When providing medical control of prehospital personnel, scene safety is paramount. Emergency medical service providers need to ensure that electrical power has been shut off by authorized personnel. The insulating material surrounding the wire should not be considered protective to rescuers; it merely protects the wire from the elements. "Insulated" objects such as rubber mats and ropes should not be used to extricate the patient from the power source, as these may be damaged or wet and may conduct high-voltage electricity.

The initial stabilization of an electrically injured patient should focus on the airway, breathing, and circulation. Respiratory arrest caused by current traversing the medulla or the chest wall is treated with immediate intubation and assisted ventilation. Electrical injuries alone do not usually cause upper airway edema, but thermal burns or inhalation injuries may cause airway obstruction. Spinal immobilization must be maintained if the possibility of cervical spine trauma exists. High-flow oxygen via face mask and continuous pulse oximetry should be provided. Cardiac arrhythmias should be treated with the advanced cardiac life support (ACLS) protocol, including standard doses of electrical shock. Cardiac monitoring should be instituted for all high-voltage patients, all symptomatic, and all high-risk low-voltage patients (Table 1.96-.8).

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