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The Electrical Injury Program and Electrical Injury Research (2003-2012) Manuel Gomez, MD, MSc.

The Electrical Injury Program and Electrical Injury Research (2003-2012) Manuel Gomez, MD, MSc. Outline. Electricity Electrical Injury Electrical Injury Statistics The Electrical Injury Program Electrical Injury Research Summary. Electrical Injury.

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The Electrical Injury Program and Electrical Injury Research (2003-2012) Manuel Gomez, MD, MSc.

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  1. The Electrical Injury Program and Electrical Injury Research (2003-2012)Manuel Gomez, MD, MSc.

  2. Outline • Electricity • Electrical Injury • Electrical Injury Statistics • The Electrical Injury Program • Electrical Injury Research • Summary

  3. Electrical Injury

  4. Effects of Electrical Current in Human Body

  5. Tissue Resistivity to Electrical Current

  6. Electrical Injury Statistics

  7. Electrical Injury in Canada – 1999-2009

  8. Electrical Injury in Canada – 1999-2009

  9. Electrical Injury in Canada – 1999-2009

  10. Electrical-related FatalitiesOntario Ministry of Labour (1998-2007) • 21% Electrical Trade Workers • Electricians • Line Workers • 79% Workers in other occupations • Maintenance Labourers • Millwrights HVAC technicians • Apprentices Equipment operators

  11. Electrical Injury, Critical Injury and Fatality in Ontario (2001-2010)

  12. The Electrical Injury Program

  13. The Electrical Injury Program was launched on November 2003 Partnership: Funding Supporters: Objectives: To provide emergency physicians with the ability to make consultations in electrical burns with experts from a regional burn center at the Sunnybrook Health Sciences Centre To provide comprehensive inpatient and outpatient electrical injury rehabilitation at St. John’s Rehab Hospital To create a multidisciplinary group of researchers to investigate the diagnosis and management of electrical injury sequelae

  14. Electrical Injury Research

  15. Results • age = 4513 years • 95.6% were men • Time from injury = 5.4±4.8 years (0.2-20 years) • TBSA burned = 15.2±11.5% • 14 (61%) had high-voltage (1000 v) injuries • 9 (39%) had low-voltage (<1000 v) injuries • length of stay = 23±20 days

  16. Results • Almost all injuries were work related (87%) • Of the 22 employed patients: • 23% (5) returned to the same duties • 45% (10) changed duties • 32% (7) did not return to work • Of those returning to work, the average time off work was 1717 weeks

  17. Conclusions • Electrical burn patients have a limited ability to return to work and an overall poor quality of life • Although improvement in the physical realms occur, emotional and psychological distress remain key features long-term outcome of electrical burn patients

  18. J Burn Care Res 2008;29:773–777

  19. Occurred at 1.7 months after the EI Occurred at 5.3 months after the EI Occurred at 1.5 months after the EI

  20. J Burn Care Res 2008;29:959–964

  21. J Burn Care Res 2010;31:333–340

  22. Multi-Meters Incidents and Serious Injuries to Qualified Electricians were Reported 26 burn injuries due to the use of multimeters among electricians and electrical apprentices in Ontario (1998-2005)

  23. Causes of Multi-meter Failure 49 21 18 10 2

  24. There were no critical injuries caused by multimeters in the years 2006, 2007, and 2008 (January to August) in Ontario.  Fused leads multimeters proved to be effective in preventing most common user errors and electrical burn injuries caused by multimeters.

  25. J Burn Care Res 2011;32(2):334-347 • 9 articles (8 RCT), involving a total of 244 participants • Investigated an intervention that impacted on acute burn edema • 1) Continuous administration of vitamin C in acute burn resuscitation reduced • Local wound edema (-3.50 ml/g; P<0.00001) • Systemic fluid retention (-8.60 kg; P=0.0005) • Mechanical ventilation time (9.20 days; 95%; P=0.03) • Resuscitation fluid volumes in the first 24 hours (P=0.0005) • Inspired oxygen requirements between 18 and 96 hours post-burn (P<0.01) • 2) Electrical stimulation with usual physiotherapy • Reduced local acute hand burn edema (-29.00 ml; P=0.02) • Increased active hand motion (10.00°; 95%; P=0.0003)

  26. 80% of Specialty Consultations were negative 72% of Diagnostic Tests were negative

  27. Archives of Physical Medicine and Rehabilitation 2012;93:623-628

  28. There was a high prevalence of PTSD (clinical or subclinical) among outpatients with burns referred to psychology. • PCL-C is a useful screening measure for PTSD in patients with burns. • Prospective screening of psychological symptoms, clinical assessment, and intervention is warranted, especially for patients with work-related burn injuries.

  29. Memory Functioning In Electrical Injury Patients: An Episodic Memory Deficit Not Related to DepressionAlisa Grigorovich MA, Manuel Gomez, MD MSc, Larry Leach PhD, C. Psych, Joel S. Fish MD MSc.Archives of Physical Medicine and Rehabilitation (Submitted) • 30 patients were recruited between January 2008 and December 2010. • Based on the severity of PTSD symptoms, subjects were divided into three groups: • Normal • Subclinical PTSD • PTSD • Subjects with PTSD had significantly (p<0.05) worse scores on immediate and • delayed verbal and visual memory than those with subclinical PTSD or without PTSD. • Electrical Injury patients with PTSD had an episodic memory impairment, possibly • due to encoding and retention of information, as opposed to general difficulties in • attention, learning or depression as previously hypothesized.

  30. The Effectiveness of the “Road to Recovery” Program Among Outpatients with Burns or Complex TraumaPaula Gardner, Sandy Cane, Loretta Kennedy, Dafna Knittel-Keren, Manuel Gomez MD MSc.Journal of Burn Care & Research (Submitted) The outcomes of 26 traumatically injured outpatients: burns = 18, complex trauma = 8 were investigated. Overall, there was a significant reduction in stress level (20.7 ± 9.9 vs. 23.2 ± 13.7, p =0.027, 95% CI =0.46 to 6.73) post-intervention Significant increase in self-efficacy(HAQ = 13.1±2.9 vs. 11.8±2.3, p=0.005. 95% CI = -2.37 to -0.47) post-intervention

  31. Future Research Exploring the Link Between Personality Type and the Risk of Occupational Electrical Injury Paula Gardner EdD, Manuel Gomez, MD, MSc, Gavan Howe, PhD (student), Joel S. Fish, MD, MSc, FRCS(C) Patterns of Brain Activation During Cognitive Tasks in Patients with Neuropsychological Sequelae Following Electrical Injury  Manuel Gomez MD, MSc, Alisa Grigorovich MA, Gary R. Turner PhD, Joel S. Fish MD, MSc, FRCS(C) Operationalizing the Process Necessary for Successful Workplace Accommodations for Individuals with Severe Injuries: The Case of Brain and Electrical InjuriesMary Stergiou-Kita, Manuel Gomez, Angela Colantonio Calcium and Cortisol Levels During the Acute and Rehabilitation Phases of Electrically Injured Patients and Their Relationship with Patients’ Outcomes  Manuel Gomez MD MSc, Alisa Grigorovich MA, Marc Jeschke MD MSc, Joel S. Fish MD MSc FRCS(C)

  32. Summary • Electricity may cause serious injuries and long term consequences • Research is important to understand • Electrical Injury • Complications • Medical, Surgical, and Rehab Management • Prevention • The Electrical Injury Program has: • Benefited many electrical injury patients in Ontario & Canada • Enriched electrical injury knowledge • Provided funding for electrical injury research • Benefited from a multi-institutional partnership

  33. Thank you

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