X |s2cid=30085032 }}</ref>

As the body comes into contact with an electrical source, it becomes part of the electrical circuit. As such, the current has a point of entry and an exit at two different points on the body. The point of entry tends to be depressed and leathery whereas the exit wound is typically more extensive and explosive.<ref name="r1"/> It is hard to accurately diagnose an electrical burn because only the entry and exit wounds are visible and the internal damage is not.<ref name="WB4">“What is an Electrical Burn?” Electrical Safety. n.p. n.d. Web. 29 September 2011. <http://www.electricalsafety.org/what-is-an-electrical-burn/ {{Webarchive|url=https://web.archive.org/web/20181028033846/http://www.electricalsafety.org/what-is-an-electrical-burn/ |date=2018-10-28 }}>.</ref>

==Prevention==
===Basic electrical safety===
The following are some examples of unsafe practices which could lead to electric injury (this list is not exhaustive.):<ref name="WBebp">“Electrical Burns Prevention.” ThirdAge.com. ThirdAge Media, LLC. n.d. Web. 29 September 2011. <http://www.thirdage.com/hc/c/electrical-burns-prevention {{Webarchive|url=https://web.archive.org/web/20120406114428/http://www.thirdage.com/hc/c/electrical-burns-prevention |date=2012-04-06 }}>.</ref>

* Using [[electrical appliance]]s while wet (showering, bathing, etc.) as [[plumbing]] is often connected to [[Ground (electricity)|electrical ground]], and wet skin loses much of its [[Electrical resistance and conductance|resistance]]. Exception for newer quality appliances ''intended for the bathroom'' when ''not'' simultaneously showering, bathing, being in a path of water going to plumbing, or touching bare [[concrete]] or [[sheet metal]]. Standing on a dry carpet or rug is ideal.
* All power mains outlets should have a [[Electrical Wall Outlet Cover|wall cover]] to avoid accidentally touching the electrified sides between the wall and outlet. This is especially important for children, as their small fingers can easily reach into this gap along the sides.
* Using AC electrical appliances around bathtubs, swimming pools, hot tubs, etc. with the risk that the appliance may fall into the water and cause [[electrocution]]. Only battery-operated devices are safe. 
[[Image:BritishPlugforWikipedia.jpg|thumb|160px |right|UK Type G plug (BS 1363)]]
* Failure to use child safety plugs in all outlets, and to keep children away from electrical cords.
* Adjusting prongs of an electrical cord that are too wide or narrow them with your fingertips while simultaneously plugging the cord into the power mains. The [[AC power plugs and sockets#BS 1363 .28Type G.29|power plug used in the UK]] and some Commonwealth countries provides limited protection (Type G, with the lower half of the live prongs insulated), but all others do not.
* Not following manufacturer safety instructions for electrical appliances. This includes not using and immediately unplugging any appliance with a damaged electrical cord. If this cannot be done safely (i.e. damage is too close to the plug), the [[circuit breaker]] should be turned off beforehand. 
* Touching metallic areas of an [[Alternating current|AC]] electrical appliance while also simultaneously touching [[faucet]]s, water pipes, another metallic AC appliance, or being even partly immersed in water (including wet feet). This could [[Ground (electricity)|ground]] the body through metal or water, with the risk that a faulty appliance is electrically "hot" on its outside cover or [[chassis]].
* Not installing [[Ground Fault Circuit Interrupter]] (GFCI) outlets or circuit breakers in all areas with plumbing, bare concrete flooring, exposed to the elements, or outdoors by a qualified [[electrician]]. (Many newer homes already have these devices pre-installed.) Running an [[extension cord]] from non-GFCI areas such as bedrooms and hallways defeats this safety feature. Oral burns (above) cannot be prevented by GFCI.
* At poolside, not having a non-metallic [[fiberglass]] pole or net on hand to pull someone to safety in case the pool water is electrified, and the victim is still conscious. Furthermore, to not know where the circuit breakers for the pool are located.
* Failure to install a "feed-through" type GFCI to all electrical devices that are an integral part of a [[Swimming pool]], or not testing it weekly. This is a particular concern due to the use of electric lights and pumps where persons are immersed in water. The GFCI has the typical "test" and "reset" buttons, but no plug-in outlets. A 12-volt system is safer, though not foolproof, as it is ultimately connected to the 120/240 volt power mains. Most electrocutions come from incorrectly [[Ground (electricity)|grounded]] or [[Electrical bonding|bonded]] lights. This can send electric current through a pool light even if it is not turned on.
* Using an ordinary [[vacuum cleaner]] in wet or damp areas. Only a "[[Vacuum cleaner#Wet./dry|wet vac]]" is suitable for this purpose. Overfilling its collection container is also unsafe. 
* Not double checking [[Electrical polarity|polarity]] before doing a [[Jump start (internal combustion engine)|jump start]], or attempting a jump on a frozen battery. Although 12-volt batteries used in vehicles are at a safe voltage, a [[short circuit]] can still cause various types of burns and an explosion.
* Failure to replace high-risk appliances of decades past with new ones (hand-held corded [[electric drill]]s, [[blow dryer]]s, etc.)
* Not inquiring about the voltage when traveling abroad for those residing in the [[Americas]], [[Japan]], and [[Taiwan]] (countries with 110-125 volts). This includes inter-American travel, as a few countries commonly use 220-240 volts. A matching electrical socket (power mains) does ''not'' necessarily mean the voltage is the same as one's home country. The doubling of voltage results in a very dangerous four-fold increase in power and heat. Not checking that dual-voltage small appliances have been adjusted correctly for 220-240 volts is also unsafe. 
* Going near or under a downed power line, even if there's no direct contact with the wire. Also, not remaining inside your vehicle and waiting for rescue should a power line fall on it.
* See also [[Lightning strike#Prevention and mitigations|Lightning safety]]

==Treatment==

===First aid===
An electrically burned patient should not be touched or treated until the source of electricity has been removed.<ref name="WB2"/> Electrical injuries often extend beyond burns and include cardiac arrhythmia, such as ventricular fibrillation. First aid treatments include assessment of consciousness of the victim, evaluation of pulse and circulation, and treatment of burns.<ref name="WB5">“How to Treat and Electrical Burn.” Livestrong.com. Demand Media, Inc. n.d. Web. 29 September 2011. <http://www.livestrong.com/article/234861-how-to-treat-an-electrical-burn/>.{{MEDRS|date=July 2015}}</ref>

===Hospitalization===
Typically, an electrical burn patient has a lower affected body surface area than other burn patients, yet complication risks are much higher due to internal injury.<ref name="r4">{{cite journal |last1=Tredget |first1=Edward E. |last2=Shankowsky |first2=Heather A. |last3=Tilley |first3=Wendy A. |title=Electrical Injuries in Canadian Burn Care: Identification of Unsolved Problems |journal=Annals of the New York Academy of Sciences |volume=888 |issue= 1|pages=75–87 |year=1999 |pmid=10842620 |doi=10.1111/j.1749-6632.1999.tb07943.x |bibcode=1999NYASA.888...75T |s2cid=38792364 }}</ref> Often, the damaged internal tissue demands hospitalization. If not treated, this damaged tissue can cause complications (such as gaseous [[gangrene]] from dead tissue or loss of blood flow to limbs) and the damaged body parts may need to be [[amputate]]d.<ref name="WB4"/>  Repeated removal of the damaged tissue and extensive rehabilitation are common, while limb amputation rates for victims who experience direct electrical contact can be as high as 75%.<ref>"Electrical Injury." Cetri.org, n.p. 2010. Web. 23 July 2013 <[http://cetri.org/electrical_injury.html http://cetri.org/electrical_injury.html>]</ref> Burn treatment for severe wounds may require [[skin grafting]], [[debridement]], excision of dead tissue, and repair of damaged organs.<ref name="r3">{{cite journal |last1=Orgill |first1=Dennis P. |last2=Pribaz |first2=Julian J. |title=Functional Reconstruction following Electrical Injury |journal=Annals of the New York Academy of Sciences |volume=888 |issue= 1|pages=96–104 |year=1999 |pmid=10842622 |doi=10.1111/j.1749-6632.1999.tb07945.x |bibcode=1999NYASA.888...96O |s2cid=8049757 }}</ref>

===Rehabilitation===
Electrical burning has an effect on most vital body functions and is accompanied by several other electrical related injuries:
*Damage to the veins and arteries which can cause [[ischaemic]] [[necrosis]].
*Involuntary contraction of muscles due to [[electrical interference]] which can cause bone fractures and dislocations.
*Interference with the electrical conductivity of organs such as the heart and nerves. This can lead to [[seizures]], lung injury due to severe central nervous system damage, and [[cardiac arrest]].
*Forceful propulsion of the body, producing such injuries as spinal and limb fractures.<ref name="r1"/>

These injuries must be treated in addition to the burns themselves. In very rare instances, a high voltage electric shock can cause [[cataracts]] in the lens of the eyes, and detachment of the [[retina]]. This may be delayed for some days or weeks after the initial injury.<ref>{{cite web | url=https://abcnews.go.com/blogs/health/2014/01/24/shock-leaves-man-with-star-shaped-cataracts/ | title=Shock Leaves Man with Star-Shaped Cataracts | website=[[ABC News]] }}</ref>

==See also==
* [[Electric shock]]
* [[Electrocution]]

==References==
{{Reflist}}

{{Consequences of external causes}}
{{Authority control}}

[[Category:Burns]]
[[Category:Electricity]]
[[Category:Electrical safety]]