Electrical Injury/Medical Understanding
Most medical providers and experts know to look for the obvious signs of electrical injury. These include evidence of muscle and heart trauma—determined often by serum creatine kinase (CK) levels—and external burns. Because currents above 100 mA (potentially a fatal exposure level) leave marks where the skin contacts the electricity, providers may also further look for or notice electrical entry or exit wound points. Indeed, current levels near and above 10,000 mA can cause serious burns that require amputation of the affected limb.
However, medical science continues to lack awareness of, experience with, and understanding of electrical injuries and the wide, often unpredictable array of signs, symptoms, and multi-faceted injuries they involve. The vast majority of medical providers have never seen an electrical-injury patient. Those that have generally have only seen one or two patients. This widespread lack of electrical injury experience often leads medical providers to reach erroneous diagnoses, which include malingering and somatoform disorders.
Problems also exist when noted signs and symptoms are either thought to be the only injuries, or when these signs and symptoms are not present, leading to untreated injuries and misdiagnoses. For example, when external burns are visible, internal burns may exist too. However, patients are often misdiagnosed as having only minor external burns because of the visible tiny, charred spots on the skin. Even in clear electric shock and injury cases, doctors often miss the full extent of the damage on the erroneous belief that only high-voltage exposure cases result in serious long-term injuries, or the equally erroneous belief that physical injuries occur only along the electricity’s path between the entry and exit wounds.
Moreover, there is a rare class of electrical injury that was largely unknown until recently. In fact, most physicians will never see such a case in their careers. This class of electrical injury—known as Diffuse Electrical Injury (DEI), electric shock syndrome, and/or post electric shock syndrome—defies explanation by all prior theories. Still, we know with scientific certainty that it exists. The scientific literature from multiple researchers now recognizes that there is in fact a common set of symptoms among many who have suffered DEI.
DEI can easily confound medical providers. Because the classic electrical injury symptoms may be absent, the victim’s physiological and psychological response is often not proportional to the shock parameters, and the tissue response is not limited to the theoretical current pathway (i.e., the linear electrical path from entrance to exit). The manifestations of DEI are an assortment of path and non-path (i.e., remote) physical symptoms and neuropsychological sequelae. Such signs and symptoms may include generalized weakness, fatigue, broad diffuse pain, muscle aches, chronic pain, erectile dysfunction, personality changes, depression, anxiety, cognitive deficits, and short-term memory loss—to name a few. The fingerprint for DEI consists of these symptoms taken in the context of the occurrence and aftermath over time. Indeed, electrical injuries often cannot be diagnosed using modern diagnostic technology, such as blood chemistry or imaging.
While DEI’s mechanism is not fully understood, there are well-established scientific principles at play. For example, the current (amperage) causes electrical injury, and it takes voltage to drive the current though the body. Less voltage is required to move the current through a wet or sweaty body. If the skin is wet or the current is spread over a wide area, a person may have a massive shock with no indication that it ever occurred. In theory, a voltage as low as 25 volts could cause fibrillation. Indeed, we represented a longshoreman with catastrophic, permanent injuries with only a 54-volt shock.
In the human body, low resistance paths tend to be both the shortest paths and also the paths that include bulk tissues like muscle and high conductive tissues like fluids and nerves. Nerve injuries are a common primary response to an electric shock. Because nerves offer very little resistance to the passage of current, the central nervous system is particularly vulnerable to an electric shock. Long-term damage to the nerves and the brain will depend on the voltage, current, duration, and extent of the nerve injury. This type of damage is known to cause psychiatric disorders. Other disorders can appear too in the weeks or months following the shock, depending on which nerves and organs were harmed.