The year was 1997. On the campus of pharmaceutical manufacturer G.D. Searle LLC (now a wholly owned subsidiary of Pfizer) in Skokie, Ill., employees of High Voltage Electric Testing and Maintenance Inc., Wasco, Ill., had stopped working on an electrical installation to take a lunch break. That’s when Bart Curtin, CEO and founder, checked on a switchbox.   

Curtin had asked a foreman if the power was off, but someone—possibly not an employee of High Voltage—must have turned it back on. 

“I went to open the switchbox and that’s when it got ahold of me,” Curtin said. “I could smell burning flesh and realized I was being electrocuted.”

High Voltage company policy now requires employees to put on PPE gear and properly check groundings rather than rely on someone’s word. At that moment, however, Curtin’s left hand was in contact with 15,000V. When he touched the metal door, the other contact was his right, leaving burn marks an inch wide and a half-inch long. The pain from both wounds was intense. The wound on the right seemed worse because it bled. Even more alarming, Curtin found it impossible to lift either arm.

Curtin was luckier than most. He said he never lost consciousness, and he was admitted to a local hospital, mostly for observation. 

“The doctors made me lay there all hooked up with monitors,” Curtin said. “They told me, ‘We don’t know enough about electrocution to do much to treat it.’” 

Like many in the industry, Curtin was hale and hearty, with the physique of a professional body builder. He lifted weights and ate a healthy diet. Within two weeks, he was back on the job site building a successful electrical contracting business.

What’s the real toll?

Curtin’s family members, however, remember the incident as far more catastrophic. 

“As we recall, the current traveled from hand to hand, across his chest and out his feet,” said his daughter, Carrie Curtin-Liberio, now COO of High Voltage. “He looked purple, possibly from all the capillaries that may have burst. Bystanders said the current only stopped running through him when his heart stopped and he fell to the ground.”

After spending a week in the hospital, Curtin came home a changed man. 

“The person who’s injured doesn’t always see what we see as family members,” Curtin-Liberio said, “but, as his child, someone who knew my dad before, I’d say it completely rewired his brain. I never heard him swear until that happened, but afterward, he did.”

Over the last two decades, medical researchers have uncovered evidence suggesting survivors of electrical injury often develop cognitive and emotional disorders. They may handle stress differently, lose patience, cry more easily, have trouble learning new tasks, struggle to retain new information, and often exhibit deficits in attention, slower mental speeds and impaired motor skills. 

Medical Challenges for caretakers

Some of the symptoms resemble those experienced by people suffering traumatic brain injuries, and others may be unique to electrical trauma. For every person, the consequences are different.

Twenty-five years later, much remains to be learned, according to Dr. Raphael Lee, a burn trauma surgeon and biomedical engineer who is considered one of the world’s leading experts on the biophysics of electrical shock injuries. Lee is also a co-founder of the Chicago Electrical Trauma Rehabilitation Institute (CETRI) and a distinguished service professor in the Surgery and Medicine departments at the University of Chicago.

CETRI’s mission is to advance rehabilitation strategies for treating electrical shock survivors, and to discover more about physiological consequences of electrical shock trauma to inform medical care advances. 

“Initially, when a person is injured by electrical shock, doctors must focus on life support and improving tissue recovery from the multiphysical trauma,” Lee said. “That apparent clinical severity of the injury can range from a minor skin wound to completely destroyed limbs and damaged organs. But this injury scale is not a reliable predictor of the neurological complications that can occur later, including the changes in personality and cognitive functioning. Often times, survivors of electrical shock physically look fine, while manifesting more subtle maladies that can take hold.” 

While exposure thresholds for cardiac arrest, “no-let-go” grip and acute pain are known for commercial electrical power frequency, a challenge facing CETRI and similar programs is discovering exposure thresholds for coordination and balance problems, emotional disorders or cognitive changes. The research is just beginning and is a main focus of CETRI’s Electrical Safety Science Program. 

“How electrical injury causes various conditions is not completely understood, and we don’t know how to accurately predict the consequences of electrical shock and trauma,” Lee said. “We want to get to the point that we can do that.”

In 1993, Lee contacted Dr. Neil Pliskin, a neuropsychologist and researcher affiliated with the University of Illinois at Chicago (UIC), to obtain his professional opinion as to why many of his electrical injury patients seemed to struggle with emotional regulation, depression, memory and cognition. 

At the time, Pliskin was an assistant professor. He is now a professor of clinical psychiatry and neurology at UIC, director of the university’s Neurobehavior Program and Neuropsychology Service and a nationally recognized expert in electrical shock injuries.

In preparing a response to Lee’s inquiry, Pliskin discovered a lack of scientific literature and only a handful of studies.

Working to understand

The pair decided to work together to unravel the mysteries and enlisted the help of several other doctors from a variety of medical disciplines. 

“We discovered a lot of people had pain issues, which interfere with sleep and lower mood,” Pliskin said. “So, we involved pain doctors. We also discovered a lot of folks experienced memory problems and other psychiatric issues, so we involved Dr. Kathleen Kelly, a psychiatrist who treats trauma patients.” 

Over time, the number of experts grew, and in 2009, the group formed CETRI. 

That year, Pliskin conducted the first functional imaging study to document alteration of central nervous system function related to cognition in electrical injury survivors. 

While inside an MRI, 14 electrical injury survivors and 15 control subjects individually performed tasks involving eye movements that tested working memory and procedural learning abilities. The study yielded real-time images indicating that for electrical injury survivors, smaller portions of the brain became activated during learning activities, and larger portions of the brain were activated while trying to accomplish tasks. 

“Our findings basically supported what people have been telling us,” Pliskin said. “Things like, ‘It’s not that I can’t do things, it’s that I have to concentrate so much harder.’”

Pliskin and Lee acknowledge that the electrical industry has made great strides in safety and accident reduction. Even so, in 2020, there were 126 fatal electrical injuries, according to the National Fire Protection Association.

U.S. workers in private industry and public administration suffered 2,380 nonfatal injuries caused by exposure to electricity in 2020, according to a May 2022 NFPA report, “Nonfatal Work Injuries Caused by Exposure to Electricity in 2020.” 

Given those statistics, it’s not surprising that the majority of CETRI patients have suffered workplace exposure and are referred from rehabilitation clinics. 

CETRI’s clinicians have been collaborating to understand electrical injury for more than 30 years. CETRI founders operate with great hope for recovery, and Lee embraces the concepts of physical adaption through training, exercise and neural plasticity. 

Hope for future discoveries

“I don’t want to overstate our current understanding,” Lee said. “Electrical forces in the body produced by electrical shock may damage tissue by both heating and by the direct action of electrical forces on tissue structures like cells. Besides thermal burn damage to flesh and bone, electrical current disperses water across cell walls and causes cell membranes to become more porous. Called electroporation, the process changes cells’ ability to survive.” 

As far as understanding this process, Lee said, “We’ve been making progress—we can see the mountain, but we’re still at base camp.” 

The group has been working on developing treatments and studies to determine which physical mechanisms lead to neurological and psychological issues.

CETRI is in the process of creating a division called Electrical Safety Science. For this, it is gathering input from experts who have spent their careers in electrical safety—physicians, scientists and safety clinicians. The first step is to consistently “stratify” exposure levels and predict outcomes based on factors relating to electric force exposure, Lee said. Because so many factors must be considered, developing a process of assessment and prediction could take years. 

“Questions remain as to why many people suffer neurological issues that affect control of limbs and muscle movements, making it difficult to maintain balance, move in a coordinated fashion, as well as why they seem to develop neuropsychological performance changes,” Lee said. 

If muscle control issues manifest, psychological issues are also likely to appear, Pliskin said. Psychological issues also can occur independent of muscle-control problems.

As with any injury or illness, Lee said, age, overall health, and fitness appear to figure heavily in determining an individual’s ability to recover from electrical trauma. 

These factors may have worked in Curtin’s favor. Now 83, he continues to lift weights, eat a healthy diet and serve as CEO for High Voltage Electric. His memory is as sharp as ever, his daughter said.

For more information about electrical trauma, rehabilitation and services accessible through CETRI, visit https://www.cetri.org.