JBUR-4061; No.

of Pages 5

burns xxx (2013) xxx–xxx

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/burns

Electrical injury in construction workers: A special

focus on injury with electrical power

Seyed Hamid Salehi a, Mohammad Javad Fatemi b, Kamran Aśadi b,*,

Saeed Shoar a,c, Anita Der Ghazarian a, Rogeieh Samimi a
a
Department of General Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
b
Department of Plastic and Reconstructive Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences,
Tehran, Iran
c
Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

article info abstract

Article history: Background: Electrical injury in construction workers due to contact with overhead power
Accepted 27 May 2013 lines accounts for an important cause of admission at the emergency department. Due to
lack of specific treatment options for this type of injury, prevention remains the mainstay of
Keywords: management.
Construction workers Aims: Our study aimed to demonstrate the characteristics of electrical injury in construc-
Electrical injury tion workers among one of the largest Iranian population at a burn care hospital.
Construction Methods: Through a retrospective review of hospital data base, patients with electrical
Overhead power line injuries admitted to Motahari hospital in Tehran, Iran between March 2011 and June
2012 were included for analysis. Patients were divided into construction workers and other
patients. Primary characteristics and final outcomes were then compared between the 2
study groups.
Results: Of 202 patients included in this study, 105 patients (52%) were construction workers
and 97 patients (48%) constituted the remainder. There was significant difference between
the 2 groups in terms of mean age, gender, and average burn size. In contrast, mean duration
of hospitalization and mortality rate did not differ significantly between the 2 study groups
( p > 0.05). Contacts with over head power-lines accounted for the most common mecha-
nism of injury. There was significant difference between the 2 groups in terms of place of
injury and electrical current power. However, total cost of treatment did not differ signifi-
cantly between the 2 groups ( p > 0.05). Frequency of severe complications was higher in
construction workers and this group underwent more invasive procedures such as limb
amputation and fasciotomy.
Conclusion: The most common mechanism of electrical injuries in construction workers is
due to contact with over head high voltage power-lines at workplace. This type of electrical
injury is associated with higher use of fasciotomy, flap and limb amputation.
# 2013 Elsevier Ltd and ISBI. All rights reserved.

* Corresponding author at: Department of Plastic and Reconstructive Surgery, Motahari Burn Hospital, Tehran University of Medical
Sciences, Rashid Yasami Street, Vali-e-Asr Avenue, Tehran, Iran. Tel.: +98 21 88772030; fax: +98 21 88770048.
E-mail addresses: asadi_km@yahoo.com, mahabibi@gmail.com (K. Aśadi).
0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved.
http://dx.doi.org/10.1016/j.burns.2013.05.019

Please cite this article in press as: Salehi SH, et al. Electrical injury in construction workers: A special focus on injury with electrical power. Burns
(2013), http://dx.doi.org/10.1016/j.burns.2013.05.019
JBUR-4061; No. of Pages 5
2 burns xxx (2013) xxx–xxx
1. Introduction
As a global health concern, electrical injury occurs due to
lack of safety in workplace [1–3]. Electrical injury can
involve the body from just a superficial skin burn to
systemic and multi-organ damage and death [1,4]. The
injury causes 20,000 emergency department (ED) admission
in the US each year [5] and is considered the most common
cause of job-related injury in both developing and high
income countries [5,6].
In 2004, they were 7.7% of the U.S. workforce [7], but
suffered 22.2% (1278) of the national 5764 reported work-
related deaths [8]. Electrical injury is among the most common
cause of occupational fatalities in construction workers [9–11].
Moreover, according to the data derived from the U.S. Labor
Department’s Bureau of Labor Statistics’ census of fatal
occupational injuries (CFOI), survey of occupational illnesses
and injuries (SOII), and current population survey (CPS),
contact with overhead power lines has been responsible in
42% of all on-the-job electrical deaths. The construction
industry accounted for 47% of all electrical deaths between
1992 and 2002 [12].
Along with advance in burn cares, trends have been
attracted to the preventive approaches as the mainstay of cure
for electrical burn injury [5,9,13]. The management of
electrical burn is associated with heavy barriers as there is
no specific treatment for it [3]. For this reason, the epidemiol-
ogy and characteristics of this type of injury should be
documented in construction workers, so further prevention
strategies could be implemented. To the best of our knowl-
edge, there are little studies investigating the causes and
characteristics of electrical injuries among construction
workers. Our study aimed to address this issue with specific
focus on electrical injuries due to overhead power lines in an
Iranian population of construction workers.
2. Methods and materials
2.1. Study design
In a retrospective cross-sectional study in Motahari Burn Care
Center, a university hospital affiliated to Tehran University of
Medical Sciences in Tehran, Iran, providing sub-specialized
tertiary care to the burn patients, medical profile of all the
admitted patients between March 2011 and June 2012 were
reviewed to extract data of patients with electrical injuries.
The institutional review board of our hospital approved the
study protocol.
2.2. Patient
All the admitted patients with documented electrical injury
were included in this study for analysis. Patients with
incomplete in-hospital treatment or lack of medical recording
were excluded from the study. Included patients were
classified into 2 groups according to their occupation and
location of injury. Construction workers constituted the main
group while the remainder electrically injured patients
Please cite this article in press as: Salehi SH, et al. Electrical injury in construction workers: A special focus on injury with electrical power. Burns
(2013), http://dx.doi.org/10.1016/j.burns.2013.05.019
employing with other jobs were assigned to another group
for comparison.
2.3. Construction worker
Construction occupation was defined as being employed as
bricklayer, roofer, carpenter steel fixer, ironworker, laborer,
painter, plasterer, plumber, tiller, welder, pipefitter, landscap-
er, heavy equipment operator, or being involved with boom
trucks, dump trucks cranes or hoisting equipment.
2.4. Cares and treatment
All the patients had received intensive care and trauma survey
at the first line visit by ED expertise physicians of our hospital.
Standard acute phase management including electrocar-
diographic monitoring, emergency surgical intervention (fas-
ciotomy) and fluid resuscitation were performed if indicated.
Following initial treatment and stabilization of general
condition, patients were admitted to the hospital wards for
further assessment and advanced medical or surgical care.
2.5. Data collection
All the medical records of Motahari hospital during the study
period were reviewed for eligible patients by 3 independent
data collectors. All the information was recorded in the study
data base. Information included socioeconomic and occupa-
tional characteristics of study patients, features of electrical
injuries, provided initial and advanced cares including trauma
management, inpatients rehabilitation and surgical proce-
dures, and cost of treatment.
2.6. Statistical analysis
Data were analyzed using statistical package for social science
(SPSS, 16, Chicago Inc., USA). Independent sample t-test for
quantitative continuous variables and chi square and Fischer
exact test for categorical variables were applied. Values are
presented as number (%) or mean  SD when appropriate and
a p value < 0.05 was considered statistically significant.
3. Results
Data of 202 patients with electrical injury were retrieved from
1-year records of the hospital data base. Of these, 105 patients
(52%) were classified as construction worker group and the
remainder 97 patients (48%) were classified in another group
(Fig. 1). Table 1 summarizes primary and demographic
characteristics of the study patients. As it is obvious from
the table, there is significant difference between the 2 groups
in terms of mean age, gender, and average burn size ( p < 0.05).
However, there was no significant difference between the 2
groups of patients for mean duration of hospitalization and
mortality rate ( p > 0.05).
Mechanisms of injury showed significant difference be-
tween the 2 study groups ( p < 0.05). Moreover, contacts with
over head power-lines accounted for the most common
mechanism of injury overall and in either of the groups
JBUR-4061; No. of Pages 5

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60.0 extremities was performed in 38% of the cases needing

amputation.
50.0 With regard to the type of injury and surgical procedure, a
statistically significant difference was observed between the 2
40.0
groups in terms of limb amputation, injury to the finger, and
number of flapping and fasciotomy ( p < 0.05). However, there
30.0
was no other significant difference for frequency of fracture,
20.0
laparotomy, skin graft, or head trauma ( p > 0.05) (Table 3).

10.0
4. Discussion
.0
Electric ulity
Construcon Municipal Industry
workers workers workers
industry
workers
Employee Housewife Unemployed Others
Our study showed that construction workers injured by
Workers 52.0 3.0 3.5 5.0 5.0 3.5 17.8 10.4 electrical power were all man and older compared to other
patients. Average burn size was significantly larger in
Fig. 1 – Distribution of patients’ occupation.
construction worker group. According to our data review,
over 92% of electrical injuries in construction workers were
due to contact with overhead electrical power lines with
electrical current over 1000 V. The injury had occurred in the
(Table 2). There was also significant difference between the 2 work place in all construction workers. However, there was no
groups in terms of place of injury and electrical current power statistically significant difference between construction work-
( p < 0.05). However, total cost of treatment did not differ ers and the remainder of electrically injured patients in terms
significantly between the 2 groups ( p > 0.05) (Table 2). of duration of hospitalization, mortality rate and treatment
The frequency of digit, upper or lower limbs amputations costs.
(proximal to the wrist or the ankle) was 23.2% among all the According to the report of Bureau of Labor Statistics (BLS) in
patients of which upper limbs amputations devotes predomi- 2000, the primary cause of construction electrocutions was
nantly a prevalence of 13.3% (Table 3). Amputation of 2 or more contact with overhead power lines [8]. In 2005, the BLS

Table 1 – Demographics characteristics of all electrical injuries and comparison between the constructions electrical
injured workers and other patients with electrical injury.
Overall patients’ characteristics Constructions workers (n = 105) Other patients (n = 97) p value
Mean age (29.7 years) 32.7 28.2 0.01
Gender <0.0001
Male (95%) 100% 89.7%
Female (5%) 0 10.3%
Nationality 0.09
Iranian (85.6%) 78.1% 93.8%
Foreigner (14.4%) 21.9% 6.2%
Mean burn size (15.1%) 13.9% 16.4% <0.0001
Mean duration of hospitalization (18.9 days) 19.2 17.5 0.9
Mortality rate (4.45%) 5.71% 3.09% 0.08

Table 2 – Comparison of mechanism of injury, place of occurrence, electrical current power, and cost of treatment between
the groups.
All the patients (n = 202) Constructions workers (n = 105) Other patients (n = 97) p value
Mechanism of injury <0.0001
Contacts with overhead power-line (84.7%) 92.3% 76.2%
Electrical wiring/light fixture (9.9%) 3.9% 16.5%
Appliances (0.99%) 0.9% 1.1%
Tolls, machines, transformers (4.5%) 2.9% 6.2%
Place of injury <0.0001
Work place (66.3%) 100% 29.9%
Home (14.9%) 0% 30.9%
Street (18.8%) 0% 39.2%
Electrical current power <0.0001
Over 1000 V (89.6%) 95.3% 83.6%
Lower 1000 V (10.4%) 4.7% 16.4%
Treatment cost (IRR/USD) (63,631,717/5190) 63,614,874/5188 63,649,950/5191 0.40
RR: Iran rial; USD: US dollar.

Please cite this article in press as: Salehi SH, et al. Electrical injury in construction workers: A special focus on injury with electrical power. Burns
(2013), http://dx.doi.org/10.1016/j.burns.2013.05.019
JBUR-4061; No. of Pages 5
4 burns xxx (2013) xxx–xxx
Table 3 – Comparison of types of injury and surgical procedures in each group.
Overall patients Constructions workers (n = 105)
Fasciotomy (16.8%)
Skin graft (64.8%)
Upper limbs amputation (13.3%)
Lower limbs amputation (2.9%)
Finger (12.8%)
Flap (27.2%)
Head injury (6.4%)
Fracture (1.9%)
Laparotomy (0.49%)
reported that 107 construction workers were fatally injured by
contact with electricity [7,8]. Of the 107 expired workers, 49
died because of contact with overhead power lines. According
to the National Institute for Occupational Safety and Health
(NIOSH), electrocution as a result of contact with overhead
power lines leads to an average of 128 work-related fatalities
per year [14]. In our study, overhead power line was also the
main cause of electrical injury in both the construction
workers and other patients. In the study by Hinze et al., nearly
60% of the accidents involved equipment. Cranes and boom
trucks were the most frequent equipment involved in power
line contacts. Most equipment contacts occurred in relation to
the boom or the load line. Carrying or handling metallic items,
especially aluminum ladders, are the cause of many non-
equipment related fatalities [13]. However, in our record, the
most common cause of electrical injuries in construction
workers were due to direct or indirect contact of carrying
metal objects (such as beams, bars, etc.) with energized
overhead power line.
McCann et al. in their study on electrical injury of
construction workers retrieved data of 1019 registered
electrical death between 1992 and 1998 and compared them
with 61 electrical injuries admitted to a university ED within
the same period [11]. Their study showed that among non-
electrical workers, contact with overhead power lines was the
major cause of death. Other studies have also confirmed that
low voltage current is responsible for majority of electrical
injuries [15,16]. In contrast to the published data, our results
represented high voltage electrical current (>1000 V) to be the
cause of injury in 95.3% of construction workers and 83.6% of
the remainder patients, respectively. This controversy may
arise from the fact that minor injuries with low voltage
electrical current may not be perceived significant by the
workers or by their employee leading to avoidance from
attending a hospital.
The average duration of hospitalization was slightly lower
in our study [18.9] compared to the literature documenting a
range of 0–60 days [1,4]. In this regard, construction workers in
our study although not significant, had experienced a longer
hospital stay than the remainder patients. Duration of hospital
stay may differ between studies with different population
(construction workers vs. ordinary people) and due to study
period and availability of advance and modern burn care [17].
Electrical injury is still a major risk factor for amputations
[18] and hence considered a disabling accident [19]. As per this
study result, construction workers underwent amputation
more frequently than the other patients which may result
from accidents due to higher voltage. Mortality rate due to
Please cite this article in press as: Salehi SH, et al. Electrical injury in construction workers: A special focus on injury with electrical power. Burns
(2013), http://dx.doi.org/10.1016/j.burns.2013.05.019
Other patients (n = 97) p value
18.0% 15.4% 0.01
63.8% 65.9% 0.47
15.2% 11.3% 0.02
3.8% 2.0% 0.04
20.9% 4.1% 0.05
31.4% 22.6% 0.04
8.5% 4.1% 0.68
1.9% 2.0% 0.60
0% 1.0% 0.27
electrical injury has been reported to vary between 3 and 25%
[11,16–18]. This variation may simply arise from severity of
injury, characteristics of electrical injury, and level of
specialized care that each patient receives. However, recent
studies have shown decreased electrical injury-related mor-
tality over time [6,9,16,17,19] probably as a result of advance in
modern burn and trauma care.
Direct injury-associated costs include payments for hospi-
tal, physician, and allied health services, rehabilitation,
nursing home care, home health care, medical equipment,
burial costs, insurance administrative costs for medical
claims, payments for mental health treatment, police, fire,
emergency transport, coroner services, and property damage.
Indirect costs refer to victim productivity losses including
wage losses and household production losses and adminis-
trative costs which include the cost of administering workers’
compensation wage replacement programs and sick leave.
Quality of life costs refer to value attributed to the pain and
suffering that victims and their families experience as a result
of the injury or illness [4,17,20]. Studies across industries
suggest that injury rates and cost rates are higher for
construction than for the average of all industries [20]. Direct
treatment cost in our study was calculated as 5190$ for each
patient with no significant difference between construction
workers and other patients. It should be noted that costs of
loosing job (wage lost), costs due to decreased quality of life,
and indirect costs of disabilities have not been accounted in
this estimation. A study from US estimated direct medical
costs, indirect losses in wage and household productivity due
to industrial injury [20]. The study revealed that the average
cost of injury in construction workers was $27,000 per case
[17].
Employees are responsible for a safe workplace for
construction workers and it is crucial that preventive strate-
gies to be planned before establishment of constructing
programs. Integrating safety into every aspect of the con-
struction process is the issue that should be noted at the first
step of implementing new strategies in work places. Con-
struction workers also need to follow precautions provided by
their supervising employee about workplace hazards. Lack of
knowledge to the potential hazards has been considered as the
most cause of injury in construction workers and training and
education are the tombstones to increase awareness about
electrical hazards in this population [23]. None of our patients
mentioned a previous education regarding safety in working
with electrical devices in construction places. Careful atten-
tion to occupational Safety regulations will reduce the
incidence of occupational injuries.
JBUR-4061; No. of Pages 5
burns xxx (2013) xxx–xxx
As this study emphasizes, more safety measures should be
considered so as to reduce the incidence of electrical burns.
These preventive precautions include De-energizing or cover-
ing the overhead power lines with electrical insulator, alerting
the workers regularly about workplace electrical hazards such
as overhead power lines, and keeping the safe distance from
the overhead power lines as working with elevated equipment
like cranes or work on the scaffold [21].
Due to the retrospective design of the current study, it was
not possible to investigate early or late outcomes including
time to return to work, permanently or severely disability,
patients’ quality of life, and long-term complications. Future
studies should focus on long term survival, patient’s quality of
life, and associated direct and indirect costs following
electrical injuries in construction workers. By this, benefits
of prevention strategies could be measured over its costs.
5. Conclusion
The most common mechanism of electrical injuries in
construction workers is due to contacts with over head high
voltage power-lines at workplace. This type of electrical injury
is associated with higher need to fasciotomy, flap and limb
amputation. Further studies are also needed to investigate the
cost-benefits of implementing preventive strategies.
Conflict of interest statement
The authors declare that they have no conflicts of interests.
references
[1] Arnoldo BD, Purdue GF, Kowalske K, Helm PA, Burris A,
Hunt JL. Electrical injuries: a 20-year review. J Burn Care
Rehabil 2004;25:479–84.
[2] Rai J, Jeschke MG, Barrow RE, Herndon DN. Electrical
injuries: a 30-year review. J Trauma 1999;
46:933–6.
[3] Leibovici D, Shemer J, Shapira SC. Electrical injuries:
current concepts. Injury 1995;26:623–7.
Please cite this article in press as: Salehi SH, et al. Electrical injury in construction workers: A special focus on injury with electrical power. Burns
(2013), http://dx.doi.org/10.1016/j.burns.2013.05.019
5
[4] Hussmann J, Kucan JO, Russell RC, Bradley T, Zamboni WA.
Electrical injuries – morbidity, outcome and treatment
rationale. Burns 1995;21:530–5.
[5] Mohammadi AA, Amini M, Mehrabani D, Kiani Z, Seddigh
A. A survey on 30 months electrical burns in Shiraz
University of Medical Sciences Burn Hospital. Burns
2008;34:111–3.
[6] Opara KO, Chukwuanukwu TO, Ogbonnaya IS, Nwadinigwe
CU. Pattern of severe electrical injuries in a Nigerian
regional burn centre. Niger J Clin Pract 2006;9:124–7.
[7] Employed persons by detailed industry, sex, race, and
Hispanic or Latino ethnicity, 2004 (household data annual
average, Table 18). Bureau of Labor Statistics; 2005.
[8] Census of fatal occupational injuries Summary, 2004.
Bureau of Labor Statistics; 2005.
[9] Janicak CA. Occupational fatalities due to electrocutions in
the construction industry. J Safety Res 2008;39:617–21.
[10] Ore T, Casini V. Electrical fatalities among U.S. construction
workers. J Occup Environ Med 1996;38:587–92.
[11] McCann M, Hunting KL, Murawski J, Chowdhury R, Welch
L. Causes of electrical deaths and injuries among
construction workers. Am J Ind Med 2003;43:398–406.
[12] Cawley J. Trends in electrical injury, 1992–2002. In: Petroleum
and Chemical Industry Conference, 2006 (PCIC ‘06’): IEEE
Industry Applications Society, 53rd Annual. 2006. p. 1–14.
[13] Singerman J, Gomez M, Fish JS. Long-term sequelae of low-
voltage electrical injury. J Burn Care Res 2008;29:773–7.
[14] National Institute for Occupational Safety and Health
(NIOSH).
[15] Buja Z, Arifi H, Hoxha E. Electrical burn injuries, an eight-
year review. Ann Burns Fire Disasters 2010;23:4–7.
[16] Haddad SY. Electrical burn – a four-year study. Ann Burns
Fire Disasters 2008;21:78–80.
[17] Mashreky SR, Rahman A, Khan TF, Rahman F.
Consequences of non-fatal electrical injury: findings of
community-based national survey in Bangladesh. Injury
2012;43:109–12.
[18] Dokov W. Assessment of risk factors for death in electrical
injury. Burns 2009;35:114–7.
[19] Vierhapper MF, Lumenta DB, Beck H, Keck M, Kamolz LP,
Frey M. Electrical injury: a long-term analysis with review
of regional differences. Ann Plast Surg 2011;66:43–6.
[20] Waehrer GM, Dong XS, Miller T, Haile E, Men Y. Costs of
occupational injuries in construction in the United States.
Accid Anal Prev 2007;39:1258–66.
[21] Homce GT, Cawley JC, Yenchek MR, Homce GT, Cawley JC,
Yenchek MR. A performance evaluation of two overhead
power line proximity warning devices. Information
circular; 9510 DHHS (NIOSH) publication; no 2009-1102008.