A 30-year-old construction worker was working on a fire escape in a building being renovated. Another worker handed the victim a metal pipe, and he was holding it with both hands when it contacted a nearby high voltage line, completing a path-to-ground. The worker instantly collapsed from this contact with electrical energy. Approximately 4 minutes after he collapsed, the fire department rescue squad arrived and began CPR. Within 6 minutes, a paramedic unit was on the scene providing defibrillation and other ACLS measures. They were able to establish a heartbeat and pulse, but the individual continued to require respiratory support during transport to the hospital. He regained consciousness and was discharged within two weeks. He did have to return for further medical care for burns he received on his hands (current entrance) and buttocks (current exit) [6]. (NIOSH Pub. No. 87-103)

Conclusion: In Case #1, basic life support was begun within 4 minutes by the fire department rescue squad who happened to be stationed nearby. They were experienced and had up-to-date knowledge in CPR techniques. In this case, CPR was begun within the 4-minute recommendation. An ambulance, equipped and staffed to provide ACLS, arrived within 6 minutes. The standards and guidelines [5] for CPR within 4 minutes, and ACLS within 8 minutes, were met and the worker did survive. 

An 18-year-old male restaurant worker contacted electrical energy when he kneeled to plug a portable electric toaster into a 100-120 V/20 amp floor outlet. After a scream was heard, the victim was found convulsing on the damp floor, with one hand on the plug and the other on the receptacle box. The assistant manager went to the electrical panel, but was unable to locate the appropriate circuit breaker. A coworker attempting to take the victim's pulse received an electrical shock, but was not injured. After telephoning the emergency medical service, the assistant manager returned to the panel and de-energized all of the circuits (3 to 8 minutes after the worker contacted electrical energy). The injured worker was covered with a coat to "keep him warm." After about 5 minutes, another call was placed to the emergency squad, and the assistant manager "yelled" for an off-duty employee who lived in an apartment across the lot, who came and began CPR. The emergency service was on the scene 10 minutes after receiving the first call. ACLS measures were available but the resuscitation was unsuccessful and the worker was pronounced "dead on arrival" at the local hospital. The exact time span between the worker contacting electrical energy and the beginning of CPR is unknown, but it is reasonable to assume that it was longer than 4 to 6 minutes. Paramedics with ACLS capability arrived 10 minutes after receiving the call, but more than 10 minutes after the accident occurred [7]. (NIOSH Pub. No. 87-103)

Conclusion: In Case #2, the worker's contact with electrical energy was prolonged and a coworker who aided him received an electrical shock, because coworkers did not know how to de-energize the circuit. The optimal times for CPR and ACLS were exceeded, and the resuscitation was unsuccessful. Providing appropriate medical care after an electrical energy incident will not guarantee success. However, it has been reported elsewhere [5] and supported in the NIOSH case reports, the chance for successful resuscitation after cardiopulmonary arrest is best when the criteria for providing emergency medical care are met. 

This case study looks into various options and situation in dealing with older adults and Do Not Resuscitate orders. Should a health provider/rescuer preform CPR? Click here for full case study. (Case study on pages 1-5)