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Like peeling away the layers of an onion, research into electrical injuries is revealing more all
the time. In work spearheaded by the Chicago Electrical Trauma Research Institute (CETRI),
researchers are finding that electrical shock can be as much a stealthy, progressive disrupter
to the body as a silent immediate killer. Chicago-area physicians, therapists, and scientists
working under the CETRI umbrella are growing more convinced every day that electrical
shock causes much more than devastating burns and other physical injuries. As this article
shows, theyre finding it can also trigger a chain of events that leads to potentially disabling
changes in mood, personality, emotions, and cognitive functioning.
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Like peeling away the layers of an onion, research into electrical injuries is revealing
more all the time. Its enough to bring a tear to the eye when the full extent of the
potential damage to unfortunate victims most from the workplace is completely
grasped.
In work spearheaded by the Chicago Electrical Trauma Research Institute (CETRI), a
group that coalesced in 2009 to centralize more than two decades of scattered but
intensive research into electrical injury and its treatment, researchers are finding
that electrical shock can be as much a stealthy, progressive disrupter to the body as a
silent immediate killer.
Chicago-area physicians, therapists, and scientists working under the CETRI
umbrella are growing more convinced every day that electrical shock causes much
more than devastating burns and other physical injuries (see Rare but Deadly).
Theyre finding it can trigger a chain of events that leads to potentially disabling
changes in mood, personality, emotions, and cognitive functioning.
Most of us are well aware of the physical effects of an electrical shock, such as this heat injury.
But the good news, as CETRIs work and research is revealing, is that the prognosis
for recovery is good and improving. Addressed early in the treatment process, these
non-physical injuries can be mitigated to the point where the victim can function in
daily life. The key is timely, aggressive, and focused therapy.
Armed with an expanding view into the full range of damage electric shock can
produce, a core of about a dozen affiliated clinical investigators is helping
CETRI pioneer new treatment strategies. In addition to treating the injurys physical
toll, the CETRI regimen is incorporating an expanding focus on its less understood
mind/body component. In the course of pursuing new avenues of treatment for the
patients who come through a comprehensive treatment and rehabilitation program
that feeds its research efforts, the institutes work is becoming a model for other
caregivers to purse a more comprehensive, multi-faceted approach to diagnosis and
treatment.
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Were banging the drum about electrical injury not being just a physical injury,
says CETRIs Assistant Director Kristina Adams, Ph.D. Were out doing seminars at
meetings of groups like the Construction Safety Council, trying to take any and every
opportunity we get to help everyone better understand electrical injury and know
what to look for.
to be around other people, some become very tearful or upset, or cant tolerate stress.
And the change the level of disruption is traumatic. These are people who
havent been utilizers of psychiatric services now going through significant
psychiatric changes.
And the problems often dont end there. Research has also found that some victims
are prone to developing cognitive deficits. They seem to develop over a course of
several years following the incident and likely spring from emotional changes. While
generally not disabling, problems with memory and task completion are nevertheless
disruptive.
What happens, in studies where we compare these victims with others of their same
age, they think more slowly and have a more difficult time paying attention, says
Pliskin. Things that were once automatic are no longer automatic for some of these
people. What they say is, its not that I cant do things, its just that I have to work so
much harder to be able to do the things I could do before.
Thats left investigators searching for other possible causes. One theory is that its not
physical; its that victims are wrestling with the unique emotional trauma of having
been shocked. Memories of the incident, the suddenness and randomness of the
event, along with the powerful realization that they could have died, might
overwhelm victims. Left to linger without treatment, those symptoms can worsen
and result in an experience approximating post-traumatic stress disorder.
This can be very complex, an element of this thats tied up in the circumstances of
what happened and the nature of the injury, says Pliskin.
A re-set theory
Then theres the notion that something more inexplicable is at work. Some point to
the still-common practice of using electro-convulsive shock therapy (ECT) to treat
the hardest-to-treat depressive patients. While the exact mode of action in ECT was
never reliably established, use of ECT does lead to mood changes, leading
researchers to draw parallels. Essentially, the same thinking that led psychiatry to
ECT at one time could provide at least some clue to whats happening with shock
survivors.
Im not equating the two, but the concept of being advertently exposed to an
electrical field and that having an impact on functional brain systems so that it
changes someones ability to regulate their emotions its just not that far-fetched,
says Pliskin.
Another theory invokes the mind/body connection concept. It holds that the
electrical shock itself, independent of any serious tissue burn, fundamentally
damages the bodys muscle and peripheral nerve complex and that the trauma gets
coded into the central nervous system. The resulting pain, sensory changes, and
effect on motor functions lead to physical changes in the brains circuitry that can
produce changes in mood, behavior, and cognition.
The idea has a basis in the study of pain treatment and therapy, says Raphael Lee,
M.D., professor of surgery and medicine at the University of Chicago, whose
pioneering work in electrical injuries set the stage for the eventual establishment of
CETRI.
Pain management specialists, he says, are convinced that peripheral nerve injury can
lead to changes in the brain. That leads to changes not only in the experience of pain,
but also emotional and cognitive expression. The fact that so many electrical shock
victims exhibit these problems even in cases where serious burns arent involved
leads researchers to conclude that the shock itself can actually damage nerves.
Someone gets a brief electrical shock, there can be substantial damage to peripheral
nerves and muscle that is not caused by generalized heating, where severe tissue
injury would be expected to cause nerve damage, says Lee. Exactly how it happens
that electrical forces themselves could, in a brief moment, cause significant injury to
muscles and nerves, is not clear. That was a controversial idea at one time, but today
that controversy is gone.
Forestalling decline
That can be critically important, given the high stakes for the victim, their families,
and their gainful employment. The average age of a patient who goes through the
CETRI program is 35, Adams says, which means many more working years where
theyll need their full physical and mental faculties to thrive.
Plus, victims not fully treated likely wont be as productive. And employers, many
still largely unaware of the full nature and complexity of electrical injuries, may lack
the skills and patience to deal with chronically afflicted workers. In addition,
treatment delays or detours due to inaccurate or incomplete diagnoses will also add
costs and extend the recovery period.
Given what researchers now know, Lee concludes, electrical injury generally
warrants aggressive, thoughtful, and
comprehensive treatment. That marks a departure from the long-held belief that
victims of shock and other physical trauma that dont show visible injuries can
simply get up, dust themselves off, and get back to work.
Electric injury in the workplace is a common cause of long-term disability, and one
of the most common outcomes of individuals who have a disabling problem is that
they become disabled in a permanent sense, he says. So Im convinced that early
intervention, early aggressive monitoring, and rehabilitation approaches are
helpful.
Zind is a freelance writer based in Lees Summit, Mo. He can be reached
attomzind@att.net.
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Nonfatal electrical injuries as a percentage of the total for the two largest categories of electrical accidents
remained relatively unchanged from 1992-2010, even though the total number of nonfatal electrical
accidents declined by more than 60%.
Meanwhile, non-fatal injuries fell 60% in that 18-year span (Figure). Injuries were
highest in the construction and electric utility industries, where injury rates were 0.6
and 0.2 per 10,000 workers between 2003 and 2010. Contact with current from
machines, tools, appliances, etc., and contact with transformers, wiring, and similar
components caused the most injuries.
But what electrical injuries lack in incidence they make up for in consequence. The
Chicago Electrical Trauma Research Institute (CETRI) has compiled data that
measure the toll these injuries may be exacting.
Citing figures from the Electric Power Research Institute, Palo Alto, Calif. an
independent, non-profit organization that conducts research, development and
demonstrations for the electric utility industry CETRI says electrical injuries cost
to employers has been estimated at $15.75 million per case in direct and indirect
costs. It also cites data that puts the average cost of just treating burns from electrical
injury at about $14,000.
Another statistic cited by CETRI shows one-quarter to two-thirds of injuries caused
by contact with overhead power lines resulted in more than 31 days away from work.
The range for other occupational injuries and illnesses was between 18% and 20%.
The bigger costs, though, likely stem from treating the non-physical component of
the injuries the emotional and cognitive issues that often accompany the injuries.
That quest often involves heading down blind alleys and arranging consultations
with multiple specialists. CETRI cites one study in which 31 patients participated in
83 separate consultations, but 80% of those visits yielded no clinical diagnosis.
Statistics show non-physical problems are prevalent. CETRI says half of all victims
experience anxiety, and 25% endure chronic pain. In many victims, weight gain,
fatigue, depression, poor concentration, and post-traumatic stress disorder show up
one to six months after the event, and physical symptoms like numbness, tingling,
and weakness, can appear within two months.
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Electrical injury survivors may experience muscle weakness, fatigue, and have difficulties doing everyday
tasks. With the help of an occupational therapist, Ted does work conditioning exercises, such as lifting, to
help restore his strength, endurance, movement, and flexibility (Courtesy of Sunnybrook Health Sciences
Centre).
According to the experts at St. Johns, not all electrical injuries are created equal
each patient presents different symptoms at different times. They may experience
neurological symptoms such as numbness, weakness, memory problems, paresthesia
(paralysis of the tongue), fatigue, and chronic pain, as well as psychological
symptoms, such as anxiety, nightmares, insomnia, and flashbacks of the event.
Because these symptoms often arise unpredictably, electrical injury survivors are
often challenged or misunderstood by family, co-workers, insurers, and employers.
Ted (an assumed name) is one such survivor.
After 600V of electricity radiated throughout his body, Ted showed no visible signs
of trauma. He even continued to work for months following the accident until the
after-effects began to reveal themselves below the surface. Today, Teds recovery is
ongoing. He works with a multi-disciplinary team of nurses, physiotherapists,
occupational therapists, neuropsychologists, and other health professionals at St.
Johns Rehab to address needs specific to his condition. He suffers from severe posttraumatic stress disorder, with lack of sleep being one of the most problematic postaccident conditions. With the help of his customized rehabilitation program, his
attention, concentration, and memory have improved. His anxiety and depression
have also decreased, and he is finally able to get some sleep.
I was completely dysfunctional, says Ted. I started having nightmares every night.
I couldnt sleep. My muscles were weak, and I kept losing my balance. I still hear
ringing in my ears. St. Johns Rehab gave me my life back.