title: Electrical injury from subway third rails: serious injury associated with intermediate voltage contact.
abstract: BACKGROUND
  Railway and subway-associated electrical trauma is rare and typically involves high voltage (> 20,000) arc injuries. Not all rail systems utilize such high voltage. We report 16 cases of electrical trauma due to 600 V direct contact with subway 'third' rails.
  
  
  METHODS
  A case series of injured patients presenting to Shriners Burns Institute, Boston or Massachusetts General Hospital between 1970 and 1995 was retrospectively analyzed.
  
  
  RESULTS
  A total of 16 cases was identified. Among seven subway workers, the mechanism of rail contact was unintentional by a tool, a hand or by falling; no deaths occurred. Among nine non-occupational victims, injuries involved suicide attempts, unintentional falls, or risk-taking behavior. This group suffered greater burn severity, operative procedures, and complications; three deaths occurred.
  
  
  CONCLUSIONS
  This is the largest report series of direct electrical trauma from a subway third rail. The high morbidity and mortality from this 600 V contact suggests that the traditional classification of low voltage (< 1000 V) exposure can be subdivided to reflect the serious and lethal potential of intermediate range exposures compared to household range exposures (0-220 V).
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rabban
authors.forename: J
authors.initials: J
authors.lastname: Adler
authors.forename: C
authors.initials: C
authors.lastname: Rosen
authors.forename: J
authors.initials: J
authors.lastname: Blair
authors.forename: R
authors.initials: R
authors.lastname: Sheridan
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D002058:Burns, Electric / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D004560:Electricity / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D011890:Railroads; D012189:Retrospective Studies; D012307:Risk Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D015996:Survival Rate