Professional Documents
Culture Documents
2
Mark W. Kroll and Dorin Panescu
J.D. Ho et al. (eds.), Atlas of Conducted Electrical Weapon Wounds and Forensic Analysis, 25
DOI 10.1007/978-1-4614-3543-3_2, © Springer Science+Business Media New York 2012
26 M.W. Kroll and D. Panescu
Current
Household and industrial electrical power is AC While RMS current is used for utility power
(alternating current) with a frequency of 50 or safety standards, RMS current is fundamentally a
60 Hz. At any point in time, the instantaneous predictor of heating capability. The most com-
current is given by the blue line in Fig. 2.2. mon misunderstanding of nonspecialists—in
Consider the example of a 120 W bulb being bioelectricity—is that RMS current somehow
powered by a 120 V hospital outlet. The instanta- predicts tissue stimulation capability [10, 11].
neous current through the bulb varies from −1.4 A current composed of rapid very short pulses
to +1.4 A. Thus, the average current is 0! To can have high RMS currents but be poor stimula-
arrive at a simple single number to replace this tors due to the small electrical charge carried in the
“average” current, the RMS current is calculated. short pulses. For this reason, specialized
28 M.W. Kroll and D. Panescu
−0.5
−1
−1.5
calculations were developed for ascertaining the decades, the volt was set at 98% of the voltage of
safety of electric fences [12, 13]. However, even a mercury-cadmium cell, known as the Weston
these calculations do not appear to be quantitatively cell. The standard is now based on a solid-state
supported by any identified published studies. circuit, based on the Josephson effect.
This gap has been recently filled with the The other function of voltage (when high
identification of the aggregate current [14]. Over enough) is to cause the breakdown of insulators.
the range of pulse rates of 10–30 PPS, the capa- With rounded electrodes, air typically breaks down
bility of rapid short pulses to induce ventricular with a voltage difference of 30 kV/cm. (This gra-
fibrillation is given by the aggregate current, dient of voltage is referred to as the “electric field”
which is the pulse charge multiplied by the pulse and is analogous to an arterial pressure gradient of
rate [14]. For example, the aggregate current of mmHg/cm.) With sharp electrodes, air breaks
the popular TASER® X26 CEW is: down at about 15 kV/cm, and this can be observed
with an “arc” test of a CEW. This is also why light-
1.9 mA = 100 m C·19 PPS ning rods are pointed. See Fig. 2.3 for a simple
analogy with a high-pressure “squirt gun.”
The ability of rapid short pulses to induce VF is
approximately equal to a 60-Hz AC current with an
RMS current of 7.4 times the aggregate current of Resistance
the rapid short pulses [14]. For example, the aggre-
gate current of the popular TASER® X26 of 1.9 mA Electrical resistance is simply the resistance to
can be compared to an AC source of 14.1 mA RMS. the flow of current. If a circuit has a resistance of
That is less than the long-application VF safety 1 W, then for each 1 A of desired current, a pres-
level of 35 mA of international standards [15]. sure of 1 V is required. As another example, the
human body resistance is typically estimated at
1 kW (1,000 W) from hand to foot. Thus, if some-
Voltage one barefoot in wet concrete touches a 220 V
line, the current passed through the body will be
Voltage is merely the pressure pushing a current about 220 mA (= 220 V ÷ 1,000 W). This
through its path. Since the original voltage definition is often referred to by the grandiose
sources were batteries, the definition of the “volt” term of “Ohm’s law.”
was that of a standard battery (technically a sin- Electrical resistance is highly analogous to
gle cell which does not a battery make). For the fluid resistance of arteries. The higher the
2 Physics of Electrical Injury 29
Current Power = I 2 R
(flow)
Energy
Fig. 2.4 The flow (current) is proportional to the voltage
(pressure) and inversely proportional to the resistance
The product of power and time duration gives the
energy in joules:
or
3,600 s, 1 kWh is equal to 3,600 kJ (3.6 MJ). The tissue. The unit of bulk resistivity is the “ohm·cm”
joule is about one fourth of a physics calorie or and this allows for the calculation of an arbitrary
about 1/4,000 of a food calorie. sized sample of the tissue. Note that the unit is
“ohm·cm” and not “ohms per cm.” Rather, it is
ohm multiplied by cm.
Summary of Electrical Units Example:
Blood has a bulk resistivity of about 150 W
The electrical units are summarized in Table 2.3. ·cm. What is the electrical resistance of a 20 cm
Note that the unit terms are all lower cased. Since section of the aorta with a 2 cm2 cross-sectional
all electrical unit terms are eponymous, it is some- area?
times tempting to capitalize these terms. For rea-
sons unknown to these authors, the predilection Resistance = Bulk resistivity(W cm)
for capitalizing electrical units is more commonly ( )
·length (cm )¸ cross - sectional area cm 2
seen with the coulomb and joule but almost never 2
= 150 W cm · 20 cm ¸ 2 cm
seen with the volt or watt. Another common error
is the assumption that “amp” is the abbreviation = 1,500 W
for “ampere.” “Amp” is technically the abbrevia-
tion for “amplifier” while “A” is the abbreviation The electrical injury literature often has
for “ampere.” comments that electrical currents are carried by
The presence of these errors in reports is a the blood vessels. This is clearly a very mis-
sure sign of a superficial knowledge of electricity leading statement as the 1,500 W resistance cal-
and should be avoided. culated above is very high compared to the
typical 75 W thoracic impedance seen with
defibrillation [16]. This misconception may
The Body as a Resistor derive from a confusion of resistance with
resistivity.
Resistivity Versus Resistance
160
140
Resistivity (Ω•cm)
120
100
80
60
40
20
0
0 10 20 30 40 50 60
Hematocrit percent
Dermis and Fat that red cells actually carry current.) The resistiv-
ity of blood varies in a direct affine relationship
The dermis and fat are the easiest tissues to clas- with the hematocrit level as seen in Fig. 2.8 [20].
sify electrically. The resistivity is minimally Hence, the blood of females is a better conductor
affected by various factors that change other tis- than the blood of males.
sue resistivities. A typical value for the dermis At higher frequencies (such as those seen with
resistivity is 500 W . cm while that of fat is around RF ablation), there is capacitive coupling across
2,200 W . cm [17]. the red cells; the hematocrit no longer affects the
resistivity and the resistivity drops to near that of
physiological saline [17, 20, 21].
Lungs Even though blood is a good conductor, it is
generally irrelevant to electrical injury as the
A nonedematous and inflated lung has a fairly large vessels are centrally located and the skel-
high resistivity. Obviously, the inspired air is not etal muscle and dermis end up carrying the
a conductor and electrical current is essentially current. In addition, the largest blood vessel
carried by the blood from the pulmonary and sys- (inferior vena cava) runs vertically so it could
temic circulation. Typical values are 1,100 W · not carry current from side to side or front to
cm [17]. At exhalation, the resistivity drops by back anyway. Urine and amniotic fluid are bet-
about 20–30% [18, 19]. ter conductors than blood but generally not rel-
evant to electrical injury.
Blood
Bone
Blood is the best significant electrical conductor in
the body. A typical resistivity value is 150 W · cm Bone is generally the best electrical insulator in
[20]. The resistivity of blood is about 2× that of the body with a high resistivity of around 10,000
normal physiological saline (70 W · cm) as the red W · cm. This varies with age as cartilage is a bet-
cells are insulators. (Ironically, some have stated ter conductor than hardened bone [21].
34 M.W. Kroll and D. Panescu
Tissue Injury field was high enough (1,600 V/cm) for permanent
electroporation and the tissue bulk resistivity was
There are two ways that an electrical current can 500 W · cm, then the current density would be 3.2
injure tissue. The first is electroporation and the A/cm2 by using the bulk version of Ohm’s law.
second is thermal. The power density would then be:
Electrode
Epidermis
Dermis
700
500
400
300
200
100
80
60
Time(s)
40
30
20
10
8
6
4
3
2
Fig. 2.10 The time to
epidermal necrosis varies 0 0.1 0.2 0.3 0.4 0.5 0.6
inversely with the exponent of
the current density Current density (A/cm2)
2 Physics of Electrical Injury 37
2
60 Power = 41, 040 W = (2 A ) · 10, 260 W
0 0.1 0.2 0.3 0.4 0.5 0.6
Current density (A/cm2) However, that is the total power delivered to
the body. The power delivered to the stratum cor-
Fig. 2.11 The peak skin temperature actually increases neum is given by:
with lower current densities
2
Power = 40, 000 W = (2 A ) · 10 k W
2,500
Arcing and Polarity
0 In an arc, electrons carry charge from the cathode
0 0.1 0.2 0.3 0.4 0.5 0.6
Current density (A/cm2) (−) to the anode (+) while positive ions carry charge
in the opposite direction [49]. Since the electrons
Fig. 2.12 The energy required for necrosis decreases move so rapidly, they arrive at the anode before the
with current density
positive ions arrive at the cathode. This implies that
the initial, transient current density is highest at the
point, on the cathode, where the arc initiated and
launched the electrons as seen in Fig. 2.13 [50].
Consider a case in which a CEW probe is Note that this effect is very short lived (~10 ms) so
embedded in a subject’s leg and the other is it is more relevant to short-pulse devices such as the
embedded in a leather jacket arcing to dry skin TASER M26 CEW (40 ms pulse) than the Stinger
over the pectoralis major. At the initiation of the ST-200 CEW (350 ms pulse).
current flow, the total resistance is about 10,260 Consider a CEW arcing discharge where the
W. This is broken down as: anode has a good contact with the skin and the
38 M.W. Kroll and D. Panescu
Single Pulse
Current (mA)
IEC
UL
102
10
10−4 10−3 10−2 10−1 1 10
Duration (s)
typical CEW pulse, it does not appear possible to in his authoritative text “Applied Bioelectricity,”
induce VF with a T-shock even with a probe compiled all known studies on the effects of time
touching or inserted into the heart. The direct duration on the direct electrical induction of VF
induction of asystole, by a lighting strike landing [49]. The VFT goes down, with increasing dura-
outside of the T-wave, is not relevant here and will tions, until the exposure duration reaches 1–5 s.
not be discussed further. This is reflected in recognized standards, as shown
in Fig. 2.14. In other words, if an electrical current
does not fibrillate within about 5 s, it will not
Multiple Pulses fibrillate with longer durations (except as shown
below by the third mechanism of extended high-
Sufficiently strong repetitive external currents rate capture and ischemically lowered VFT).
will capture epicardial cells. According to the The ability of rapid short pulses to induce VF
multiple wavelet hypothesis of VF, formation of is approximately equal to a 60-Hz AC current
new wavelets occurs through the process of with RMS current of 7.4 times the aggregate cur-
wave break (or wave splitting), in which a wave- rent of the rapid short pulses [14]. For example,
let breaks into new (daughter) wavelets. Wave the aggregate current of the popular TASER®
break occurs at sites of electrophysiological X26 of 1.9 mA (= 100 mC · 19 PPS) can be com-
inhomogeneity, where regions of refractoriness pared to an AC source of 14.1 mA RMS. That is
provide opportunities for reentry to form. less than the long-application VF safety level of
Epicardial cells are intrinsically heterogeneous 35 mA of international standards and the 20-mA
in their repolarization properties [62]. This UL standard.
intrinsic heterogeneity provides a substrate for
reentry formation during rapid (~450 BPM)
capture. When a portion of the incoming wave Long-Term Cardiac Capture
front encounters refractory tissue while other
portions continue to propagate, wave break Current densities of about 40% of the threshold
occurs leading to VF. for the direct induction of VF will lead to VF
The VFT (VF threshold) is the amount of cur- after 90 s [63]. These current densities are well
rent required to induce VF in a particular subject above the threshold for continuous hypotensive
with a particular connection configuration. Reilly, capture [64, 65]. Cardiac capture at rates of >220
40 M.W. Kroll and D. Panescu
100
Ischemia
modulated
electrocution
50
Nimunkar
Roy
0
0 5 60 90 150 300
Duration (s)
BPM, in swine, can eventually lead to VF. The important to note—and clearly shown by Scott—
required durations for this are on the order of that there is no known mechanism for VF induc-
minutes rather than seconds. tion taking 5–60 s [66]. In fact, the same is true for
Prolonged rapid capture reduces cardiac out- durations between 5 and 80 s by our CEW swine
put at the same time that the heart muscle contin- data [63]. The Nimunkar swine results, based on a
ues to need blood. This causes ischemia sufficient 17 mm dart-to-heart spacing, reflect lower current
to lower the VFT in about 90 s in swine. In the densities and required a median 150 s to induce
presence of ischemia, the VFT is cut to about VF [67]. Finally, Roy showed that a cardiac arrest
40% (of the direct-induction VFT) in large mam- would always occur within 300 s with hypoten-
mals. This method of VF induction is compared sive capture in canines [68].
to the others in Table 2.5.
Figure 2.15 shows the three distinct time scales
for the induction of VF by electrical current. The VF Risk from a CEW
T-shock induction occurs instantly and is shown
by the vertical line at 0 s. Direct (multiple pulse) The possible risk of VF induction by a CEW is
induction of VF occurs typically in 0.1–5 s with obviously of concern. Several animal studies have
the current required decreasing rapidly. Long- examined the required spacing from the tip of a
duration high-rate capture (with current densities CEW probe tip to the epicardium required to
close to the VFT) leads to an ischemically reduced induce VF in swine [31, 69, 70]. These data were
VFT after ~90 s, or longer, of rapid pacing. It is fit by logistic regression and are shown in Fig. 2.16
2 Physics of Electrical Injury 41
Probability of VF in swine
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0 2 4 6 8 10 12 14 16 18 20
Dart-to-heart distance (mm)
[71]. The median “dart-to-heart” distance was infarction [75–78]. This is also not expected from
6 mm in order to induce VF. Since swine are more a CEW application as VT induction generally
susceptible to VF than are humans, this corre- requires specialized pulse timings [75].
sponds to a distance of 4 mm in humans [71].
The VF risk, for a typical field application, has
been modeled by extending swine VF studies Asystole Versus VF
into humans by means of finite-element human
thoracic models [69, 72]. The early models sug- There are many challenges in deriving epidemio-
gested a risk of 6 PPM (or a probability of 6 VF logical estimates of the VF risk from electrical
inductions per million applications). This calcu- devices. One problem is that VF will eventually
lation was based largely on female thoracic deteriorate into asystole even though asystole is
echocardiography studies. When refined for male not a rhythm that is electrically inducible. Massive
subjects, and corrected for the increased suscep- electrical insults such as lightning exposure can
tibility of swine to VF induction, this risk was lead to asystole (see Table 2.2) due to central ner-
lowered to less than 0.4 PPM [71]. vous system damage but that is not relevant to
this discussion. Asystole is also the first arrhyth-
mia in about one-third of spontaneous cardiac
Nonfibrillation Rhythms arrests [79, 80].
Animal studies by Robertson (swine) and
Ventricular Tachycardia Worley (canine) showed that VF never deterio-
rated into asystole in 20-min studies [81, 82].
A rapid unstable VT (ventricular tachycardia) is The literature has few human cases of VF dete-
occasionally but not commonly induced from riorating to asystole. There are seven well-docu-
steady electrical stimulation. Even in that case, mented cases in five sources [83–87]. The times of
an unstable VT will degenerate into VF within VF deteriorating to asystole were 13, 16, 18, 20, 21,
34 ± 7 s in humans [73]. An unstable VT has such and 42 min. The 42-min case was the only one for
a rapid rate that it almost always leads to immedi- electrically induced VF and is consistent with the
ate syncope [73, 74]. animal results showing no deterioration (to asys-
A stable VT cannot be induced absent tole) during 20 min of VF [81, 82]. The logarithm of
significant scarring from a previous myocardial the deterioration times was well fit by a normal
42 M.W. Kroll and D. Panescu
0.8
0.7
Probaility of asystole
0.6
Log-normal fit
0.5
Cases
0.4
0.3
0.2
0.1
0
0 5 10 15 20 25 30 35 40 45
Minutes in VF
distribution (p = 0.64 by Shapiro-Wilk test where a 2. Butler ED, Gant TD. Electrical injuries, with special
reference to the upper extremities. A review of 182
large p is good). The data and fit are shown in cases. Am J Surg. 1977;134(1):95–101.
Fig. 2.17. The median time was 19 min. Since most 3. Donaldson RI, Hung YW, Shanovich P, Hasoon T,
of these data were from spontaneous VF (instead of Evans G. Injury burden during an insurgency: the
electrically induced VF), we would expect that the untold trauma of infrastructure breakdown in Baghdad,
Iraq. J Trauma. 2010;69(6):1379–85.
deterioration time for electrical accidents would be 4. Luce EA, Gottlieb SE. “True” high-tension electrical
larger in keeping with the animal results. With car- injuries. Ann Plast Surg. 1984;12(4):321–6.
diopulmonary resuscitation (CPR) this deterioration 5. Baker MD, Chiaviello C. Household electrical inju-
time might be extended to over 60 min [88]. ries in children. Epidemiology and identification of
avoidable hazards. Am J Dis Child. 1989;143(1):
A presenting rhythm of asystole within 20 min 59–62.
of an electrical current exposure is most likely 6. Dawes DM, Ho JD, Kroll MW, Miner JR. Electrical
not due to electrically induced VF deteriorating characteristics of an electronic control device under a
to asystole. Regardless of the time to presenta- physiologic load: a brief report. Pacing Clin
Electrophysiol. 2010;33(3):330–6.
tion, a presentation of asystole was probably not 7. Salisbury v Itasca County et al: Civil No. 09–1945
due to deterioration from VF if there was inter- (RHK/LIB), (U.S. District Court, Minnesota 2010).
current CPR. New animal data has demonstrated 8. Dawes DM, Ho JD, Sweeney JD, Lundin EJ, Kunz
that the median time for electrically-induced VF SN, Miner JR. The effect of an electronic control
device on muscle injury as determined by creatine
to deteriorate to asystole is 35 minutes. kinase enzyme. Forensic Sci Med Pathol. 2011;7(1):
3–8.
Acknowledgment Special thanks to Lori Kroll, BSN 9. Ho JD, Dawes DM. TASER device-induced rhab-
for artwork. domyolysis is unlikely. J Emerg Med. 2011;40(1):
68–9. author reply 69.
10. Reilly J. Cardiac sensitivity to electrical stimulation.
In: Reilly J, editor. Applied bioelectricity: from elec-
trical stimulation to electrical pathology. New York:
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