Kaloudova Y, Sin P, Rihova H., Brychta P, Suchanek I., Martincova A.

Burn Centre, University Hospital, Brno, Czech Republic

SUMMARY. Between 1999 and 2005, a total of 41 patients were hospitalized at the Burn Centre of Brno University Hospital with high voltage electrical injuries, representing 6.06 % of the total number of patients treated at the Burn Intensive Care Unit (ICU) for extensive burn trauma. The average age of patients with serious electrotraumas was 27.29 years. The youngest patient was 9 years old, the oldest 64 years. Lethality amounted to 17.07 % of the total number of patients. The article clearly shows the sinister dimension (a frighteningly high number of cases) of high voltage electrical injuries suffered outside work context in the vicinity of railway tracks and affecting in particular the youngest age groups - children.

Key words: high voltage electrical injuries, injury mechanism, patients' age, lethality

INTRODUCTION

The effects of high voltage electrical current on human organism consist first and foremost in a change of electrical energy into thermal energy in affected tissues with high resistance, and depolarisation of cell membranes accompanied by a host of possible consequences that may result in the death of the cells so affected.

The extent of damage depends on both. the voltage and type of current (alternating versus direct), as well as on the duration of exposure of the organism to the current, and the resistance of single tissues.

The creation of an electrical are between the conductor and the person (victim) in close proximity of the conductor is facilitated by the distance involved, as well as by greater humidity of the environment and the victim's clothing, etc. The extent of injury is thus determined by several factors present at the moment of the accident (Fig. 1).

MATERIAL AND METHOD

Between January 1, 1999 and December 31, 2005, a total of 41 patients were hospitalized at the Bum Centre of Brno University Hospital with high voltage electrical injuries, representing 6.06% of the total number of patients treated at the bum ICU for extensive (serious) burn trauma.

A total of 10 patients who suffered injuries in the proximity of high voltage conductors (power poles) was treated, one half of that were work accidents.

A total of 20 patients injured at the railways by electric arc from trolley wires were treated, only 3 accidents of that number were work-related.

There were 10 patients who suffered injuries in control roomstransformer stations, 6 of that were work accidents. Between January 1999 and the end of September 2005, we treated only one case of injury caused by lightning (Tab. 1). The principal statistical characteristics were defined for data concerning the basic group of patients treated between 1999 and 2005 at our Centre for high voltage electrical injuries (absolute frequency number of elements in the group, arithmetic mean and standard deviation, SD), depending on the injury mechanism.

RESULTS

The average age of patients injured in close proximity of highvoltage conductors (power poles) in case of work accidents was 28.40 years (SD = 4.18), and in case of accidents not related to work 16.80 years (SD = 5.27). Work accidents accounted for 5 canes, accidents not related to work also for 5 cases.

There was a total of 20 high voltage electrical injuries at the railways, 3 of those were work accidents, 17 were not related to work.

Patients with work accidents were of the average age of 45.67 years (standard deviation SD = 10.37). Injuries not related to work were suffered by patients who were 15.50 years old on average (SD = 4.34).

Work accidents in control rooms - transformer stations - ensued in 6 patients, average age of the patients was 42.67 years (SD = 12.79).

Accidents not related to work occured in 4, average age was 31.25 years (SD = 15.85).

The average age of patients in the entire high voltage electrical injury group was 27.29 years. The youngest patient was 9 years old, the oldest 64.

The group consisted of 39 men and only 2 women one was struck by lightning. the other one climbed a high-voltage pole in a suicidal attempt (Tab. 2).

Seven patients died due to serious electrotrauma, i.e., 17.07%0 of the total number of patients injured by highvoltage electrical current over the studied time period of the last seven years (Tab. 3).

The following study established guilt causing the accidents first for the entire group (23 cases of "at fault" accidents, 4 cases where the accident was caused by another person, 1 suicidal attempt, 2 cases suffered injury when committing a crime, and 11 cases where no fault was established) (Tab. 4).

In the group of work accidents, 4 were "at fault" accidents, in 5 cases, the accidents were caused by another person, and in 5 cases no exact mechanisms of the accidents were established (Tab. 5).

In Tab. 6 the average extent of soft tissue necrosis is shown, the number of mummified upper and lower limbs or their parts (and the ensuing number of necessary amputations and exarticulations of limbs in the group of our patients with serious clectrotraumas in 1999-2005).

The average duration of hospitalization in our group was 62.31 days (SD = 32.69 days) - for the purpose of the calculation. seven patients who died due to electrotrauma were excluded.

DISCUSSION

In total. 8695 patients (children and adults-outpatients and hospitalized patients together) were treated at our Centre from 2001 to 2005.

Of them, 470 (5.41%) were qualified as serious cases. Electrical current was the cause of accident in 46 patients (0.53%). High-voltage current caused burns in 27 patients (0.31%). In the 19808 and the 1990s electrical burns represented 3-4°/r of all burns (4.0% (1), 3.890 (5), 3.4°k (6) resp.).

Decreasing number of electrical burns is the wend also described in other developed countries (2), nevertheless, the ratio 0.53%r of all burns was quite surprising for us. There is a question if some low-voltage traumas were treated at local hospitals in our region. No doubt. the improved prevention (technical security, increased awareness of people) contributes to decreased numbers of all electrical burns, however number of serious, non joh-related highvoltage traumas still remains very high. Youngsters and children should be systematically infonned at schools about risks of electrical burns (caused particularly by highvoltage power lines) as they are usually less informed and more reckless than the adults.

CONCLUSION

High-voltage electrical current accidents are a problem affecting the entire society. They often result in the injured person's death or permanent disability.

These serious accidents frequently tend to be caused by negligence and lack of awareness (in particular where children are concerned).

On the one hand, the figures obtained correspond to the expectations or notions of our team; on the other hand, they arc surprising even for us. In any case, they clearly showed the stunning magnitude (a frighteningly high number of cases) of high-voltage electrical current accidents not related to work and suffered at the railways. This phenomenon is particularly alarming when we realize that these accidents evidently affect the youngest age groups, and moreover, with fatal outcome.

The Table showing the number of work accidents and accident mechanisms in individual years reveals that in our group, the number of work accidents at the railways dropped to zero since 2000.

A reduction of the number of electrotraumas would undoubtedly be facilitated by an increase in technical safety tncasures and more stringent security of the various facilities. railway depots and yards.

We stress that greater prevention concerning electrical injuries has to be held, in particular among children at schools.

REFERENCES

1. Achauer, BM. Management of the Burned Patient. Norwalk: Appleton & Lange, 1987, p. 4-9.
2. Bruck, JC., Muller, PE.. Steen, M. Handbuch der Verbrermungstherapie. Landsberg: Ecomed, 2002, p.27-33.
3. Burke, JF., Boyd, RJ., Mc Cape, CHJ. Trauma Management. Chicago: Year Book Medical Publishers, 1988, p. 208-226.
4. Konigova. R. ct at. Komplexnì lecba popalenin Praha: Grada, 1999.
5. Konigova R. et al. Rozsahlé popaleninove trauma. Praha: Avicenum, 1990.
6. Simko, S., Koller, J. et al. Popaleniny. Martin: OSVETA, 1992.

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