Burns and Electrical Shock First Aid: A Workplace Guide

Burn injuries and electrical shock are among the most common serious injuries in construction and general industry. The Electrical Safety Foundation International reports 5,180 nonfatal electrical injuries involving days away from work in 2023-2024, a 59% increase from the previous two-year period. Overhead power line contact is the leading cause of fatal electrical injuries in the workplace, accounting for 49% of all electrical fatalities over the 2011-2024 period.

This guide covers first aid response for thermal burns and electrical shock injuries in the workplace, based on the 2024 American Heart Association and American Red Cross First Aid Guidelines and OSHA requirements under 29 CFR 1910 Subpart S and 29 CFR 1926 Subpart K.

Who This Guide Is For

This guide is written for designated first aid responders, supervisors, safety officers, and any worker who may be the first person on scene when a burn or electrical injury occurs. It covers recognition, scene safety, first aid response sequencing, and the most common errors in burn and electrical injury management. Formal first aid certification requires hands-on training with a qualified provider. This guide is a reference for recognition and initial response decisions.

OSHA requirement: When employees are working with exposed wires or a current of 50 volts or more, at least one person trained in first aid including CPR must be present on site. This applies under both 29 CFR 1910.151 (general industry) and 29 CFR 1926.50 (construction). The first aid training requirement for electrical work is not optional based on perceived risk level; the voltage threshold triggers it.

Part 1: Burns

Burn Classification

The severity of a burn determines both the first aid response and whether the injury requires emergency care. The classification system used in US first aid is based on depth of tissue involvement.

Burn classification: depth and characteristics

Degree

Depth

Appearance

EMS needed?

First degree

Epidermis only

Red, dry, painful (like a sunburn). No blistering.

No (unless large area)

Second degree

Epidermis + dermis

Red, blistered, wet-looking, intensely painful. May appear white or splotchy.

Depends on size/location

Third degree

All skin layers

White, brown, or black. Dry or leathery. May be painless (nerve destruction).

Always — call 911

When to Call 911 for a Burn

Call 911 immediately for any burn that:

911 triggers for burn injuries

!Goes through all layers of skin (third degree), or the skin appears charred, white, brown or black

!Is larger than 3 inches (about 8 cm) across in any dimension

!Affects the face, hands, feet, genitals, buttocks, or major joints (knees, elbows, shoulders)

!Wraps around an arm or leg (circumferential burn — impairs circulation)

!Is accompanied by smoke inhalation (any burn sustained in a fire or enclosed space)

!Was caused by electricity, lightning, or strong chemicals

First Aid for Thermal Burns

Thermal burn first aid: step-by-step

Remove from the heat source if it is safe to do so. Move the person away from the source of the burn. Do not attempt to rescue someone from a burning structure without fire suppression training.

Cool the burn with cool running water for at least 10 minutes. Research supports cooling for up to 20 minutes for best outcomes. Use cool water, not cold or ice water. Ice water can cause additional tissue injury through ischemia and may induce hypothermia in larger burns. Do not use ice packs, butter, toothpaste, or any other substance.

Remove jewelry and non-adhering clothing from the burn area before swelling starts. Do not pull off clothing that is stuck to the burned skin. Do not remove clothing if doing so requires force.

Cover loosely with a clean, dry dressing or sterile gauze. Do not use fluffy cotton or adhesive dressings directly on the burn. Do not wrap tightly.

Elevate the burned area above the level of the heart if possible to reduce swelling.

Watch for shock. Large burns cause significant fluid loss and can lead to hypovolemic shock. Monitor for pale, cool, clammy skin; rapid weak pulse; and confusion. Lay the person flat and keep them warm if shock signs develop. Call 911 if not already done.

What Not to Do with Burns

Do not use ice or ice water

Ice water causes additional tissue injury through vasoconstriction and ischemia. In large burns, it can also cause hypothermia. Cool running water is the correct intervention.

Do not apply butter, oil, or toothpaste

These substances trap heat in the tissue, increase the risk of infection, and make clinical assessment more difficult when the person reaches an emergency department.

Do not pop blisters

Blisters are a protective barrier against infection. Breaking them exposes the wound to contamination. If a blister breaks on its own, clean gently with water and cover with a non-adherent dressing.

Chemical Burns

Chemical burns require a different approach than thermal burns. The goal is dilution, not cooling.

Chemical burn first aid: Flush with large amounts of cool running water continuously until EMS personnel arrive. Do not try to neutralize the chemical with another chemical (applying a base to an acid or vice versa). The neutralization reaction generates heat and can worsen the injury. Remove contaminated clothing while protecting yourself from exposure. The Safety Data Sheet for the chemical (SDS Section 4) will specify first aid measures for skin contact.

Part 2: Electrical Shock

Understanding Electrical Injuries

Electrical injuries are deceptive. The external burn visible at the entry and exit points of the current is often far less severe than the internal damage along the current’s pathway through the body. A current of 50 milliamperes can stop the heart. The severity of electrical injury depends on the current type (AC is more dangerous than DC at the same voltage), voltage, resistance of the tissue, pathway through the body, and duration of contact.

Field Observation

In post-incident reviews of electrical injuries on construction sites, the most consistent finding is that workers who appeared to have only minor skin burns were later diagnosed with significant internal injuries including cardiac arrhythmias, muscle damage, and nerve injury. An electrical injury that looks minor externally always requires medical evaluation. The burn on the skin is not a reliable indicator of internal damage.

Scene Safety: The Non-Negotiable First Step

The single most important principle in electrical injury first aid is that the first responder must not touch the injured worker until the electrical source is confirmed off. Contact with a person who is still connected to an electrical source will result in the first responder receiving the same shock. This is not a risk to manage; it is an absolute restriction.

Electrical scene safety: what to do before approaching

Low-voltage incidents (household or industrial current):

Turn off the power at its source (circuit breaker, disconnect switch, or power strip). Do not use the switch near the worker; turn off the circuit. Confirm power is off before approaching or touching the worker.

High-voltage incidents (fallen power lines, transformers):

Do not approach. Do not use any object, including wooden ones, to try to move the worker or the wire. Everything will conduct at high voltage. Stay at least 30 feet away and call 911 immediately. Do not enter the area until the power company has confirmed the line is de-energized.

Vehicle contact with a power line:

If a vehicle has contacted a power line, occupants should stay inside the vehicle. The vehicle may be energized but the current is contained within it. Exiting the vehicle creates a path for current to flow through the person to the ground. Call 911 and wait for the utility company to de-energize the line.

Critical: Do not attempt to move fallen power lines or electrical wires using wooden sticks, rubber gloves, or any improvised non-conductive material. At high voltage, all materials conduct. Do not approach downed lines under any circumstances.

First Aid Response After Power Is Confirmed Off

Once the power source is confirmed off and the scene is safe, the first aid response follows the primary survey and then addresses specific electrical injury needs.

Electrical injury response after scene is safe

1Call 911 immediately for any electrical injury. All electrical injuries require medical evaluation even if the worker appears unhurt. Internal injuries may not be apparent.

2Check for responsiveness and breathing. If the worker is unresponsive and not breathing normally, begin CPR immediately and retrieve the AED. Cardiac arrest is a primary risk from electrical contact.

3Do not move the person unnecessarily. Electrical injuries from falls or muscle contractions can cause spinal injuries. Treat every unconscious electrical injury victim as having a potential spinal injury until EMS evaluates them.

4Cover burn sites. Apply a clean, dry dressing loosely over entry and exit burn points. Do not use wet dressings on electrical burns as the current may have disrupted skin and tissue integrity significantly.

5Monitor continuously. Cardiac arrhythmias can occur after electrical injuries, sometimes delayed. Keep the worker still, warm, and monitored until EMS arrives.

Arc Flash Injuries

Arc flash is a form of electrical explosion caused when electrical energy jumps through the air between conductors. Arc flash incidents can cause severe thermal burns across exposed skin, pressure wave injuries, flash blindness, and hearing loss. The temperature of an arc flash can exceed 35,000 degrees Fahrenheit at its core. Arc flash injuries account for a significant proportion of electrical burn hospitalizations in industrial environments.

Arc flash first aid distinction: Arc flash victims may have extensive thermal burns but may not have been directly in contact with live electrical conductors. Scene safety still requires confirming that the electrical system is de-energized before approaching, because the arc event itself does not guarantee the system is off. Treat arc flash burns as thermal burns of the degree indicated, plus assess for pressure wave injuries (barotrauma) and potential hearing loss from the event.

Common Mistakes in Burn and Electrical Shock Response

Touching an electrical injury victim before confirming the power is off

This converts the first responder into a second victim. Scene safety is not optional. Confirm power off before any contact with the worker or anything they are touching.

Using ice water to cool a thermal burn

Ice water causes additional tissue injury and risks hypothermia in large burns. Cool running water for 10 to 20 minutes is the correct intervention; ice is not.

Applying butter, oil, or toothpaste to a burn

These trap heat, increase infection risk, and obscure the wound for medical assessment. They have no first aid benefit and have been contraindicated in guidelines for decades.

Assuming a minor-looking electrical injury requires no medical attention

External appearance is not a reliable indicator of electrical injury severity. Internal burns to muscles, nerves, and heart tissue may be severe despite minimal visible skin damage. All electrical injuries require medical evaluation.

Trying to use a wooden stick to move a downed power line

At high voltages, wood conducts. No non-trained person should approach downed power lines or attempt to move them with any material until the utility company confirms the line is de-energized.

Neutralizing a chemical burn with another chemical

Applying a base to an acid or vice versa generates heat through the neutralization reaction and can worsen the burn. Flush with large amounts of cool running water continuously until EMS arrives.

OSHA Reporting Requirements for Burn and Electrical Injuries

Recordability

Work-related burns and electrical injuries that require medical treatment beyond first aid must be recorded on the OSHA 300 log within 7 days. A burn requiring only cool water and a dressing is first aid and is not recordable. A burn requiring prescription medication, debridement, or skin grafting is medical treatment and is recordable.

Mandatory Reporting

OSHA requires employers to report certain incidents directly to OSHA regardless of recordability:

OSHA mandatory reporting (29 CFR 1904.39)

!Fatality: Report within 8 hours of learning of the death

!Inpatient hospitalization: Report within 24 hours. An electrical injury requiring hospital admission triggers this requirement.

!Amputation: Report within 24 hours. Severe electrical burns can result in amputation.

!Loss of an eye: Report within 24 hours. Arc flash incidents can cause permanent eye injury.

FAQs

Can I cool a burn with cold tap water instead of running water? Cold tap water is acceptable if running water is not immediately available, but it should not be used for extended periods because of the risk of hypothermia in large burns. Running cool water is preferred. Ice and ice-cold water are not acceptable.

Should I remove clothing from a burn area? Remove loose, non-adherent clothing before swelling makes it impossible. Do not forcibly remove clothing that is stuck to the burned skin; leave it in place and let medical personnel remove it.

What do I do if I cannot turn off the power source? If the power cannot be quickly isolated by an authorized person, do not approach the victim. Call 911 immediately. High-voltage injuries in particular require utility company intervention before any approach is safe.

Is an AED appropriate for an electrical injury victim? Yes. If the worker is in cardiac arrest following an electrical injury, begin CPR and use the AED as soon as it is available. Electrical injury frequently causes ventricular fibrillation, which is a shockable rhythm.

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