Burns and Scalds First Aid: Electrical Burns and Shock Basics

1) Why electrical injuries can be deeper than the skin suggests

Electrical injuries are often misleading because the visible burn on the skin may be small while the damage underneath can be significant. Electricity can travel through the body along paths of least resistance (such as nerves, blood vessels, and muscle), generating heat internally and disrupting normal electrical signals in the heart and nervous system.

• Small mark, big injury: A tiny “spot” on the hand may hide deeper muscle injury along the current’s path.
• Heart rhythm risk: Even without a large burn, current can interfere with the heart’s electrical system and cause dangerous rhythms.
• Muscle and nerve effects: Current can cause strong muscle contraction (sometimes throwing the person or locking them onto the source) and can injure nerves, leading to weakness, numbness, or confusion.

Because of these hidden risks, electrical injuries should be treated as potentially serious even when the skin looks only mildly affected.

2) Scene safety: disconnecting power without becoming a victim

Your first job is to avoid becoming part of the circuit. Do not rush in. Take 2–3 seconds to identify the power source and the environment (wet floor, metal surfaces, downed lines, damaged cords).

Step-by-step: low-voltage household sources (typical outlets/appliances)

1. Do not touch the person if they may still be in contact with electricity.
2. Shut off power at the source if you can do so safely: unplug the device, switch off the wall switch, or turn off the circuit breaker.
3. If you cannot shut off power quickly, separate the person from the source using a dry, non-conductive object (e.g., a dry wooden broom handle, plastic chair). Keep your hands away from any metal parts.
4. Stand on a dry, non-conductive surface if possible (dry rubber-soled shoes; avoid wet floors).
5. Once power is off and the person is free, move to assessment and calling for help.

High-voltage or uncertain sources (downed lines, substations, rail systems, industrial equipment)

• Do not approach. High voltage can arc (jump) and can energize the ground around the source.
• Keep others back and call emergency services immediately.
• If a wire is down, stay far away and warn others; do not attempt rescue until professionals declare the area safe.

3) What to look for after the power is off

After the scene is safe, look for clues that electricity passed through the body and for signs of shock or internal injury.

Skin findings: entry and exit points

• Entry point: often on the hand or finger where contact occurred; may look like a small crater, pale/charred spot, or blistered area.
• Exit point: often on the foot or another contact point with ground/metal; can be larger or more damaged than the entry site.
• Multiple contact points: possible if the person touched more than one conductor.

Symptoms suggesting deeper injury

• Muscle pain or tenderness (especially in a limb the current traveled through), cramping, or weakness.
• Numbness/tingling or reduced sensation.
• Confusion, headache, dizziness, or memory gaps (including not remembering the event).
• Chest discomfort, palpitations, or unusual shortness of breath (possible heart rhythm involvement).
• Falls/trauma: electrical shock can cause a fall; look for head injury, neck/back pain, or limb deformity.

Quick check you can do without advanced training

• Level of responsiveness: are they alert, confused, or unresponsive?
• Breathing: normal, abnormal, or not breathing?
• Skin: very pale, sweaty, or bluish lips can signal a serious problem.

4) When to call emergency services immediately

Call emergency services right away if any of the following apply. Electrical injuries can deteriorate quickly, and heart rhythm problems may not be obvious at first.

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• Loss of consciousness at any time (even briefly).
• Abnormal breathing (gasping, very slow, very fast, or struggling) or not breathing.
• Chest pain, pressure, palpitations, or faintness.
• High-voltage exposure or any contact with downed power lines/industrial sources, or if voltage is unknown.
• Confusion, seizure, severe headache, or new weakness/numbness.
• Significant burns at entry/exit sites or burns on hands/feet (common contact points) that look deep, charred, or waxy.
• Pregnancy, implanted devices (e.g., pacemaker), or significant medical history where shock could be more dangerous.
• Associated trauma (fall from height, suspected head/neck/back injury).

If you are unsure, err on the side of calling. Provide: what happened, whether power is confirmed off, the person’s responsiveness and breathing, and whether there are chest symptoms.

5) Basic monitoring while waiting for help

Once emergency services are on the way (or while someone else calls), focus on simple, high-impact monitoring and comfort measures that do not require advanced skills.

Step-by-step monitoring checklist

1. Confirm the scene remains safe (no re-energizing, water hazards, exposed wires).
2. Check responsiveness: ask simple questions (name, location, what happened). Note confusion or worsening alertness.
3. Watch breathing continuously: look for chest rise, listen for abnormal sounds, and note any increasing effort.
4. Positioning: if the person is awake and breathing normally, keep them still and comfortable. If they become drowsy or vomit, place them on their side only if you can do so safely and there is no concern for spinal injury.
5. Limit movement: electrical injury plus a fall can mean hidden injuries; encourage them not to stand up suddenly.
6. Remove constricting items near a burn site if easy and safe (rings, watches) because swelling can develop—do not struggle if stuck.
7. Cover visible electrical burn sites lightly with a clean, dry dressing or cloth to protect from contamination while awaiting care.
8. Track changes: note the time of injury, any fainting, chest symptoms, and whether symptoms are improving or worsening.

If the person is not breathing or becomes unresponsive

Call emergency services (or have someone call) and follow dispatcher instructions. If you are trained, begin CPR and use an AED if available and the scene is safe. Electrical injuries can involve heart rhythm problems where early defibrillation is critical.

6) What not to do

• Do not touch the person until you are certain the power is disconnected and the area is safe.
• Do not use metal or wet objects to separate the person from the source.
• Do not approach downed power lines or assume a line is “dead.” Keep a wide distance and wait for professionals.
• Do not apply ointments, creams, butter, or home remedies to electrical burn sites; they can trap heat, contaminate the wound, and complicate medical evaluation.
• Do not break blisters or scrub burn marks; electrical burns may be small but medically important.
• Do not give food or drink if the person is nauseated, very drowsy, or may need urgent procedures.
• Do not dismiss symptoms because the skin looks “fine.” Confusion, chest symptoms, weakness, or significant pain after a shock warrants urgent evaluation.