Electrical injury from subway third rails: serious injury associated with intermediate voltage contact

Direct current electrical injuries: A systematic review of case reports and case series

BACKGROUND

Direct current (DC) powered equipment and devices, including photovoltaic systems, high-voltage direct current power lines and novel concepts in electromobility have become increasingly popular in recent years. However, under adverse circumstances by malfunction or mishandling of these applications electrical injuries may occur when electric current passes through the human body. This review aimed at systematically summarizing the medical consequences of DC electrical injuries described in case reports and case series.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided the methodological conduct and reporting.

RESULTS

Sixteen case reports and 3 case series were eligible for this review and included 70 patients. The reviewed articles were very heterogeneous regarding sources of DC electrical injuries and the reported medical consequences, including burns and skin lesions (n=67), neurological consequences (n=11), unconsciousness (n=10), cardiac consequences (n=8) and bone fractures (n=6). Seventeen individuals did not survive the electrical injuries.

CONCLUSION

From the few available data and partly incomplete documentations of cases we could gather hints of DC medical consequences, however, it was not possible to identify well-defined medical consequences for various circumstances of DC electrical injuries in occupational and non-occupational settings. To achieve this goal, additional studies are required, each providing a comprehensive description of the medical consequences and the circumstances of the electrical injuries.

Subway-Related Trauma: An Urban Public Health Issue with a High Case-Fatality Rate

BACKGROUND

Between 1990 and 2003, there were 668 subway-related fatalities in New York City. However, subway-related trauma remains an understudied area of injury-related morbidity and mortality.

OBJECTIVE

The objective of this study was to characterize the injuries and events leading up to the injuries of all patients admitted after subway-related trauma.

METHODS

We conducted a retrospective case series of subway-related trauma at a Level I trauma center from 2001 to 2016. Descriptive epidemiology of patient demographics, incident details, injuries, and outcomes were analyzed.

RESULTS

Over 15 years, 254 patients were admitted for subway-related trauma. The mean (standard error of the mean) age was 41 (1.0) years, 80% were male (95% confidence interval [CI] 74-84%) and median Injury Severity Score was 14 (interquartile range [IQR] 5-24). The overall case-fatality rate was 10% (95% CI 7-15%). The most common injuries were long-bone fractures, intracranial hemorrhage, and traumatic amputations. Median length of stay was 6 days (IQR 1-18 days). Thirty-seven percent of patients required surgical intervention. At the time of injury, 55% of patients (95% CI 49-61%) had a positive urine drug or alcohol screen, 16% (95% CI 12-21%) were attempting suicide, and 39% (95% CI 33-45%) had a history of psychiatric illness.

CONCLUSIONS

Subway-related trauma is associated with a high case-fatality rate. Alcohol or drug intoxication and psychiatric illness can increase the risk of this type of injury.

The management of electrical burn

Aim of treatment is to achieve skin cover to prevent infection and to allow early mobilization. Electrical injuries are a relatively uncommon. Adult electrical injuries usually occur as an occupational hazard, whereas children are primarily injured accidently. The spectrum of electrical injury is very broad, ranging from minimal injury to severe multiorgan involvement, with both occult and delayed complications and death. This is a prospective study from Indira Gandhi Government Medical College, Nagpur. A total of 98 patients presenting from June 2002 to September 2011 were included. Patients were treated with surgical excision 31 (31.63 %), fasciotomy 26 (26.53 %), escharotomy 87 (88.78 %), and amputation 12 (12.24 %). In all patients debridement was performed. After follow-up, there was 8.16 % (8 patients) mortality. Minimal mortality may be due to less surface area involved or no visceral injury. Patients survived with morbidity due to amputation. Initial management of electrical burn is imperative to optimize function and minimize long-term scarring. However, further studies are required regarding flap repair and microsurgery to minimize the rate of amputation.

Suicidal behaviour on subway systems: a review of the epidemiology

Suicide on subway systems is a public health challenge that has been reported in urban centers worldwide. Our objective was to analyze studies of suicide on subway systems, develop a profile of characteristics that are suggestive of association with suicides or attempts, and show how this profile can inform prevention. A literature review involving epidemiology studies and studies relating to subway suicide was conducted. Twenty-eight studies were included in this review. Across studies, characteristics were not often assessed for risk factor status, although several characteristics were remarkably similar. Those attempting suicide on the subway appear to be affected by serious mental illness and have contact with mental health services before the suicidal behavior. Several characteristics may be shared among this population, emphasizing the potential for prevention in clinical and public health domains. Well-designed studies that utilize robust data collection and statistical methods are needed to establish the risk status associated with these characteristics.

Public health lessons learned from analysis of New York City subway injuries

Serious subway injuries are devastating to their young victims and have high rates of mortality and amputation. We identified the urban population at greatest risk for subway injuries and investigated the influence of local economies on injury rates. We propose using changes in social conditions as a "trigger" for increased vigilance and protective measures at times of higher risk.

Landmarks in burn prevention

The objective of this paper is to highlight landmarks in burn prevention. Novel strategies in the areas of law and regulation, environmental and consumer product design, and educational programs are identified and discussed. Notwithstanding marked reductions in burn morbidity and mortality, especially in economically developed countries, burn injuries remain an important public health concern throughout the world. More, and more effective, burn prevention programs coupled with renewed efforts to reduce the social and environmental correlates of burn injuries (poverty, overcrowding, family stress, and educational deficits) are needed to further reduce burn incidence and its long-term sequelae.