Evaluation of Death Cases Connected to Electric Current in Aydin Province,Western Turkey

Abstract

In this article, the authors discuss electric shock fatalities in Aydın province and compare these findings with the findings of other studies conducted in Turkey and worldwide. Data were gathered from 2001-2013 autopsy reports retrospectively. A total of 34 cases were reviewed in terms of age and gender, scene and time of event, number of lesions and their locations, organ injuries, origin of electricity, and degree of burns. In all cases, electrical death was accidental. Electrical shock fatalities were most common in the 30 to 39 age group. Fourteen cases (41.2%) involved workers: 7 cases (2.6%) were agricultural workers, 4 cases (11.8%) were housewives, 2 (5.9%) were electrical workers, and 7 (20.6%) were unemployed or in other occupations. The authors are addressing this public health problem to minimize the number of electrical deaths.

Electrically charged particles have made day-to-day living easier around the world. However, concomitant with the use of electricity at home and in industry are electric shock injuries, a serious public health problem. The intensity of the electric current, structure of the contact, affected limbs and organs, path of the current through the body, resistance of body tissues, and voltage of the current source are the most significant predictors of injury severity.

The unit of electrical current is divided into low voltage (less than 1,000 volts) and high voltage (greater than 1,000 volts; Al, Aldemir, Güloğlu, Kata, & Girgin, 2006). Most deaths are caused by contact with electrical voltage commonly used in homes and industry (110 to 380 volts; Peng & Shikui, 1995). The vast majority of deaths caused by low-voltage electrical current are accidental (Akçan et al., 2012; Dokov, 2010; Liu, Yu, Huang, Luo, & Liao, 2014; Shaha & Joe, 2010).

With industrial expansion, more accidental burns caused by contact with electrical current have been reported. Electrical burns in developed countries account for approximately 6% of all burns, whereas in developing countries, the percentage is approximately 3% (Al et al., 2006). Electrical current can damage multiple organs, including the skin (Spires, 2000). In developing countries, high-voltage lines are often found in unsafe locations, workers are inadequately trained, and occupational accidents lead to electrical injuries. In Turkey, 15% to 20% of patients hospitalized on burn units between 1980 and 1990 were burned by electricity (Haberal, Gurer, et al., 1996; Haberal, Oner, et al., 1989).

Skin lesions, burns, and damage to organs and bones can occur when humans are exposed to electrical current. Bone and skin tissue, especially parts rich in keratin, such as the palms of the hands and soles of the feet, are more resistant to electrical current. Input-output lesions may not be found on victims exposed to electric current running through large, wet surfaces, such as on bathroom floors or tubs (Soysal & Çakalır, 1999). Although rare, suicides and homicides by electricity also occur (Byard et al., 2003; Fernando & Liyanage, 1990; Lawrence, Spitz, & Taff, 1985; Melen, Walter, & Kao, 1992; Özdemir, Demirel, Akar, Balseven Odabaşı, & Dinç, 2007). Various studies conducted in Turkey determined that electrocutions accounted for 2% to 4.6% of all deaths (Tuğcu, Kaya, Ulukan, Tuğcu, & Celasun, 2004). During the acute period, tissue damage, mortality due to cardiac arrest and trauma, and secondary complications are often observed. In the subsequent period, burn-related infections, fluid-electrolyte disorders, and mortality due to organ failure were observed (Cander, Dur, Koyuncu, Gül, & Girişgin, 2010). In this study, cases of death related to electric shock, as determined by autopsies conducted by staff of the Department of Forensic Medicine, University Medical Faculty and supervised by the District Attorney, were examined in terms of demographic characteristics and wound localization.

Method

Between 2001 and 2013 in the province of Aydın, electrical fatalities presented to Adnan Menderes University for autopsy were examined. Adnan Menderes University Faculty of Medicine, Department of Forensic Medicine is the only authorized forensic unit serving all parts of the city. The age and gender of the deceased, scene and time of the event, number of lesions and their location, organ injuries, current source, and degree of burns were evaluated. All cases were forensic, so the Institutional Review Board exempted the study from the approval process. The data were entered into SPSS version 17.

Results

In this study, 34 individuals were determined to have died by electrical current. These individuals were identified from 3,097 total autopsies performed in the 12-year period from 2001 to 2013. In all cases, electrocution was accidental. Six cases (17.6%) were females, and 28 cases (82.4%) were male. The average age of the victims was 32.05 years (SD = 11.96), and the age range was between 1 and 64 years. Deaths due to electrical shock were most common in the 30 to 39 age group (n = 16, 47.1% of the fatalities). Three cases (8.8%) were under the age of 10 years (Table 1). In terms of education, 30 individuals were primary school graduates, 3 were high school graduates, and 1 was a 1-year-old infant. Fourteen (41.2%) of the fatalities were workers: 7 (2.6%) were agricultural workers, 4 (11.8%) were housewives, 2 (5.9%) were electrical workers, and 7 (20.6%) were unemployed or in other occupations.

Table 1.

Distribution of Victims’ Gender by Age Range

	Age range
	0-9	10-19	20-29	30-39	40-49	50+	Total
Gender
Male	2	0	5	13	7	1	28
Female	1	1	1	3	0	0	6
Total	3	1	6	16	7	1	34

Regarding the scenes of the accidents, 55.9% (19/34) occurred in the workplace and 44.1% (15/34) occurred at home. It was observed that 67.9% (19/28) of the male victims died from injuries in the workplace while all the female victims died in the home. According to data from the crime scene investigations, the fatal electric current came from electrical outlets (17.6%, 6/34), power cords (41.2%, 14/34), electric poles (35.3%, 12/34), and transformers (5.9%, 2/34). Regarding the times of the accidents, the majority of the events occurred in the summer (12/34, 35.3%), and nine events (26.5%) occurred in the spring and autumn. Twenty of the victims (58.8%) died at the scene, and 14 (41.2%) died at the health center.

In two cases (5.9%), only one injury was evident; in 31 cases (91.3%), more than one injury were found but in one case (2.9%), which occurred in a bathroom, lesions were not found. During the autopsy, histopathological examinations were required in 16 cases. In these cases, skin sections were taken from the lesions (i.e., surface keratinization disorders, hemorrhage in the dermis, capillary proliferation, and perivascular inflammatory infiltration) consistent with electrical burns. The majority of lesions consistent with electrical current were found in the extremities. The distribution of electrical wounds is shown in Table 2. Laboratory tests identified ethanol in the blood of 16 victims (52.9%).

Table 2.

Distribution of Electrical Wounds by Body Region

The region of wound	Number of wounds	Percentage of total wounds
Hand	12	35.3
Chest	2	5.9
Head	1	2.9
Hand-leg	8	23.5
Hand-foot	9	26.5
Total	34	100

Discussion

Electricity is used widely around the world. However, exposure to electric current causes injuries ranging from skin irritations to serious complications and death. The effects of the electrical current on the body depend on several factors: voltage of the current source, the structure of the body in contact with the current, the course of flow through the body, and resistance of the tissue. In Turkey and around the world, the numbers of electrocution injuries and deaths are substantial (Al et al., 2006; Byard et al., 2003; Peng & Shikui, 1995; Tuğcu et al., 2004).

The results of this 12-year secondary analysis showed that injury from electrical current accounted for 1.09% of all forensic deaths. In a study conducted in Bursa, this ratio reached 1.49% (Türkmen, Eren, Fedakar, & Durak, 2008). In two studies, conducted in Sivas between 1990 and 2000, postmortem examinations and forensic autopsies in all cases of electricity and lightning strike-related deaths were 1.6% and 1.9%, respectively (Beyaztaş, Demirkan, & Çolak, 2001; Katkıcı, 1997). In Ankara, a similar study was conducted between 2002 and 2006. Autopsies identified electrical death in 0.86% of cases (Cantürk, Alkurt Alkan, & Cantürk, 2008). In another study, conducted between 2000 and 2003 in Aydın, this percentage was 2.3% (Erel, Katkıcı, Pınarbaşılı, Özkök, & Dirlik, 2005). Considering the wide range of study results, fewer electrocution deaths may be explained by technological developments in electrical installation, which have reduced the risk of electrocution. Moreover, awareness of personal injury due to electrical current in Turkey has increased.

In the Bursa and Ankara studies, 53.9% and 53.85% of the cases, respectively, occurred in the summer months. According to a study conducted between 1996 and 2000 in Sivas, most of the injuries and deaths resulting from electric current occurred in the summer. In the construction industry, heavy sweating during the summer decreases the body’s resistance and increases the risk of electrical shock (Beyaztaş et al., 2001; Cantürk et al., 2008; Katkıcı, 1997; Türkmen et al., 2008). In this study, the researchers found that electrocution rarely occurred in the winter (11.8%, 4/34).

Both abroad and in Turkey, electrical fatalities are more common in men who work in the electrical field than in women or workers in other fields (Beyaztaş et al., 2001; Cander et al., 2010; Cantürk et al., 2008; Shepherd, 2003; Soysal & Çakalır, 1999; Türkmen et al., 2008). In this study, 82% of the victims were men. In the study conducted in Ankara, the average age of the victims was 28.7 years (Cantürk et al., 2008); in the Bursa study, the average age was 32.5 years (Türkmen et al., 2008); and in the Sivas study, the average age was 24.9 years (Beyaztaş et al., 2001). In Germany, a study conducted by Karger, Süggeler, and Brinkmann (2002) found that the average age was 33 years. In this study, the researchers determined the average age to be 32.05 years. From these results, it can be concluded that the majority of electrocution deaths occur in young adults.

Electrical deaths in childhood are not only tragic but also more preventable. In this study, 8.8% of the fatalities were under 10 years of age and 11.7% were under 18 years of age. A study in Adana found that deaths of children under 18 due to electrical current accounted for only 0.8% of all childhood deaths (Akçan, Hilal, Gülmen, & Cekin, 2007). According to a study in Istanbul, of 1,591 deaths among children under 18 years that occurred in the home, 1.25% were caused by electrical current (Asirdizer, Yavuz, Albek, & Canturk, 2005). In a similar study conducted in India, only 4% of deaths among children under the age of 10 were caused by electrical current (Sachil, Anoop, & Uma, 2014).

A small number of suicides and homicides are caused by electrical current; the majority of deaths are accidental. In Turkey, many adults work at home, and work-related accidents are sometimes the cause of electrical deaths (Beyaztaş et al., 2001; Cantürk et al., 2008; Katkıcı, 1997; Türkmen et al., 2008). The electrical fatalities in this study all occurred accidently.

In a study conducted in Gaziantep, 46.4% of the electrocutions were caused by work-related accidents, and 34.69% were caused by home accidents (Erkol, 1995). In a German study, 30% of cases were caused by occupational accidents (Karger et al., 2002). In this study, 55.9% of the individuals died from electrical injuries in the workplace, and 44.1% died from electrical injuries at home. All female victims were exposed to electrical stimulation in the home. Over 58% died at the scene; and 41% died at the health center. In the study conducted in Bursa, 6.3% of cases arrived at the hospital dead, 4.8% died on the same day during treatment, and 1.5% died on the 10th day after electrocution (Türkmen et al., 2008).

As reported in many studies, in this study, lesions (i.e., input and output) were primarily observed in the upper and lower extremities (Beyaztaş et al., 2001; Sachil et al., 2014; Türkmen et al., 2008). In this study, 8.8% of the victims were found to have nonspecific contact between the chest and head and electrical current.

Implications for the Occupational Health and Safety Team

Systematic scientific studies on workplace health and safety can protect workers from unhealthy or unsafe conditions (Act No. 6331, 2012; Turkish Medical Association, 2012). Some employee safety issues are directly related to rapid industrialization and technological progress in Turkey and around the world. Studies on occupational health and safety typically have the following aims:

• To provide employees with the healthiest possible environment

• To protect employees from adverse working conditions

• To eliminate workplace risk and minimize the effects of injuries

• To prevent financial or emotional damage to employees and employers

• To improve employee’s work performance (Act No. 6331, 2012).

The Ministry of Labor and Social Security is responsible for occupational health and safety in Turkey. The Ministry enforces laws, rules, regulations, and legal decisions. The Directorate of Occupational Health and Safety within the Ministry protects employees and ensures safety in business and industry (Ministry of Labor and Social Security, 2015).

Occupational health and safety have recently been emphasized in Turkey. A health and safety law went into effect in 2012 (Act No. 6331, 2012; Turkish Medical Association, 2012). As a result, all businesses were categorized as low risk, medium risk, or high risk. Now it is mandatory for businesses to create workplace health and safety units (i.e., occupational health team) in accordance with their workplace category and number of employees (i.e., more than 50 employees or less than 50 employees). Businesses classified as medium risk or high risk must have an occupational health team and immediately put health and safety interventions into practice. Low-risk businesses that employ less than 50 workers must make changes by 2016 (Act No. 6331, 2012; Ministry of Labor and Social Security, 2015).

Electrical energy is used in everyday life and by nearly all businesses around the world. As a result of this common usage, many physical injuries are caused by electrical currents. The following factors are generally responsible for electricity-related injuries at work (Act No. 6331, 2012; Cal/OSHA, 2012):

1. Electrical wiring has not been installed by a qualified licensed electrician or has not been repaired and maintained by these tradespeople.

2. No static grounding is used on the metal parts of machines or instruments, or necessary insulation is missing.

3. Employees are not equipped with personal protective gear and safety equipment or employees are not using this gear and equipment.

4. Employees do not receive occupational health and safety training, and they do not believe electricity is a serious occupational hazard or they do not obey work rules.

5. Employees without training, knowledge, or experience may feel overconfident and not pay careful attention to electrical sources.

Occupational health teams have full authority in implementing the above strategies, providing training, and identifying hazards for businesses when necessary. The following methods may be used to protect employees from electricity-related injuries (Act No. 6331, 2012; Cal/OSHA, 2012):

1. Using protective insulation: Insulating the ground on which employees stand

2. Using lower voltage

3. Using static grounding

In addition, residual current devices should be used in all Turkish businesses (Act No. 6331, 2012).

Conclusion

Forensic medical experts see the results of accidents caused by contact with electrical current at home and work. A greater number of these deaths occur in young adults, which could be prevented by taking necessary measures: maintaining clearances around electrical panels, using proper protective devices and personal protective equipment, following manufacturers’ instructions and safe work practices, and using proper lockout/tagout procedures to ameliorate this public health issue (Cal/OSHA, 2012). The aim of this study was to decrease the number of electrical deaths in Turkey. Measures should be taken to ensure that electrical wiring meets the highest standards, problems related to wiring infrastructure are eliminated, and public education and awareness of electrical safety measures are implemented.

The forensic aspects of suspicious death cases should include careful examination of the scene, particularly electrical appliances. The autopsy team should be given technical information gathered in the investigation. Suspicious lesions should be examined in detail and samples of these lesions should be sent to histology for review.

Applying Research to Practice

To prevent fatal electrical injuries at work and in the home, occupational and environmental health nurses should identify electrical hazards in the environment and provide worker safety training. In addition, employers should provide lower voltage when appropriate and static grounding to reduce the consequences of electricity-related exposures.