Table of Contents

1 Introduction.- 1.1 General Perspective.- 1.2 Electrical Exposure.- Electrical Fatalities.- Typical Electrical Exposures.- 1.3 Scales of Short-Term Reactions to Contact Current.- Sensory Reactions.- Muscle Reactions.- Cardiac Reactions.- Thermal Reactions.- Electroporation.- 1.4 Reactions to Electric and Magnetic Field Stimulation.- 1.5 Variables Affecting Thresholds.- 2 Impedance and Current Distribution.- 2.1 Dielectric Properties of Biological Materials.- Conductivity and Permittivity.- Cellular Membranes.- Skin Depth.- 2.2 Skin Impedance.- Detailed Structure of Skin.- Equivalent Circuit Models.- Area Proportionality of Skin Admittance.- Skin Capacitance.- Time-Variant and Nonlinear Aspects of Skin Impedance.- 2.3 Total Body Impedance: Low-Frequency and DC.- Distribution of Current and Impedance Within the Body.- Current Through the Heart.- Applicability of Measurements on Corpses.- Statistical Distribution of Impedance.- 2.4 Impedance at Higher Frequencies.- 2.5 Impedance Through Foot Contact.- 2.6 High-Voltage and Transient Properties.- Spark and Contact Components.- Plateau Voltage.- Spark Discharges and Corneal Degradation.- Discharge Impedance.- Variation with Stimulus Location.- Polarity Effects.- Stimulus Time Constants.- Minimum Impedance with Spark Discharge.- Internal Body Impedance.- 2.7 Impedance of Domestic Animals.- 3 Electrical Principles of Nerve and Muscle Function.- 3.1 Introduction.- 3.2 Cellular Membranes.- The Nernst Equation.- 3.3 The Excitable Nerve Membrane.- The Hodgkin-Huxley Membrane.- The Frankenhaeuser-Huxley Membrane.- Species Dependence of Action Potential.- Dynamics.- Propagation of Nerve Impulses.- 3.4 Action Potential Models for Cardiac Tissue.- 3.5 Sensory Transduction.- Intensity Coding.- 3.6 Muscle Function.- 3.7 Synapses.- General Properties.- Synaptic Interactions with In-Situ E-Fields.- 3.8 The Spinal Reflex.- 4 Excitation Models.- 4.1 Introduction.- 4.2 Linear Strength-Duration Model.- Empirical Strength-Duration Relationships.- 4.3 Electrical Cable Representations.- One-Dimensional Cable Models.- Nonlinear Models.- 4.4 Myelinated Nerve Model.- Threshold Criterion.- Position and Number of Nonlinear Nodes.- Suprathreshold Response.- 4.5 Response to Monophasic Stimulation.- Strength-Duration Relations.- Polarity Sensitivity.- Current Density and Electric Field.- Relationships.- 4.6 Response to Biphasic and Repetitive Stimuli.- Strength-Duration Relationships.- Sinusoidal Stimuli.- Repetitive Stimuli.- Nonlinear Interaction of Multiple Waveforms.- 4.7 Parameter Variation Effects.- 5 Electrical Properties of the Heart.- 5.1 Cardiovascular System: General Anatomical and Functional Aspects.- 5.2 Origin and Spread of Excitation.- Autorhythmicity and Geometry of Propagation.- Hierarchy of Pacemaker Activity and Artificial Pacemakers.- 5.3 Elementary Processes of Excitation and Contraction.- Ionic Mechanisms of Excitation.- Mechanism of Contraction.- Excitation-Contraction Coupling.- 5.4 Stimulation, Propagation, and Refractoriness.- Elementary Mechanisms.- Conduction of the Action Potential.- Definition and Mechanism of Refractoriness.- 5.5 Regular and Ectopic Pacemakers.- Elementary Events in Impulse Formation.- Actual and Potential Pacemakers.- Ectopic Pacemakers.- 5.6 Effects of Autonomic Nerves and of Changes in Electrolyte Composition.- Parasympathetic and Sympathetic Innervation.- Chronotropy, Inotropy, and Dromotropy.- Vagal and Sympathetic Tone.- Mechanism of Autonomic Transmitter Actions.- Effects of the Ionic Environment and of Drugs.- 5.7 Electrocardiogram.- ECG Form and Nomenclature; Relation to Cardiac Excitation.- Origin of ECG.- ECG Recording.- Use of the ECG in Diagnosis.- 5.8 Abnormalities in Cardiac Rhythm as Reflected in the ECG.- Rhythms Originating in the AV Junction.- Rhythms Originating in the Ventricles.- Extrasystoles.- Atrioventricular Disturbances of Conduction.- Atrial Flutter and Fibrillation.- Ventricular Flutter and Fibrillation.- 5.9 Mechanism of Flutter and Fibrillation.- Conditions for Reentry; Anatomical and Functional Pathways.- Length of the Excitation Wave.- Mechanisms of Abbreviated Refractory Periods.- Mechanisms of Slow Conduction.- Unidirectional Block and One-Way Conduction.- 5.10 Vulnerable Period: Threshold for Fibrillation.- The Threshold for Fibrillation.- Relation to the Threshold for Stimulation.- Effects of Alternating and Pulsed Direct Current.- Significance of Single and Repetitive Extrasystoles.- 5.11 Electrical Defibrillation.- 6 Cardiac Sensitivity to Electrical Stimulation.- 6.1 Introduction.- 6.2 Threshold Sensitivity with Respect to Cardiac Cycle.- 6.3 Strength-Duration Relations for Unidirectional Currents.- Electrode Size.- Polarity.- Size of Tissue Preparation.- Fibrillation by Prolonged Currents.- Consistency of Data.- 6.4 Biphasic and Sinusoidal Stimulation.- 6.5 Duration Sensitivity for Oscillatory Stimuli.- Excitation Sensitivity.- Fibrillation Sensitivity.- The Z Relationship for Fibrillation by AC Currents.- 6.6 Energy Criteria and Impulse Currents.- 6.7 Body-Size Scaling.- Experimental Body-Size Data.- Scaling Arguments.- 6.8 Statistical Distribution of Thresholds.- 6.9 Combined AC and DC Stimuli.- 6.10 Electrodes and Current Density.- Electrode Area.- Current Density.- Locus and Direction of Stimulus Current.- 7 Sensory Responses to Electrical Stimulation.- 7.1 Introduction.- 7.2 Mechanisms of Electrical Transduction.- 7.3 Perception of Transient Monophasic Currents.- Strength-Duration Relationships.- Capacitor Discharges.- 7.4 Suprathreshold Responses.- Magnitude Scaling.- Categorical Scaling.- AC or Repetitive Stimuli.- Dynamic Range of Electrical Stimulation.- 7.5 Stimulus Waveform Factors.- Biphasic Stimuli.- Repetitive Stimuli.- Sinusoidal Stimuli.- Polarity Effects.- 7.6 Electrodes and Current Density.- Cutaneous Electrodes.- Current Density Considerations.- 7.7 Body Location Sensitivity.- 7.8 Skin Temperature.- 7.9 Tactile Masking.- 7.10 Individual Differences in Electrical Sensitivity.- Potential Sources of Variability.- Distribution of Sensitivity.- Correlates of Sensitivity.- 7.11 Startle Reactions.- 7.12 Electrical Stimulation of Domestic Animals.- Reactions to 60-Hz Stimulation.- Reactions to Transient Stimulation.- Statistical Distribution of Bovine.- Reaction Thresholds.- Magnetic Field Stimulation of Cows.- 7.13 Visual and Auditory Effects.- 8 Skeletal Muscle Response to Electrical Stimulation.- 8.1 Introduction.- 8.2 Neuromuscular Structure and Function.- Skeletal Muscle Innervation.- Peripheral Nerve Trunk Structure.- Muscle Action Potentials and Excitation-Contraction Coupling.- Skeletal Muscle Force Production.- Differentiation of Skeletal Muscle Fiber Types.- Recruitment and Firing Patterns.- Fatigue in Normal Physiological Use.- Dynamic Nature of Skeletal Muscle Fiber Types.- 8.3 Fundamental Principles of Skeletal Muscle Electrical Stimulation.- Strength-Duration (S-D) Relations for Neuromuscular Excitation.- Regulated-Current Versus Regulated-Voltage Stimulation.- Biphasic Stimulation.- Fatigue and Conduction Failure in Response to Electrical Stimulation.- Sinusoidal Stimulation Strength-Frequency (S-F) Effects.- 8.4 Functional Neuromuscular Stimulation Systems.- Objectives and Applications of FNS Systems and Technologies.- Electrical Excitation of Skeletal Muscle by Functional Neuromuscular Stimulation.- Electrodes for Functional Neuromuscular Stimulation.- Recruitment and Rate Modulation in Functional Neuromuscular Stimulation.- Electropathology of Functional Neuromuscular Stimulation Systems.- 8.5 Skeletal Muscle Stimulation in Electrical Accidents.- History and Overview.- Let-Go Thresholds for Hand Contact with Electrical Stimuli.- 8.6 Analysis of the Let-Go Phenomenon.- Functional Anatomy of the Hand and Wrist.- Excitation Threshold Estimates.- 8.7 Effects of Electrical Stimulation on Respiration.- Anatomy and Physiology of Respiration.- Accidental Electric Shocks and Respiration.- Artificial Respiration by Electrical Stimulation.- 9 Stimulation via Electric and Magnetic Fields.- 9.1 Introduction.- 9.2 Electric Field Induction Principles.- Induction Mechanisms.- Body Surface Effects.- Induced Electric Shock Principles.- 9.3 Direct Perception of ELF Electric Fields.- Mechanisms for Human Detection.- 9.4 Human Reactions to AC Electric Field-Induced Shock.- Perception Thresholds.- Superthreshold Effects.- Multiple Discharges.- Extrapolation to Other Frequencies.- Skin Erosion from Low-Energy Discharges.- 9.5 Time-Varying Magnetic Field Induction.- 9.6 Principles of Excitation by Time-Varying Magnetic Fields.- Pulsed Fields: Large Area Exposure.- Minimum Excitation Thresholds.- Strength-Duration Time Constants.- Anatomical Considerations.- Calculated Nerve and Cardiac Excitation Thresholds.- Sinusoidal Fields: Large Area Exposure.- Criteria for Nerve and Heart Excitation: Large Area Exposure.- Body Size Scaling.- 9.7 Experimental Investigations of Magnetic Excitation: Large Area Exposure.- Thresholds for Nerve Excitation.- Thresholds for Cardiac Excitation.- Stimulus Duration and Frequency Effects.- Suprathreshold Nerve Excitation Reactions.- 9.8 Visual and Auditory Reactions to Electromagnetic Exposure.- Direct Perception of Magnetic Fields.- Visual Sensations.- Mechanisms for Phosphenes.- Duration and Frequency Relationships for Visual Effects.- Implications of Phosphenes for.- CNS Synaptic Interactions.- Auditory Sensations.- 9.9 Local Magnetic Stimulation.- Small Coil Stimulators.- Induced Electric Field.- Local Stimulation of the Brain Cortex.- 9.10 Scales of Reaction: Power Frequency.- Magnetic Field Exposure of the Head.- 9.11 Magnetic Forces on Moving Charges.- Magnetohydrodynamic Effects.- Ion Resonance.- 10 High-Voltage and High-Current Injuries.- 10.1 Introduction.- 10.2 Modes of Injury.- Thermal Injury.- Electroporation.- Fibrillation.- 10.3 Impedance Considerations and Current Distribution in the Body.- Total Body Impedance.- Contact Impedance and Segmental Body.- Impedance.- Tissue Current Densities and Current Distribution.- 10.4 Thermal Trauma.- Heating at the Contact Site.- Heating of the Tissues.- 10.5 Nonthermal Trauma.- 10.6 Lightning Injuries.- 10.7 Clinical Observations.- Electrical Burns.- Tissue Lesions.- Neurologic Sequelae.- Cardiovascular Effects.- 10.8 Clinical Treatment.- 11 Standards and Rationale.- 11.1 Introduction.- 11.2 Electromagnetic Field Exposure Standards.- Standards of the IEEE and ANSI.- Rationale for IEEE/ANSI C95.1 Standards.- Electric and Magnetic Field Criteria for IEEE/ANSI C95.1.- Induced Current and Electric Shock Considerations.- Other Standards on Electromagnetic Exposure.- Electromagnetic Exposure Limits at Low Frequencies.- Static Electric and Magnetic Fields.- 11.3 Pulsed Electromagnetic Fields.- Pulsed Field Limits in Magnetic Resonance Imaging.- Extrapolation of MRI Exposure Limits to EMF Standards.- Limits of Applicability.- 11.4 Consideration of Spark Discharges in EMF Standards.- 11.5 Absorbed Energy and Thermal Considerations in EMF Standards.- Specific Absorption Rate (SAR) Limits.- Endogenous Field Limits to EMF Interactions.- 11.6 Consideration of EMF Interaction Mechanisms in Standards Setting.- Categories of Mechanisms of Bioelectric Interaction.- Established Mechanisms for Human Bioelectric Response.- Proposed Mechanisms for Human Bioelectric Response.- 11.7 ELF Magnetic Field Standards Derived from Established Mechanisms.- Threshold Criteria.- Limit Criteria.- Other Considerations for ELF Standards.- 11.8 Standards in Consumer Products and Installations.- Standards Setting Agencies.- Safety Criteria for Consumer Products.- Hazard Criteria Versus Current Duration and Frequency.- Limits for Capacitor Discharges.- Ground Fault Current Interrupter.- References.

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