Electrocution

16

Deaths caused by electrocution are infrequent. Virtually all are accidents, with suicides rare and homicides even rarer. These deaths involve both lowvoltage (<600 V) and high-voltage (>600750 V) currents. They virtually always involve alternating currents, because direct current is used less. In addition, humans are four to six times as sensitive to alternating currents as to direct. Alternating currents between 39 and 150 cycles per s have the greatest lethality. In the U.S., alternating current is generated at a 60-Hz frequency; in Europe at 50-Hz. Amperage, or the amount of current ow, is the most important factor in electrocution. It is directly related to the voltage and inversely related to the resistance. Voltage is a measure of the electromotive force and ohms are the resistance to the conduction of electricity. This is expressed in the formula: A = V/R Residential voltage in the U.S. is approximately 110120 V from line to ground. High-voltage lines in suburban and urban areas are approximately 75008000 V line to ground with transcontinental high-tension lines 100,000 V or greater. For electrocution from low-voltage (110120 V) household current, there must be direct contact with the electrical circuit, with death primarily caused by ventricular brillation. In high-voltage accidents, direct contact with the wire is not necessary. As the body approaches the highvoltage line, an electric current (arc) may jump from the line to the body. Death from high-voltage electrocution is usually caused by either the electrothermal injury produced by the current, or respiratory arrest. The temperature generated by an arc current can be as high as 40,000C. In urban areas, the usual high-voltage line carries 70008000 V, line to ground. Electrocution from these lines occurs when they break, fall to the ground and are touched, or when an intact or live line is touched by a tall metal object such as a ladder, pole, or crane with which a person is in contact. Resistance to electrocution in humans involves the skin. With 120 V, dry skin may have a resistance of 100,000 ohms; dry and calloused skin up to a million ohms; moist skin 1,000 ohms or less, and moist, thin skin as low as

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Table 16.1

The Distance An Electric Arc Can Jump* Distance Current Can Arc few mm 1 cm 6 cm 13 cm 35 cm

Voltage 1,000 5,000 20,000 40,000 100,000

* as given by Somogyi and Tedeschi1

100 ohms.2 With high-voltage currents, skin condition plays no signicant role in resistance to electrocution. Mechanism of Death Amperage is the most important factor in electrocution. Since voltage is usually constant, the main factor in determining the amount of amperage that enters the body is the resistance, as expressed in ohms. The minimal amount of amperage perceptible to a human as a tingle is 1 mA (0.001 A). A current of 5 mA will produce tremors of the musculature while 1517 mA will cause contracture of the muscles, which prevents release of the electrical source. This latter current is the no-let-go threshold. At 50 mA, there is contracture of all muscles, respiratory paralysis and death if the current is sustained. Ventricular brillation occurs at currents between 75 and 100 mA. Extremely high currents, ~1 A and higher, do not cause ventricular brillation, but rather ventricular arrest. If the current is then turned off, and there is no signicant electrothermal injury to the heart, the heart should begin to beat normally. When electrical current enters the body, it runs from the point of contact to the point of grounding, following the shortest path. Most commonly, the path is from hand to foot or hand to hand. The time necessary for a current to cause death depends on the amperage. Thus, in very low-amperage electrocutions, where death is caused by paralysis of the muscles with secondary asphyxia, prolonged contact, (i.e., several minutes) with the electrical current would be necessary. With household current, in which the mechanism of death is ventricular brillation, the duration of contact necessary to produce brillation may be measured in seconds or tenths of seconds, depending on the amperage. This is, of course, determined by the resistance. Thus, with 120-V current and 1000 ohms of skin resistance, 120 mA reach the body. In such a case, contact for 5 s would be necessary to produce ventricular brillation. 3 If the point of contact is thin moist skin, resistance may be as low as 100 ohms. In such cases, the current entering the body would be approximately 1200

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mA (1.2 A) and ventricular brillation could occur in 0.1s. With highvoltage electrocution, cardiac arrest is essentially instantaneous. In low-voltage electrocution with ventricular brillation, consciousness may not be lost immediately. In fact, it is very common for the individual receiving a fatal electric shock to not lose consciousness, but to yell out or state that he just burned himself prior to collapse. This is because the brain has approximately 1015 s of oxygen reserve, irrespective of the heart. Thus, an individual can remain conscious for 1015 s after cessation of the heart as a pumping organ. In cases of low-voltage electrocution, resuscitation and debrillation may prevent death. It should be kept in mind that ventricular brillation is occasionally self-reversible in that the heart will revert to spontaneous rhythm following a short time of brillation. In high-voltage electrocution, there may be irreversible electrothermal injury. While the heart may start again spontaneously following cardiac arrest, respiration might not resume because of paralysis of the respiratory center. This is probably caused by damage to the respiratory center of the brain stem by the hyperthermic effects of the current. The hyperthermic effects of high-voltage currents can be seen in judicial execution, where third-degree burns develop at the site of contact between the electrodes and skin, as well as in the observation by Werner that, following execution, the brain temperature was as high as 63C.4 Fractures Caused by Electrocution When an individual contacts an electried source having a current of 50 mA or greater, there is generalized muscular contraction. Whether the current is low- or high-volatage, these contractions can fracture bones. Tarquinio et al. reported bilateral scapular fractures from a 440-V, 60-Hz current; Dumas and Walker from exposure to a 220-V, 50 Hz current.5,6 Stueland et al. described a case of bilateral humeral fractures from contact with 110 V; Shaheen and Sabet bilateral fractures of the femoral necks secondary to contact with a 220-V current.7,8 Fractures of T12 and L1 vertebrae have been reported.9 Tarquinio et al. mention that fractures were frequently seen as complications of electroconvulsive or shock therapy prior to the use of muscle relaxants in this therapy.5 Involuntary Movements Caused by Electricity-Induced Contraction of Muscle Contact with current, especially high-voltage current, may produce violent muscle contractions. As previously noted, these can cause fractures. Wright et al. describe the following reactions that can result from electrically induced contraction of muscle:10

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The back and neck arch backward. The arms rotate inward the elbows ex and the hands form sts. The hips and knees lock straight and the feet extend If the individuals are grasping something, they will continue to do so. Wright et al. feel that these muscular contractions, if violent enough, can propel an individual forward or backward, depending on the original position. Autopsy Findings In all cases of high-voltage electrocution but in only about half (50%) the cases of low-voltage electrocution, electrical burns will appear on the body. In low-voltage electrocution, these may occur at the point of entry or the point of exit, at both, or at neither. If the current enters over a broad surface area that offers minimal resistance, there may be no electrical burn. The best example of this is an individual electrocuted in a bathtub. Absence of burns in low-voltage electrocutions, however, can occur with only a small area of contact. Electrocution can produce accelerated onset of rigor mortis caused by the muscle contractions and depletion of ATP. If this does occur, it may be eccentric, reecting the passage of the current through the body. Electrical burns tend to be on the palms of the hands and tips of the ngers (entry sites) and soles of the feet (exit sites) (Figure 16.1). In lowvoltage electrocutions, they may appear as either an erythematous area of blistering or as an irregular chalky white lesion, often with raised borders and a central crater. There may be some yellowish or black discoloration of the burn sites caused by heat. Generally, the burns are small in size, from a few millimeters up to 11.5 cm. Microscopically, the epidermis shows a Swiss cheese appearance. If there is only brief contact with a live wire, there may be no burns. The person may collapse from ventricular brillation and fall away from the wire. When there is prolonged contact, there will be severe burns caused by the heat generated by the electrical current. One cannot differentiate antemortem from postmortem electrical burns. The burns indicate only that current has passed through the skin. Minute particles of metal from the conducting surface may be deposited in the burns, especially in high-voltage electrocutions. These can be located and identied by scanning electron microscopy. In contrast to low-voltage burns, high-voltage burns may be extremely severe, with charring of the body. If the burns occur from contact or proximity to a high-voltage line, numerous individual and conuent areas of third-degree burns will present (Figure 16.2). The multiple small burns are caused by arcing of the current. If the contact with the high-voltage current is not direct, but through current running through an intermediary object such as a ladder or pole, the burns are large and irregular, chalky white in

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B
Figure 16.1 (A and B) Electrical burns of hands representing points of entry.
(continued).

color, often with raised borders and a central crater with yellowish or black discoloration of the burn sites caused by heat. If the individual is wearing shoes, and the exit site is a foot, there may be arcing exit burns. With very high voltage, there can be massive destruction of tissue with loss of extremities and rupture of organs. In all cases of suspected electrocution, there should be an examination of the alleged source of the electrical current including electrical devices the individual was handling at the time of death. In low-voltage electrocutions, examination of the device rather than examination of the body will often provide the cause of death, because burns may not be present. Thus, one can make a diagnosis of electrocution without an electrical burn, based on the circumstances of the death, negative autopsy ndings and the examination

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D
Figure 16.1 (continued) (C and D) Electrical burns of feet representing exit sites

of the electrical device in use. In high-voltage electrocution, tissue from the victim may be adherent at the point of contact with the source of the current (e.g., a metal ladder). Manner of Death Most deaths caused by electrocution are accidental in manner. Not infrequently, these can be blamed on defective tools or electrical appliances. Electrocutions caused by high-voltage wires occur secondary to inadvertent contact with a high-voltage line when operating or in contact with a device such as a cherry picker. Other causes of electrocution are touching a downed electrical line or inadvertently making contact with a line via a radio antenna or kite. The authors have also seen cases of a sexual nature where electrodes have been found in the anus or attached to the penis. Suicides are rare, although occasionally, individuals will build elaborate devices to electrocute themselves. Homicides are even rarer. The most common method of homicide with electrical current is to drop a plugged-in

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B
Figure 16.2 (A and B) High-voltage electrical burns with multiple individual and conuent burn areas (continued).

electrical device into a bathtub while an individual is taking a bath. There are usually no electrical burns in such a case and, if the electrical device is removed, the cause of death will be missed. Bathtub electrocutions, both homicidal and accidental, are becoming less common, because of the fairly widespread use of low-voltage Ground-Fault Current Interrupters (GFCI). These are required in kitchens, bathrooms and outside outlets. This device monitors the current ow. If there is a greater than 5-mA difference, the circuit is broken, thus preventing electrocution. A normal circuit breaker does not function until a 15-A difference is detected. Thus, in most cases of electrocution, the house fuse is unaffected by the electrocution. Electrocution in water could also be caused by defective lights in a swimming pool. GFCIs prevent this type of accident. Lightning A lightning bolt is produced when the charged undersurface of a thundercloud sends its electrical charge to the ground. Since the undersurface is usually negatively charged, virtually all discharges are also negative. Approx-

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D
Figure 16.2 (continued) (C) High-voltage electrical burns with multiple individual and conuent burn areas (D) Burn from high-voltage current conducted into body by a metal plate.

imately 5% of lightning ashes, however, are positive discharges. These are most frequent in mountainous regions. A lightning bolt may injure or kill an individual by a direct strike, a side ash, or conduction through another object. An example of the last instance

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would be a lightning bolts hitting a crane, with the electricitys owing down the metal structure and striking a grounded worker who is touching the crane. The injuries produced would be the same as if the crane had hit a high-power electrical line, that is, burns at the entrance and exit sites, often multiple and severe. In a side-ash strike, the bolt of lightning hits an object, such as a tree, and then ricochets, striking the individual. In a direct strike or a side-ash strike where the individual is relatively close to the object from which the bolt jumps, the current can either spread over the surface of the body or enter it, or it can follow both routes. In most cases seen by the forensic pathologist, the current has both owed over the surface of the body and entered. In such cases, it is quite common to nd the clothing torn, shoes burst, hair seared, burns on the skin caused by zippers and other metal objects heated by the lightning, and burns caused by the entrance and exit of current. Cutaneous burns are not severe but always present.11 On histological examination, the epidermis is separated from the papillary dermis. Rupture of the tympanic membrane is present in approximately 81% of cases.11 Objects constructed of ferrous metal on the body may be magnetized. Other metal objects, such as coins, may show burns. The torn clothing and burst shoes sometimes have led to misinterpretation of the nature of the injuries. People struck by lightning and found next to a road have been thought to be hit-and-run victims. If one is inside a metal vehicle, such as a car or train, when it is struck by lightning, the probability of injury is extremely small. On rare occasions, death or injury has been reported when an individual was using a telephone and the line was hit by lightning.12 Deaths from lightning are caused by high-voltage direct current. Death is caused by cardiopulmonary arrest or electrothermal injuries. With a direct hit by lightning, death is probably inevitable, because of burns and injury to the respiratory center of the brain. Amperage in this case would be in the kiloampere range. If the electrocution is secondary to a close point of impaction, survival may be possible. In fact, most individuals injured by lightning do survive. One of the lesions considered pathognomonic for lightning injury is the arborescent or fern-like injury of the skin called Lichtenberg gures (Figure 16.3). This lesion is a patterned area of transient erythema that appears within 1 h of the accident and then gradually fades within 24 h. The erythematous marks are not burns. Ten Duis et al. believe that this lesion is caused by positive discharges over the skin.13 They hypothesize that the lesion occurs when an individual struck by a negative lightning bolt is then hit by a secondary positive ashover from a nearby grounded object. Another possibility is that it represents an entrance point in an individual struck by a positively charged lightning bolt. Both explanations, neither of which are exclusive of the other, would explain the relative rarity of the arborescent lesion in individuals struck by lightning.

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Figure 16.3 Arborescent burn of lightning.

References
1. Sornogyi E and Tedeschi CG, Injury by electrical force, in Tedeschi CG, Eckert WG, Tedeschi LG (Eds): Forensic Medicine. Philadelphia, WB Saunders Co, 1977, pp 645-676. 2. Bruner JMR, Hazards of electrical apparatus. Anesthesiology 1967; 28: 396-425. 3. Ferris LP, et al., Effect of electroshock and health. AIEE Trans 1936; 55:498. 4. Werner AH, Death by electricity, NY Med J 1923; 118:498-500. 5. Tarquinio T, Weinstein, ME and Virgilio, RW, Bilateral scapular fractures from accidental electric shock. J. Trauma. 1979; 19(2): 132-133. 6. Dumas JL and Walker N, Bilateral scapular fractures secondary to electrical shock. Arch. Orthopaed & Trauma Surg, 1992; 111(5):287-8. 7. Stueland DT, et al., Bilateral humeral fractures from electrically induced muscular spasm. J. of Emerg. Med. 1989; 7(5):457-9. 8. Shaheen MA and Sabet NA, Bilateral simultaneous fracture of the femoral neck following electrical shock. Injury. 1984; 16(1): 13-14. 9. Rajam KH, et al., Fracture of vertebral bodies caused by accidental electric shock. J. Indian Med Assoc. 1976; 66:35. 10. Wright RK, Broisz HG, and Shuman M, The investigation of electrical injuries and deaths. Presented at the meeting of the American Academy of Forensic Science, Reno, NV, February 2000. 11. Wetli CV, Keraunopathology: An analysis of 45 fatalities, Am J Forens Med Path 1996; 17 (2): 89-98. 12. Johnstone BR, Harding DL, and Hocking B: Telephone-related lightning injury. Med J Aust 1986; 144:706-709. 13. ten Duis HJ, Klasen H1, Nijsten MWN, et al., Supercial lightning injuries Their fractal shape and origin. Burns 1987; 13:141-146.
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