Electrical shock first aid, CPR, and AED field guide

Electrical shock first aid, and the move that keeps you alive

Electrical shock first aid is the sequence you run when a worker is in contact with electric current: get the power off, get help coming, and keep the victim alive until it arrives. The first move is the one that feels wrong. You do not grab the person. Current that is flowing through them will flow through you the moment you make contact, and now there are two victims on the ground instead of one.

That is the whole reason this response has an order to it. De-energize first. Call 911. Then check the victim and start CPR, and get an AED on the chest as fast as one can be brought. The cardiac and the burn damage from electricity are time-driven, so minutes are the currency here.

This guide is awareness, not a course. It will not make you a first-aid provider. Get certified through the American Heart Association or the American Red Cross, keep the card current, and treat the steps below as a map of what trained response looks like, not as the authority on how to perform it.

Read this first: awareness, not certification

Nothing in this guide substitutes for hands-on training. CPR and AED use are physical skills that fade without practice, and the current details, compression depth, rate, the ratio, when to give breaths, change as the American Heart Association and the Red Cross update their guidance. Learn them in a class where an instructor watches your hands, not from a page.

Get certified, and keep it current. A first-aid, CPR, and AED card from the AHA or the Red Cross is the baseline for anyone who works around energized equipment, and on many sites it is a requirement, not a nicety. The card lapses, usually on a two-year cycle, so the renewal matters as much as the first class.

Where this guide gives a number, treat it as a pointer to current AHA or Red Cross guidance, not as the procedure itself. The part that does not change, the part worth memorizing, is the order of the response and the rule that you de-energize before you touch.

Why electrical injury is different from any other

Electricity does four things to a body, and any one of them can kill. The first is the one that makes it an emergency: current across the chest can throw the heart into ventricular fibrillation, a quivering rhythm that pumps no blood. OSHA notes that as little as 50 V can drive enough current to do it, and currents above roughly 75 mA can put the heart into fibrillation that turns fatal within minutes unless a defibrillator restores the rhythm. That is why the AED matters so much on an electrical call.

The second is burns. Current burns at the entry and exit points on the skin, but it also cooks tissue along the path it took through the body, and that internal damage is routinely far worse than the marks on the skin suggest.

The third is muscle tetany. Current at the frequency of building power locks the muscles, and if the hand is gripping the conductor, the victim cannot let go. They are stuck on the wire, taking the full duration of the contact, and unable to call for the help they need.

The fourth is the fall. A worker shocked on a ladder or a lift comes off it, and the secondary injury from the fall, a head or a spine, can be the one that does the lasting harm.

De-energize first: power off before you touch

The first thing you do for a shock victim is kill the power, not reach for the person. While current is flowing, the victim is part of a live circuit, and anyone who touches bare skin becomes part of it too. Rescuers die this way, reaching for a coworker on reflex.

Shut off the source. Open the breaker, pull the disconnect, unplug the cord, trip whatever source you can reach fastest. On a circuit you isolated yourself, this ties straight into lockout/tagout: the same disconnect you would lock out is the one you open now. If you cannot identify the source with certainty, get the power killed by whoever can, and do not assume a tripped breaker means the right circuit is dead.

Only after the power is confirmed off does the victim become safe to touch. Until then, every second feels like it costs the victim, and it does, but a second rescuer down costs them more. The discipline to not touch is the hardest and most important part of this whole response.

If you cannot cut the power, separate the victim

Sometimes the disconnect is not reachable and the victim is still in contact. If you cannot get the power off, you separate the victim from the source without becoming part of the circuit yourself, and you never use your bare hands or anything wet or metal.

Use a dry, non-conductive object. Dry wood, a fiberglass hot stick, a length of dry rope, a thick dry plastic, something that does not conduct, to push the victim clear of the conductor or move the conductor off the victim. Stand on something dry and insulating if you can. Know the limit of this: it is a last resort at ordinary building voltage, not a plan. At higher voltages, dry wood and a broom handle are not protection, and you do not try it.

This is exactly the situation that good work practice is meant to prevent. If a worker is pinned on a live conductor, the system already failed upstream, at the lockout that did not happen or the test that was skipped.

High voltage and downed lines: stay back

At high voltage the rules change, and the only safe move is distance. Do not approach a victim near a downed line or high-voltage equipment, and do not try to separate them with a stick. High voltage arcs across gaps and energizes the ground itself.

Stay back, and keep others back. The ground around a downed line can be energized for a radius commonly cited around 35 ft, and the voltage drops in rings as you move out. Step across two rings and the difference drives current up one leg and down the other. This is step potential, and it has killed people walking toward a victim to help.

If you must move through that zone, shuffle: keep your feet together and in contact with the ground, taking tiny steps so both feet stay at nearly the same voltage. Better to not be there at all. Call the utility and 911, keep everyone outside the radius, and wait. Nobody approaches a downed conductor until the utility confirms it is de-energized and grounded.

Call 911, even for a shock that looks minor

Every electrical shock that is more than a static-like nip gets professional evaluation, and the serious ones get 911 immediately. The reason is that electricity hurts in ways you cannot see at the scene. A worker who took a jolt and feels fine can have a heart-rhythm problem that shows up hours later, or internal burns along the current path that the skin gives no hint of.

Make the call early. As soon as the power is off and the scene is safe, get 911 coming while someone else checks the victim, so help is already moving before you know how bad it is. If you are alone with an unresponsive adult, current guidance is to call first, then start care, because the victim of a witnessed sudden collapse needs the defibrillator that is on the way.

A minor shock is not a thing to walk off. Even when the victim refuses, the standing advice is medical evaluation, because the delayed cardiac and internal-burn risks are real and they do not announce themselves.

How do you do CPR on an electrical shock victim?

Once the power is off and the victim is clear of the source, you treat cardiac arrest the same way you would from any cause: check, call, compress, and defibrillate. Check whether the person responds and whether they are breathing. If they are unresponsive and not breathing normally, and there is no pulse, that is cardiac arrest, and CPR starts now.

Current AHA and Red Cross guidance for an adult centers on high-quality chest compressions: push hard and fast in the center of the chest at a rate of 100 to 120 compressions per minute, let the chest come all the way back up between compressions, and keep interruptions short. For an untrained or solo responder, hands-only compressions are the recommended approach for an adult; trained providers add rescue breaths in the ratio they were taught.

Those numbers are current as of this review, and they are the kind of detail that changes. Do not rely on this paragraph in the moment. Take the class, keep the card, and follow what the AHA or Red Cross teaches now and what a 911 dispatcher coaches you through. The order is the part that holds: check, call, compress, attach the AED.

Why the AED matters most on an electrical call

An AED is the single piece of equipment most likely to bring back a shocked worker, because the rhythm electricity causes, ventricular fibrillation, is exactly what an AED is built to correct. Compressions keep blood moving; the shock from the AED is what can reset the heart to a rhythm that pumps. Get one on the chest as fast as it can be brought.

Apply it as soon as it arrives. Bare the chest and dry it, because a wet or sweaty chest can let the shock track across the skin instead of through the heart. Place the pads as the diagram on them shows, then follow the voice prompts. The device reads the rhythm and decides whether a shock is needed, so it will not let you shock someone who should not be shocked. If a medication patch sits where a pad goes, remove it and wipe the skin first.

Speed is the whole game. Survival from a shockable cardiac arrest falls fast with every minute that passes before defibrillation, which is why where the AED lives and how fast someone can run for it belong in the site plan, not in a memory you reach for during the emergency.

Electrical burns are worse than they look

The skin tells you almost nothing about an electrical burn. Current enters at one point and exits at another, leaving wounds that can look small and contained, while along the path between them it has heated muscle, nerve, and blood vessels you cannot see. Burn surgeons see electrical-injury patients with a small affected skin area and severe internal damage, which is the reverse of how a thermal burn usually reads.

At the scene, after the airway, breathing, and circulation are handled, do not pour all your attention into the skin wounds and miss the bigger picture. Look for an entry and an exit wound, because the line between them tells the responders where the current traveled. Do not move a victim with a suspected spine injury from a fall unless they are in continued danger.

For the burns themselves, do not remove clothing stuck to a burn, and do not break blisters. Cover the area loosely and let the hospital handle it. Every electrical burn beyond the most trivial is a hospital visit, because the internal damage drives the treatment, not the patch on the skin.

Arc-flash injuries: heat, blast, light, and sound

An arc flash is a different injury from a shock, and it can happen without the worker ever touching a conductor. The arc is an explosion of heat and pressure. It throws a wave of heat that can reach thousands of degrees and ignite clothing, a pressure blast that can knock a worker off their feet and rupture eardrums, a flash of light intense enough to damage eyes, and shrapnel of molten metal.

So an arc-flash victim may have several injuries at once: thermal burns over a larger skin area than a shock, a possible fall and blast trauma, hearing loss, and eye injury. If clothing is burning, stop, drop, and roll or smother the flames, then cool the burn with water once the fire is out. Do not peel away clothing fused to the skin.

The arc-rated clothing covered in the arc flash PPE guide is what stands between the worker and a survivable outcome here. When an arc-flash burn happens anyway, treat the burns, watch the airway and breathing closely because inhaled hot gases swell the airway, and move the victim to definitive care fast.

The fall after the shock

A lot of electrical injury is not the current at all. It is the fall. A shock on a ladder, a scaffold, a lift, or a rooftop throws the muscles and the worker comes down, and the head or spine injury from that fall can outweigh the shock that caused it.

Treat the scene as a possible fall victim until you know otherwise. If the worker fell and is unresponsive or complaining of neck or back pain, keep them still and support the head in the position you found it, and let EMS handle moving them, unless a continuing hazard forces a move. The exception is always cardiac arrest: a victim who needs CPR has to be on a firm flat surface and gets it, because a heart that is not beating outranks a spine you are trying to protect.

For planning, fall protection and electrical safety are the same conversation when the work is up high and energized. The shock and the fall come together.

An AED and trained responders on site

Minutes decide electrical arrests, and EMS is often more than a few minutes out, so the equipment and the trained people have to already be on the site. OSHA does not flatly require an AED in its general first-aid rule, but it calls having one a recommended practice, and it reads its first-aid standards as expecting a roughly 3 to 4 minute response to life-threatening emergencies like electrocution and cardiac arrest. An AED in a locked truck across a large site does not meet that.

Put an AED where it can be reached and run back within that window, check its pads and battery on a schedule, and make sure the crew knows where it is. Pair it with people trained to use it. OSHA's construction first-aid rule, 1926.50, requires a person with current first-aid certification on site when a clinic or hospital is not reasonably close, and the general-industry rule, 1910.151, requires trained first-aid providers and supplies on the same logic.

The cost is small against the outcome. A shocked worker on a remote site with no AED and no trained responder is relying on an ambulance to beat a clock that is usually unbeatable.

First-aid readiness when no clinic is near

OSHA's baseline is simple: if there is no infirmary, clinic, or hospital reasonably close to the worksite, you must have trained first-aid providers and adequate supplies on site. That is 1926.50 for construction and 1910.151 for general industry, and near proximity for serious injuries has long been read as a 3 to 4 minute response.

Stock the kit for the work. A jobsite kit should match the hazards present and the crew size, and for electrical work that means burn dressings and the basics for trauma and bleeding, kept stocked and not raided for splinters. Know before the shift where the nearest emergency room is and how an ambulance reaches the site, because a remote or gated site can add minutes nobody planned for.

Readiness is a verb. A kit missing its burn dressings and a responder whose card lapsed last year are not readiness, they are paperwork. Check both the way you would check fall gear.

The best first aid is the contact that never happens

Everything above is what you do after the system has already failed. The work that actually saves the worker happens before the shock: you do not let the contact occur in the first place. De-energize and lock out before the work, and prove the circuit dead with a meter you tested on a known source, the live-dead-live check covered in the lockout/tagout guide. Test before touch is the rule that prevents most of what this guide treats.

For energized work that genuinely cannot be avoided, the shock and arc PPE in the arc flash PPE guide is the layer that keeps a mistake survivable. Ground-fault protection on temporary power trips a fault before it becomes a fatal shock. None of these replaces the others; they stack.

Frame it the way the safety hierarchy does. First remove the hazard by de-energizing, then guard against it, then wear the PPE, and only then rely on the first-aid response. A site that leans on first aid to handle shocks it could have prevented has the order backwards, and the first-aid kit is the most expensive control there is, because by the time you open it someone is already hurt.

GFCI on temporary power trips before it kills

Ground-fault circuit interrupters are cheap insurance on a jobsite, and on construction temporary power they are required. A GFCI watches the current going out against the current coming back, and the instant some of it leaks to ground, through a worker, through wet tools, it trips in a fraction of a second, before the current that is flowing becomes the current that stops a heart.

Use GFCI protection on temporary power and on any cord-and-plug tool used in damp or wet conditions, test the devices on the schedule, and replace the ones that do not trip when tested. A GFCI that is wired in but dead is worse than none, because the crew trusts it. The device buys you the margin between a shock you feel and a shock you do not survive.

The limit worth knowing: a GFCI protects people from a ground fault, the leakage path through a body to ground. It does not protect against a line-to-line contact across two conductors, and it is not a substitute for de-energizing. It is the last automatic catch when a person becomes the path to ground, not a reason to work a circuit hot.

The emergency action plan that makes minutes count

When a worker goes down, nobody should be inventing the response. The site needs an emergency action plan that everyone knows before the day they need it: the site address and how to give it to a 911 dispatcher, where the nearest AED and first-aid kit are, who is trained and who calls, and how an ambulance gets in through the gate or up to the floor.

Write the roles down and rehearse them. One person calls 911 and stays on the line, one runs for the AED, one performs care, one meets and guides the ambulance in. On a large or multi-employer site, the plan ties into the broader safety program and the site's emergency procedures, so the response is the same regardless of which crew the victim belongs to. A plan that lives in a binder nobody has read is not a plan. The one the crew has walked through is the one that saves the four minutes that matter.

After the shock: report and investigate

The response is not over when the ambulance leaves. Every electrical shock gets reported and investigated, including the near miss where someone felt a tingle and walked away, because the same fault that delivered a nip today can deliver a fatal contact tomorrow. The point of the investigation is not blame. It is finding why the contact was possible and closing the gap, the lockout that was skipped, the cord that was damaged, the GFCI that was bypassed.

Record what happened while it is fresh: what the worker was doing, what they contacted, the voltage, the path, what PPE was worn, and what the response looked like. Serious shocks carry OSHA recording obligations, and a hospitalization triggers a reporting deadline, so the documentation is not optional. Feed the finding back into the work: fix the cause, retrain if the procedure was the gap, and verify the fix held. A shock you investigate and correct is a fatality you kept from happening to the next person on that circuit.

Train the response and drill it

Knowing the response and being able to run it under stress are different things. The crew should train the electrical-emergency response and drill it the way they drill a fire evacuation: where the disconnect is for the area they are working, where the nearest AED lives, who does what, and how the address gets relayed to 911. The first time someone looks for the AED should not be the day a coworker is on the ground.

Keep the certifications and the drills tracked so nothing lapses unnoticed. Whether you track training currency, AED inspections, and toolbox-talk attendance in a binder or in a field tool like FieldOS, the goal is the same: the responder's card is current, the AED passed its last check, and the crew has actually walked the plan. A program you can prove is a program that holds up, both when an inspector asks and when a worker goes down.

What to document after a shock

The record from a shock does two jobs: it hands the EMS crew the facts that change their treatment, and it gives the investigation what it needs to close the gap. Capture it while it is fresh, because the details that matter, the voltage, the current path, the time CPR started, blur within the hour.

Walk the response in order and write down each step, what was done, and the note that makes it useful later. The entry and exit wounds, the voltage, and the time the AED first analyzed are the ones EMS and the investigators ask for first.

Common mistakes

• Touching or grabbing the victim while they are still in contact with live current, and becoming the second casualty.
• Approaching a downed high-voltage line or walking through the energized ground around it instead of staying back and calling the utility.
• No AED on site, or starting CPR late, when survival from a shockable arrest falls with every minute.
• Treating a minor shock as nothing and skipping medical evaluation, when delayed cardiac problems and internal burns do not show at the scene.
• No emergency action plan, so the crew improvises the call, the AED, and the roles while a worker is down.
• Trusting an off switch instead of proving the circuit dead, and skipping the LOTO and GFCI that would have stopped the contact.

Field checklist

Standards and references

The standards split into two families: the ones that govern getting hurt by electricity, and the ones that govern the medical response. On the electrical side, OSHA's construction and general-industry electrical rules and NFPA 70E set the safe-work practices, de-energizing, lockout/tagout, approach boundaries, and PPE, that are meant to keep the shock from happening at all. The lockout/tagout and arc flash PPE guides cover those in depth.

On the response side, OSHA's first-aid rules are 1926.50 for construction and 1910.151 for general industry. Both require trained first-aid providers and adequate supplies when professional care is not in near proximity, which OSHA reads as roughly a 3 to 4 minute response for life-threatening injuries such as electrocution and cardiac arrest. OSHA treats an AED as a recommended practice rather than a flat requirement in 1910.151, though some state plans and local codes go further.

The medical procedure itself, the compression rate, the depth, the ratio, the AED steps, follows current American Heart Association and American Red Cross guidance, which is updated on its own cycle. Cite those bodies, take their training, and follow the current version. Verify the OSHA standard against the edition in force and any state-plan differences, and treat this guide as a pointer to those sources, not a replacement for them.

Units, terms, and abbreviations

Electrical injury and emergency response carry their own vocabulary, and the same idea shows up under different names across a safety plan, a medical report, and a code.

Cardiac arrest is sometimes written sudden cardiac arrest or SCA, and the heart rhythm behind it is often ventricular fibrillation, V-fib, or VF. An AED is an automated external defibrillator. CPR is cardiopulmonary resuscitation, and the hands-only form is compression-only CPR. EMS is emergency medical services, the 911 responders. LOTO is lockout/tagout. A GFCI is a ground-fault circuit interrupter, called an RCD outside the US.

Ventricular fibrillation (VF)

A disorganized heart rhythm that pumps no blood; the shockable rhythm an AED is built to correct

AED

Automated external defibrillator, which reads the heart rhythm and delivers a shock only if one is needed

CPR

Cardiopulmonary resuscitation: chest compressions, with or without rescue breaths, to keep blood moving

Step potential

The voltage difference between your feet in the energized ground around a downed line, which drives current through the body

Tetany

Sustained muscle contraction from current, which can keep a victim from letting go of a conductor

GFCI

Ground-fault circuit interrupter, which trips on small leakage current before a shock becomes fatal

EMS

Emergency medical services, the 911 ambulance and paramedic response

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