Electrical Burns — First Aid and Assessment

Electrical burns are among the most deceptive injuries in first aid. The visible wound on the skin may appear minor — a small entry mark where current entered the body and a corresponding exit wound — while the underlying tissue damage along the current pathway can be extensive. Cardiac arrhythmia, internal muscle and organ damage, and delayed complications make electrical burns a medical emergency regardless of how they appear externally.

Understanding how electrical burns differ from thermal burns, how to respond safely, and what to assess and communicate to emergency services can directly affect survival and outcome.

Why Electrical Burns Are Different

When electric current passes through the body:

Effect	What Happens
Entry and exit burns	Skin burns where current enters and exits the body
Internal pathway damage	Current passes through the path of least resistance — often blood vessels, nerves, and muscle — causing internal burns along the pathway
Cardiac effects	Current passing near or through the heart can cause ventricular fibrillation or other arrhythmias — even after the person appears to recover
Delayed complications	Muscle breakdown (rhabdomyolysis) from electrical damage releases proteins into the bloodstream, causing kidney failure hours after the injury
Neurological damage	Nerve damage along the current pathway
Falls and secondary trauma	Electrocution often causes the person to be thrown or fall

A person who has been electrocuted may walk away appearing unhurt and then collapse from cardiac arrhythmia minutes later. All electrocution events require emergency medical evaluation.

Step 1 — Scene Safety — Do Not Touch the Person Until Safe

The most critical first response principle:

⚠️ If the person is still in contact with the electrical source, touching them will electrocute you as well. Do not approach until you are certain the power is off.

Situation	Action
Person touching live appliance	Turn off at the switch, socket, or consumer unit
Person touching live wiring	Turn off at consumer unit (main switch)
Person in contact with high-voltage source (power line, transformer)	Do not approach; call 999; wait for network operator to de-energise
Power confirmed off	Approach safely and begin assessment

If you cannot confirm the power is off, do not approach. Use a non-conductive object (dry wooden broom handle, dry rope) to push the source away if and only if you are confident the current level is low (domestic supply only — never use this technique near high-voltage sources).

Step 2 — Call 999 Immediately

Any electrocution event requires emergency services:

When calling, report:

• That the person has been electrocuted
• The voltage if known (domestic 240V, or industrial/high voltage)
• Whether the person is conscious and breathing
• Any visible burns or trauma
• Your exact location

Do not end the call — the dispatcher will guide your assessment.

Step 3 — Assess and Manage

Once the scene is safe:

Consciousness and Breathing

1. Check responsiveness — call their name, tap their shoulders.
2. If unresponsive: check for breathing — look for chest rise, listen and feel for breath at mouth.
3. If not breathing: begin CPR immediately.
4. If breathing but unconscious: place in recovery position.

Cardiac arrest from electrocution responds well to CPR and defibrillation — early CPR and AED use significantly improves survival.

Burn Assessment

Wound Type	Appearance	Management
Entry wound	Small, often circular, charred or reddened, may appear trivial	Cover loosely with clean non-fluffy material
Exit wound	Often larger and more ragged than entry wound; may be on foot if person was standing	Cover loosely
Flash burns from arc	Superficial burns to exposed skin (face, hands) without a pathway through the body	Cool with cool running water; cover

Do not remove clothing or material stuck to burns — this causes additional damage; leave for medical professionals.

Do not apply creams, butter, toothpaste, or any substance to the burn — these trap heat and cause infection.

Cooling Electrical Burns

For skin surface burns:

1. Cool with cool running water for 20 minutes — this is the single most effective treatment for any burn
2. Water temperature: cool to lukewarm (not ice cold, not cold water from a tap that may be very cold)
3. Do not ice or use very cold water — can cause vasoconstriction and worsen the outcome
4. During cooling, call for help if not already done

Do not attempt to cool internal burns — this is beyond first aid capability.

Secondary Trauma Assessment

Electrocution often causes the person to be thrown from the source or to fall:

1. Check for head injury — loss of consciousness before or after the event
2. Check for spinal injury — if the person fell from height or was thrown; minimise movement
3. Check for fractures — the violent muscle contraction caused by electrocution can fracture bones, particularly the spine and long bones

If spinal injury is possible, keep the person as still as possible and inform emergency services on arrival.

What the Medical Team Needs to Know

When emergency services arrive:

• What the current source was (domestic, industrial, high voltage)
• Duration of contact (approximate)
• Whether the person lost consciousness
• Whether cardiac arrest occurred and if CPR was performed
• Location of visible burns (helps identify the current pathway)

After Emergency Treatment

Electrical injury patients require observation for:

• Cardiac arrhythmia monitoring (24–48 hours)
• Kidney function tests (rhabdomyolysis assessment)
• Neurological assessment
• Follow-up for delayed complications (weeks to months)

Even patients who appear completely recovered after assessment may develop delayed symptoms. Electrical injury is a systemic injury, not just a skin injury.

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Quick Reference

Step	Action
Scene safety	Confirm power off before touching
High voltage (power line)	Do not approach; call 999; wait
Call emergency services	Always — every electrocution event
Cardiac arrest	CPR immediately; use AED if available
Skin burns	Cool with running water 20 minutes
Do not apply	Creams, butter, ice
Secondary trauma	Check for fall injuries; consider spinal precautions
All electrocution events	Require emergency medical evaluation regardless of appearance