Publications in Electrical Injury

by Dr. Morse

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Full Length Research Articles/Book Chapters

ELECTRIC SHOCK

Chapter in Wiley Encyclopedia of Biomedical Engineering, April, 2006.

 Michael S Morse and Jennifer S. Morse,   

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• Abstract:  When human beings were first designed, the designer must have considered that someday they would live in a society in which they were in constant and close proximity to electrical energy.  Human skin is a naturally protective barrier to the flow of electricity but still under the right conditions, humans can become part of the electric technology that touches every aspect of our daily lives and has now been a part of our world for over 100 years. Injury from electrical contact can run the gambit from momentary pain to extensive physical damage that can impair multiple organ systems. Primary mechanisms of electrical injury include thermal injury from the electrical injury of the shock, ventricular fibrillation when pacing is interrupted by current flow, and electrically induced respiratory arrest.  Secondary injury includes soft tissue damage and broken bones resultant from falls and impacts caused by electrically induced muscle contractions. Other secondary injury are flash burns and blunt force injuries caused by arc blasts.   Although electric shock has been studied for over a century, there are still as of yet unexplained responses to electrical contacts which lead researchers to conclude that given the complexity of the human machine, human response to electrical energy is more complex than originally thought.

Diffuse Electrical Injury, A Study of 89 Subjects Reporting Long Term Symptomatology that is Remote to the Theoretical Current Pathway, IEEE Transactions on Biomedical Engineering, August, 2004, Vol 51, No. 8, pp 1449 – 1459.

M.S. Morse, J.S. Berg (Morse), and R. Tenwolde

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• Abstract— Historically, tissue damage from electrical contact was thought to arise from resistive heating of tissues along to the current pathway.  The modern view has accepted that tissue damage can result from cellular rupture (electroporation) induced by the presence of an electric field.  There remain electrical injuries that defy explanation by either theory.  In rare electrical contacts, diffuse symptomatology arises that is neither proportionate to the electrical contact nor does it occur along the theoretical linear pathway of the current from entry point to exit point.  Disproportionate, remote electrical injury is most notable when the contact voltage is low (120 and 240 volts).  Symptoms  occur, absent diagnostic evidence, that defy explanation as organic injury.  A web-based interactive survey was used to locate and query individuals suffering from rarely occurring responses to electrical contact.  The results of the study suggest that there is a common symptomatology that is neither linked to voltage nor loss of consciousness at the time of contact. 

A Shocking Neurological Rarity: Diffuse Electrical Injury, Practical Neurology, August, 2004, Vol 4, No 4, pp. 222-227.

J.S. Berg (Morse) and M.S. Morse

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• Electrical injuries occur relatively infrequently but can produce various neurological and neuropsychological presentations which may be immediate or delayed. Many physicians are more familiar with cases of high voltage injury with significant full thickness burns, peripheral nerve damage, and possibly brain ischemia secondary to cardiorespiratory arrest. Other more common indirect neurological injuries are traumatic brain injury or spinal cord injury secondary to a fall after the electrical injury. Neurologists are often less familiar with the case reports documenting permanent delayed spinal cord damage resembling lower motor neuron syndrome, amyotrophic lateral sclerosis, or tranverse myelitis. These forms have been reported as occurring between days and decades following the electrical injury.  A much more rarely occurring type of electrical injury, and the focus of this article, is what has been referred to as Diffuse Electrical Injury (DEI) in which there exists diffuse symptomatology, both path related and remote to the theoretical current pathway. (The theoretical current pathway is the linear path of the electrical current from entry point to exit point). This type of injury produces remote physical, neurological, and/or neuropsychological symptoms that may exist without observed gross external injury or that exist even in the total absence of a current path that includes the brain. These cases often frustrate both the neurologist and the patient as the neurologist struggles to find “objective” proof on which to base their treatment planning, and the patient becomes increasingly frustrated and perceives that no one believes their symptoms.

Conference Articles

Product Design and the Reasonable Person – Nature versus Nurture, Presented at the IEEE Product Safety Engineering Conference in Irvine, CA, October 23-24, 2006.

M.S. Morse, R. Raney

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Use of the Finite Element Method to Assess Impact of Current on Wrist and Forearm During an Electrical Accident, Presented at the 26^th IEEE Engineering in Medicine and Biology Conference, New York, September, 2006.  

M.S. Morse, J.S. Morse

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Diffuse Electrical Injury, Study of Sequelae as a function of Gender, Presented at the 26^th IEEE Engineering in Medicine and Biology Conference, San Francisco, September, 2004

J.S. Morse and M.S. Morse

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• Abstract— Diffuse Electrical Injury (DEI) is a rarely occurring class of electrical injury that can occur even after low voltage contact. Symptoms following a low amperage electric shock are diverse and often unpredictable. The objective of this study was to compare the occurrence rate of symptoms reported retrospectively by a female DEI group with a male DEI group. A web-based interactive survey was completed by survivors of low voltage contacts of less than 1000 volts regarding symptoms present six months following electrical shock. Chi square analysis of the occurrence of 65 symptoms was performed. Despite sufficient power, the only significant differences were that unexplained moodiness and short-term memory loss were reported more often by the male group, and the diagnosis of “chronic pain” was more common to the female group. For the majority of symptoms, no significant difference between the groups was revealed. Results suggest that although male and female DEI patients present with a similar symptom profile, DEI may present with certain differences in men compared to women. The results also confirm previous reports that patients may present with broad symptomatology after low voltage contact.

Analysis of Current Density in the Carpal Tunnel Region During an Electrical Accident by way of the Finite Element Method

M.S. Morse¹, J.S. Berg², R.L.TenWolde¹

¹Department of Electrical Engineering, University of San Diego, San Diego, CA, USA

² Naval Medical Center, San Diego, CA , USA

(Presented at: The 25th IEEE Engineering in Medicine and Biology Conference, Cancun, September, 2003.)

• Abstract— Carpal Tunnel Syndrome (CTS) has been diagnosed in as many as 10% of the hand-involved electrical contacts studied by the authors. Typically a CTS diagnosis is indicative of median nerve compression.  Such would not be consistent with the known apparatus of electrical injury.  Using the finite element method, current density has been evaluated in the carpal tunnel region during an electrical contact.  The results indicate that while the majority of current does not transverse the nerve tissue, the current density is significantly elevated in the nerves as they traverse the carpal tunnel region.  In certain circumstances, the localized current elevation could cause nerve damage which would masquerade as CTS when diagnostically tested.

Diffuse Electrical Injury – A Study of 136 Subjects

M.S. Morse¹, J.S. Berg², R.L.TenWolde¹

¹Department of Electrical Engineering, University of San Diego, San Diego, CA, USA

²San Diego Naval Medical Center, San Diego, CA , USA

(Presented at: The 25th IEEE Engineering in Medicine and Biology Conference, Cancun, September, 2003.)

• Abstract—Some electrical injuries defy explanation by the theories of thermal damage or electroporation.   In rare electrical contacts, symptomatology arises that is remote to the theoretical current pathway and is often disproportionate to the parameters of electrical contact. The rarity with which this type of diffuse electrical injury (DEI) occurs often leads to diagnoses that the symptoms are of a non-organic nature.  An on-going web-based interactive survey is being used to locate and query individuals suffering from rarely occurring responses to electrical contact.    The research results indicate that there is a symptomatology fingerprint associated with the class of electrical shock injury studied. 

Diffuse Electrical Injury Presenting as "Chronic Pain": Systemic and Neuropsychological Symptomatology. J S BERG .; M S MORSE, PH.D.;  (Presented at: The 17th World Congress on Psychosomatic Medicine, Waikolao, HI, August 2003.)

NOTE:  This was presented as a poster -- There is no paper available.

• Abstract  -- BACKGROUND: Diffuse electrical injury (DEI) is a rarely occurring, poorly understood class of electrical injury which can occur after low voltage shock. Patients with DEI are frequently given the diagnosis of Chronic Pain Syndrome.  Symptoms can include physical, neurological, and neuropsychological symptoms that exist even in the total absence of a theoretical current path that includes the brain. There is considerable debate as to whether such injury is of organic or "psychogenic" origin, particularly in those patients without gross external injuries. The authors hypothesized that subjects with DEI without evidence of gross injury would have similar symptoms to those with DEI with gross injury. METHODS: A web-based interactive survey was completed by victims regarding symptoms present six months following electrical shock. Respondents included 53 subjects with DEI who experienced gross external injury and 40 DEI subjects without an external injury. RESULTS: Chi square analysis of the occurrence of 65 symptoms six months after injury in the "DEI with Gross Injury" compared to "DEI without Gross Injury" groups was performed. Despite sufficient power, no significant difference between the two groups was revealed.  CONCLUSIONS: Results indicate that DEI presents with similar symptomatology regardless of the presence (or absence) of external tissue injury.

A Study of Carpal Tunnel Injury Following Electrical Trauma, M. S. Morse  (Presented at IEEE EMBS Chicago, July 2000)

• Abstract -- Carpal Tunnel Syndrome (CTS) is sometimes diagnosed post electrical injury.  Unfortunately, there is no clear causal connection between electric shock and the electro-diagnostic indications of CTS.  One might thus infer that the electro-diagnostic appearance of signal slowing through the carpal tunnel is indicative of electrical injury to the median nerve as opposed to the mechanical compression as expected in CTS.  This hypothesis is evaluated based on an analysis using parametric data for human tissues for ten hand-to-hand electrical contacts.

An Evaluation Protocol For Electric Shock Injury Supported By Minimal Diagnostic Evidence  M.S. Morse,  D. Weiss, University of San Diego, Alcala Park, San Diego, CA 92110 (Presented at IEEE EMBS San Diego, 1993)

•   Abstract -- While the immediate effects from electric shock injuries are obvious in terms of entry wounds, exit wounds and cellular damage to the pathway traversed by the current, the long term effects are often unpredictable.  Furthermore, in electric shock injuries of either extremely short duration or of  less than 500 Volts, there may be minimal or no observable diagnostic evidence that an electric shock actually occurred.  Still, it is not uncommon to find individuals who suffer from a diverse set of neurological, physical, and psychological problems that seem to post-date the injury.  When taken in conjunction with the litigious nature of our society, it becomes essential to develop a protocol to relate cause with effect in the absence of solidly quantifiable evidence.  The protocol must provide a basis upon which a treatment plan can be established, blame can be assessed, and fraud can be detected. 

Articles of General Interest

The case of the Shocking Scaffolding Mystery, EC&M (The Magazine of Electrical Design Construction and Maintenance), June 2006.

Michael S. Morse

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Don’t Discount the Danger of 120 Volts,  EC&M (The Magazine of Electrical Design Construction and Maintenance), May 2006.

Michael S. Morse

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The Risk From Above, EC&M Magazine, February, 2004

 Michael S. Morse