Health Implications of Global Electrification

RONALD E. WYZGA AND WENDY LINDROOS

EPRI, 3412 Hillview Avenue, Palo Alto, California 94304

INTRODUCTION

We live in a rapidly changing world. The technological revolutions of the pastwere implemented over decades. The industrial revolution took place over more thana half century, and geographically it occurred over a limited region. In this century,we have seen revolutions in transportation and in the use of electricity. These are last-ing decades and more; they have occurred preferentially in limited regions, althoughthe timing has differed from region to region. The communications revolution is tak-ing place as we speak, and it is occurring at an increasingly rapid pace. By its verynature, it is leaving very few corners of the earth unscathed; moreover, it is responsi-ble for the acceleration of the earlier technical revolutions both spatially and tempo-rally, including the increasingly rapid electrification of the world.

The result has seen the developing world playing “catch-up” with the more devel-oped world. The strong desire for technological and economic progress has led to thevery quick introduction of new technologies, sometimes in the absence of safeguardsto protect consumers and workers from injury and often in the presence of con-sumer/worker ignorance about the dangers of these new technologies. Hence, we seeconsiderable numbers of electrical injuries in the rapidly developing world, but wealso see injuries occurring in the developed world. More and more people are ex-posed to high voltage sources as uses of electricity increase and, as heretofore inex-perienced people confront more and more potential exposures, accidents unfortu-nately occur.

This paper attempts to articulate the significance of injuries and to explore howthe incidence of these injuries is likely to change over time. The role of prevention isalso discussed.

INCIDENCE STATISTICS

Unfortunately, there is no comprehensive source of electric injury statistics or ofthe costs associated with these injuries.1 The data that are available are not recent,and there have been no obvious attempts to ensure that the case definitions are con-sistent over time and across areas. Often, electric injury case data come from hospitalrecords; since victims may be treated in emergency rooms, special trauma units, burnunits, or plastic surgery units, hospital records may be spread across several depart-ments. Centralized hospital data often do not exist; this in turn makes it difficult, ifnot impossible, to obtain aggregated data to describe these cases. Collecting compa-rable electrical injury and death information on an international basis is even more

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difficult due to differences in injury definitions, data reporting, and record mainte-nance in different countries.

Given these difficulties, some caveats must be placed on the data that we cite anduse in this paper. The data may be based on incomplete enumerations or estimates,and it is likely that data taken from different studies were not collected according toconsistent guidelines. Nevertheless, since they are the only data available to us, weuse them and boldly make some inferences from them.

Rates of electrical injuries are readily available for only a few nations. See TABLE

1. In 1967, the national rates for fatal electrical accidents per 100,000 inhabitantsshow national values ranging from 0.13 (Northern Ireland) to 0.76 (Italy). The avail-able data exist only for several European countries, the United States, Canada, Aus-tralia, New Zealand, and Japan. The rates vary considerably from country to country,and even neighboring countries show substantially different rates: for example, theNetherlands (0.19) vs. Belgium (0.45); Northern Ireland (0.13) vs. Ireland (0.34) vs.Scotland (0.32).2 These differences could reflect differences in injury classificationsand in data collection schemes, although we would expect similar data characteristicsfor Northern Ireland and Scotland. It is tempting to try to understand why there aredifferences across countries. Potential exposure to electricity is probably not too dif-ferent in those countries for which data are available. Differences are most likely dueto differences in data collection and reporting and to differences in public education

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TABLE 1. Electrical injury rates for selected countriesa

Fatal accidents/1 million inhabitants

Country 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982

Austria 4.27 6.37 5.17 4.52 5.59 5.05 3.20 3.73 3.20 3.46 3.06Australia 7.64 7.16 7.72 6.15 5.96 2.98 5.61 5.96 5.27 5.72Belgium 3.40 2.97 3.17 3.98 2.14 3.46 2.64Canada 3.25 3.67 4.14 3.46 2.99 4.03 2.90 3.30 2.76 2.97Denmark 2.20 2.39 1.58 0.99 1.38 0.79 0.59 0.59 1.17 0.78 1.37Finland 5.41 3.22 1.72 2.54 1.69 2.32 1.05 1.47 2.92France 3.32 3.97 3.27 3.28 3.08 3.37 3.11 3.09 2.78 3.29 3.12Germany 4.32 4.36 4.11 3.57 3.33 2.88 2.79 2.51 2.70 2.43 2.55Hungary 9.02 6.04 6.60 7.90 6.34 6.02 5.25 6.45 7.94 6.82 7.66Ireland 4.65 2.62 3.88 1.60 4.11 3.47 2.80 2.37 2.06 2.62 2.01Italy 5.73 6.74 6.36 6.05 5.86 5.76 4.92 5.23 4.69Japan 2.76 2.55 2.26 1.89 1.52 1.56 1.50 1.18 0.95 0.87Netherlands 1.58 0.89 1.33 1.32 1.31 1.25 1.29 1.00 0.71 0.63 0.42New Zealand 5.48 5.03 4.19 7.12 7.64 2.87 3.17 5.81 4.44 5.03 4.11Norway 3.05 1.77 2.78 1.74 1.74 1.73 0.98 0.98 0.98 0.73 1.94Spain 5.77 6.65 7.49 5.65 6.46 4.70 4.41 4.54Sweden 2.71 1.84 2.70 2.69 2.31 1.45 2.17 1.69 1.80 1.44 0.96Switzerland 5.30 4.58 3.43 4.25 2.85 3.97 2.21 3.65 3.65 2.47United States 5.21 5.46 5.47 5.74 4.85 5.47 4.51 4.65United Kingdom 2.67 2.59 2.52 1.93 2.49 2.11 1.97 1.72 1.95 1.42 1.85

aSource: see reference 2.

and awareness about health and safety issues. In an effort to determine whether thelatter could be a factor, we plotted infant mortality rates, often an index of publichealth awareness and success of public health programs, against national fatalityrates for electric injuries. The relatively good correlation seen in FIGURE 1 suggeststhat differences in public health and accident education and safety programs may bean important determinant of fatality rates. It is noteworthy, however, that if this is thecase, such programs are successful in reducing, but not eliminating, electrical in-juries.

CHARACTERISTICS OF THOSE INJURED

A few sources3,4 provide some information about who the victims are. Workers inthe electric utility and construction industries appear most likely to be victims. Elec-trocution is the fifth leading cause of fatal occupational injury in the United States.5

For a combined industrial category, including public utility, transportation, and com-munication workers, the third highest rate of occupational deaths is from electricalinjuries.6 A study in Virginia suggested that public utilities have the highest rate offatal electrical injuries among all industrial sectors, with a rate nearly 10 times theaverage for all industries.7 More than 90% of these injuries occur in men, mostly be-tween the ages of 20 and 34, with 4 to 8 years of experience on the job.8 A 1987 Edi-son Electrical Institute study reported on 72 nonfatal electric contact cases where theaverage age was 37.5 years and the years of experience amounted to 11.3 years.9

In a study of workers at five electric power companies done by Loomis et al., 192deaths from occupational injuries resulted in an overall death rate of 13.20 per

WYZGA & LINDROOS: HEALTH IMPLICATIONS 3

FIGURE 1. Fatal electrical accidents versus infant mortality in selected countries. Sources:reference 2 and World Development Indicators, World Bank.

100,000 persons-year at risk. Electric current was the leading agent of injury amongthe fatal injuries, causing 45% of the occupational injury deaths.3

International data appear to be similar. In a study of electrical accidents from1961 to 1967, construction and public works and the electrical industry were found tohave the largest number of electrical accidents (20.6% of all cases and 43% ofdeaths, and 18% of the total and 8.7% of deaths, respectively). The highest frequencyrates were in electricity workers (4.11 cases per 1000 workers-year, of which 0.121were fatal), electrical power line construction (3.49 cases, of which 0.376 were fatal),and construction and public works (1.46 cases, of which 0.107 were fatal). Men ac-counted for 95.9% of all electrical accidents and 99.4% of deaths.10

A considerable number of electric injuries are tied to the use of consumer prod-ucts. In 1994, the death rate from these injuries was 0.9 per million in the UnitedStates. The most frequently reported product involved in electrocutions was installedhome wiring (18%), followed closely by large appliances such as air conditioners,pumps, generators, washing machines, and clothes dryers (17%) and small appli-ances including fans, microwaves, radios, televisions, and stereos (16%). Powertools, such as drills and saws, and lighting equipment, mainly lamps and light fix-tures, accounted for 13% and 10%, respectively. Other products involved in electro-cutions included ladders that came in contact with overhead power lines, garden andfarm equipment, pipes, poles, fences, swimming pools, boat hoists, and amusementrides.11

Injuries from high-energy electrical sources are usually quite serious. In a study ofvarious types of occupational burns treated at the Regional Burn Treatment Center ofthe University of California Medical Center in San Diego from 1977 to 1982, electri-cal burns were found to be disproportionately severe, as measured by time lost fromwork, fatalities, and permanent disability, in relation to their frequency and amountof body surface area involved.4 The upper extremities are nearly always involved; asa result, extremity amputation rates from industrial accidents have been reported tobe as high as 71%.8 The variable circumstances of accidental electrical shock make itnearly impossible to predict the full extent of tissue damage, which challenges effec-tive clinical treatment of these patients.8 In the San Diego Regional Burn TreatmentCenter study, of the 13 cases of occupation-related burns studied in San Diego, theaverage percentage of body surface area burned was 14.39%, and 85.7% of thosestudied were permanently disabled. The median hospital stay was 25 days; the aver-age length of stay for all occupational burns was 15 days, and only 20% of all burn(including electric burns) patients were permanently disabled.4

TRENDS OVER TIME

Since the first recorded accident in 1879,12 both the number and variety of electri-cal injuries have increased with the advancement of technology and the utilization ofelectricity. In the first quarter of this century, the number of fatal electrical accidentsin the United States averaged about 750 annually.11 This number did not change untilrelatively recently. According to data from the National Center for Health Statistics,there were 890 electrocution deaths in 1984. Since the population approximatelydoubled during this 60-year period, the incidence of electrocutions approximatelyhalved. Since 1984, these deaths decreased to 560 in 1994.11

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TABLE 1 presents trend data for several nations. Between the years 1961 and 1967,there was a decrease in the rate of frequency of deaths from electrocution in severalcountries. This decrease was most marked in the non-European countries studied(Canada, the United States, Japan, Australia, and New Zealand). For the 14 Europeancountries taken together, the rate decreased very slightly from 0.47 to 0.46 fatalitiesper 100,000 residents. These changes occurred during a period where there was a sig-nificant increase in electrification.10

More recent statistics are difficult to find. The National Center for Health Statis-tics in the United States reports that electrocutions decreased 37% from 1984 to1994. Estimated electrocutions related to consumer products decreased 36%, result-ing in a fatality rate of 0.9 per million.11 Data outside of Europe, North America,Australia, New Zealand, and Japan are not easily available. Anecdotes and conversa-tions with physicians and hospital staff in some countries suggest that the rate of in-jury is considerably higher. Greater percentages of hospital beds appear to be devotedto these injuries.13,14 However, no rigorous collection of data is known to be avail-able. Most of the injury cases in these hospitals are reported to be the result of occu-pational injuries. Given the significant number of electric injuries that have been as-sociated with consumer products, it is clear that as the use of and exposure to theseproducts increase in developing countries, the likelihood of consumer injuries willincrease as well.

The above data suggest that there may be two countervailing trends. As exposureto electrification increases, the risk of electric injuries increases. Workers with limit-ed experience with new electrical equipment are at greater risk than those who haveworked with such equipment in the past; public health and safety measures also arenot extensive for new uses of electricity. Rapid industrialization clearly led to an in-crease in electric injury fatalities in the United States. The introduction of electricalconsumer products also increases exposures and risks. At the same time, educationaland safety programs have led to a decrease in the incidence of these injuries. In high-ly industrialized countries, the rates of injury have declined over time; some data sug-gest that the rate of decline has slowed. In any case, prevention and safety programsare not sufficient to eliminate these injuries. Within a given country, both increasedelectrification and safety and public health programs are in place. Where that countrylies with respect to these trends determines the extent of electric injuries that occur.

ECONOMIC COSTS

Electrical injury costs are high and continue long after the initial injury. Data fromone U.S. utility show direct costs (lost wages and medical payments) in the year of in-jury to be from $150,000 to $370,000 in 1990–91. Given the inflation of medicalcare costs, these figures would be much higher today. To these costs we must add thecosts of the injury in future years. Since many of those injured are relatively youngand become permanently disabled, per-case costs can persist for decades. Data arenot available to calculate the costs of these injuries beyond the first year. At the sameU.S. electric utility, however, direct costs associated with total new injuries represent-ed only $1 million of the $6.3 million total direct costs associated with occupationalinjuries within this utility. The remaining $5.3 million came from old injuries, indi-cating the compounding effect on worker’s compensation costs.13 Since the effects of

WYZGA & LINDROOS: HEALTH IMPLICATIONS 5

many other injuries do not persevere as long as those from electrical injuries, the lat-er-year costs of electric injuries may be even greater than those for injuries as awhole. These direct costs were multiplied by 8.25 to obtain the total costs of injuriesto compensate for indirect costs at this utility. Indirect or uninsured costs includemany things, such as employee lost time, productivity loss, equipment damage, re-placement employee hiring and training, fire loss, accident investigation, and over-head costs associated with running a self-insurance program. This translated to a to-tal annual loss in excess of $50 million15 to the utility involved. At that utility, electri-cal injuries represented less than 2% of the total accidents within a year, but the totalcosts of these injuries represented 28% or 52%, depending on the year, of the totalcosts of injuries at that utility.

The above example provides several lessons. First of all, even though these in-juries are infrequent, the very high costs associated with these injuries can makethem one of the most important categories of injury. Second, the costs associatedwith these injuries are much higher than the immediate medical costs. Costs continueto be incurred over time. The extent of these later costs depends upon the extent of in-jury and the age of the person injured. Given the limited data available, it would bedifficult to calculate the total costs of electric injuries. In 1991 dollars, one case inthe United States cost about $250,000/year in immediate direct costs, plus a mini-mum of $1.3 million in direct costs incurred after the initial year and $11.24 millionin indirect costs, for a total of $12.8 million. In 1998 dollars, this would translate toabout $15.75 million. If we multiply this by the number of cases in the world, wehave an astronomical number. Perhaps the cases of this utility were not typical; weknow that U.S. medical costs are high by world standards, but the total cost would re-main large even if we divided it by ten. It would take fewer than 650 cases worldwideto reach 1 billion dollars.

LESSONS LEARNED AND CONCLUSIONS

(1) Current worldwide statistics on electric injury incidence are poor.(2) There appear to be two countervailing trends that influence the rate of injury:

injuries increase with increased electrification/exposure; injuries decreasewith increased public health/safety education/awareness.

(3) Education/safety programs are not sufficient to eradicate the problem.(4) Although the incidence of injuries may be small, the economic costs can be

huge.

There are several lessons that we can learn from these conclusions. First of all, itwill be important to initiate public education/safety programs concurrently with elec-trification efforts. This clearly will limit the expected rise in electrical injuries associ-ated with increased electrification. Second, we have to anticipate that the costs andtreatment of electric injuries will last much longer than the initial period after treat-ment. This fact, along with the amount of indirect costs, needs to be conveyed tothose who decide how much to spend on preventive programs. Finally, since electri-cal injuries will not be eradicated, it is important to have the best treatments availableto minimize the costs and suffering of the injured. Research in this area must contin-

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ue and be expanded. The commitment to find more effective medical managementstrategies must grow.

REFERENCES

1. LUTTON, C. E. 1994. Economic impact of injuries associated with electrical events. Ann.N.Y. Acad. Sci. 720: 272–276.

2. KIEBACK, D. 1988. International comparison of electrical accident statistics. J. Occup. Ac-cid. 10: 95–105.

3. LOOMIS, D., V. DUFORT, R. C. KLECKNER & D. A. SAVITZ. 1999. Fatal occupational injuriesamong electric power company workers. Am. J. Ind. Med. 35(3): 302–309.

4. INANCSI, W. & T. L. GUIDOTTI. 1987. Occupational-related burns: five-year experience atan urban burn center. J. Occup. Med. 29(no. 9): 730–733.

5. BUREAU OF LABOR STATISTICS. 1997. National Census of Fatal Occupational Injuries, 1996.News, Bureau of Labor Statistics (USDL-97-266). U.S. Department of Labor. Washing-ton, D.C.

6. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH (NIOSH). 1993. Fatal in-juries to Workers in the United States, 1980–1989: A Decade of Surveillance [DHHS(NIOSH) 3-108S]. NIOSH Publications Dissemination. Cincinnati, Ohio.

7. JONES, J. E., C. W. ARMSTRONG, C. D. WOOLARD & G. B. MILLER, JR. 1991. Fatal occupa-tional electrical injuries in Virginia. J. Occup. Med. 33: 57–63.

8. LEE, R. C. 1997. Injury by electrical forces: pathophysiology, manifestations, and therapy.Curr. Probl. Surg. 34(no. 9): 684–764.

9. MCCLOSKEY, J. J. 1987. The Accident Data and Safety Information Subcommittee: Profileof a Non-Fatal Electric Contact Accident. Edison Electrical Institute.

10. ANDREONI, D. & G. SCATASSA. 1974. Statistical investigations into electrical accidents car-ried out in 19 countries from 1961 to 1967. Bulletin of the International Section of theISSA for the Prevention of Occupational Risks due to Electricity 3: 9–18.

11. NATIONAL CENTER FOR HEALTH STATISTICS. 1998. Consumer Product Safety Commis-sion/EHHA.

12. JAFFE, R. H. 1929. Electropathology. Arch. Pathol. 7: 244.13. ZHAO, C., J. YU, M. ZHONG & Y. WU. 1999. Network construction of first aid for electrical

injury in the East China area of China power. This volume.14. YAN, G-R., M. LI & Y. WU. 1999. A clinical analysis of 836 cases with electric injury. This

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