Electrical Safety

of
Medical Equipment

Each year in the United States about 100,000 people are killed in
accidents. About half the fatal accidents occur in motor vehicles, about
20 percent involve falls, and only about 1 percent of the fatalities are caused
by electric current, including lightning. The majority of accidental electro-
cutions occur in industry or on farms. The statistics, which consider medical
facilities to be industries, do not specifically show how many of these acci-

dents occur in hospitals, but the number is probably not large. Most electrical
accidents, however, are not fatal, but incidents in which staff members or
patients receive nonfatal electrical shocks are much more common than the
show.
fatality statistics
Over the years electrical and electronic equipment has found increasing
use in the hospital. Little attention was paid at first to the hazards that

might create. Some sensational reports published around

this proliferation
1970 on microshock hazard, which supposedly had killed a large number of
patients in intensive-care units, suddenly drew attention to this subject.
While the reports on microshock accidents were frequently anecdotal and
no concise statistical analysis ever seems to have been published, growing

430
16. 1 Physiological Effects of Electrical Current 431

concern about electrical hazards nevertheless resulted in numerous regula-

tions and standards which attempted to improve electrical safety in the
hospital. While some of the requirements have come under attack for
unnecessarily increasing the cost of health care, this development has
definitely contributed to improved design of electrical and electronic equip-
ment for hospital use.

16.1 PHYSIOLOGICAL EFFECTS

OF ELECTRICAL CURRENT
Electrical accidents are caused by the interaction of electric current
with the tissues of the body. For an accident to occur, current of sufficient
magnitude must flow through the body of the victim in such a way that it
impairs the functioning of vital organs. Three conditions have to be met
simultaneously [see Figure 16.1(a)]: two contacts must be provided to the
body (arbitrarily called first and second contacts), together with a voltage
source to drive current through these contacts. The physiological effects of
the current depend not only on their magnitude but also on the current
pathway through the body, which in turn depends on the location of the

2.) Second
contact
Figure 16.1. The electrical accident.
(a) The three necessary conditions.
(b) The generalized model where Rp
is the fault or leakage resistance,
First
Rci and Rc2 are first and second 1.)
contact
contact resistance, Rg is body resist-

ance and Rr is the ground return

resistance.

(a)

Current

Line
voltage I ('V

(b)
432 Electrical Safety of Medical Equipment

first and second contacts. Two particular situations have to be considered

separately: when both contacts are applied to the surface of the body and
when one contact is applied directly to the heart. Because the current sen-
sitivity of the heart is much higher in the second case, the effect of current
applied directly to the heart is often referred to as microshock, while in
this context the effect of current appUed through surface contacts is called
macroshock.
Figure 16.1(b) a generalized model of an electrical accident and will
is

be referred to appropriate sections.

later in the chapter in various
Basically, electric current can affect the tissue in two different ways.*
First, the electrical energy dissipated in the tissue resistance can cause a
temperature increase. If a high enough temperature is reached, tissue
damage (burns) can occur. With household current, electrical burns are
usually limited to localized damage at or near the contact points, where the
density of the current is the greatest. In industrial accidents with high voltage,
as well as in lightning accidents, the dissipated electrical energy can be
sufficient to cause bums involving larger parts of the body. In electrosurgery,
the concentrated current from a radio-frequency generator with a frequency
of 2.5 or 4 MHz is used to cut tissue or coagulate small blood vessels.
Second, as shown in Chapter 10, the transmission of im^pulses through
sensory and motor nerves involves electrochemical action potentials. An
extraneous electric current of sufficient magnitude can cause local voltages
that can trigger action potentials and stimulate nerves. When sensory nerves
are stimulated in this way, the electric current causes a **tingling" or
**
prickling" sensation, which at sufficient intensity becomes unpleasant and
even painful. The stimulation of motor nerves or muscles causes the con-
traction of muscle fibers in the muscles or muscle groups affected. A high-
enough intensity of the stimulation can cause tetanus of the muscle, in
which all possible fibers are contracted, and the maximal possible muscle
force is exerted.
The extent of the stimulation of a certain nerve or muscle depends
on the potential difference across its cells and the local density of the current
flowing through the tissue. An electric current flowing through the body
can be hazardous or fatal if it causes local current densities in vital organs
that are sufficient to interfere with the functioning of the organs. The
degree to which any given organ is affected depends on the magnitude of the
current and the location of the electrical contact points on the body with
respect to the organ.
Respiratory paralysis can also occur if the muscles of the thorax are
tetanized by an electric current flowing through the chest or through the

*A third type of injury can sometimes be observed under skin electrodes through which
a small dc current has been flowing for an extended time interval. These injuries are due to
electrolytic decomposition of perspiration into corrosive substances and are, therefore, actual
chemical burns.
 16. 1 Physiological Effects of Electrical Current 433

respiratory control center of the brain. Such a current is likely to affect the
heart also, because of its location.
The organ most susceptible to electric current is the heart. The peculiar
characteristics of its muscle fibers cause it to react to electric current dif-
ferently than other muscles. When the current density within the heart
exceeds a certain value, extra systolic contractions first occur. If the current
density is increased further, the heart activity stops completely but resumes
if the current removed within a short time. This type of response,
is

however, appears to be limited to a fairly narrow range of current density.

An even further increase in current density causes the heart muscle to go
into fibrillation. In this state the muscle fibers contract independently and
without synchronism, a situation that fails to provide the necessary gross
contraction. When the fibrillation occurs in the ventricles (ventricular
fibrillation) the heart is unable to pump blood. In human beings (and other
large mammals) ventricular fibrillation does not normally revert spontaneously
to a normal heart rhythm. Ventricular fibrillation and resulting cessation
of blood circulation is the cause of death in the majority of fatal electrical
accidents. It can be converted to a regular heart rhythm, however, by the
application of a defibrillating current pulse of sufficient magnitude. Such
a pulse, applied from a defibrillator (see Section 7.6), causes a momentary
contraction of many or all muscle fibers of the heart, which effects a
synchronization of their activity. an accidental situation, the heart
If, in
receives enough current to tetanize the entire myocardium and assuming the
current isremoved in time, the heart will revert to normal rhythm after
cessation of the current.
The magnitude of electric current required to produce a certain
physiological effect in a person influenced by many factors. Figure 16.2
is

shows the approximate current ranges and the resuhing effects for 1 -second
exposures to various levels of 60-Hz alternating current applied externally
to the body. For those physiological effects that involve the heart or respira-
tion, it is assumed that the current is introduced into the body by electrical
contact with the extremities in such a way that the current path includes the
chest region (arm-to-arm or arm-to-diagonal leg).
For most people, the perception threshold of the skin for light finger
contact is approximately 500 /i A, although much lower current intensities
can be detected with the tongue. With a firm grasp of the hand, the threshold
is about 1 mA. A current with an intensity not exceeding 5 mA is generally

not considered harmful, although the sensation at this level can be rather
unpleasant and painful. When at least one of the contacts with the source
I of electricity is made by grasping an electrical conductor with the hand,
currents in excess of about 10 or 20 mA can tetanize the arm muscles
and make it impossible to **let go" of the conductor. The maximum current

level a person can tolerate and still voluntarily let go of the conductor is
called his let-go current level. Ventricular fibrillation can occur at currents
 SEVERE BURNS
and physical injury

Sustained myocardial
contraction (followed
10A by normal heart
rhythm if current V Danger of
is removed in, time) respiratory paralysis

1 A- DANGER
of ventricular
fibrillation

100 mA

Pain, fatigue, possible

physical injury

Maximum "let go" current

10 mA

Accepted safe level (5 mA)

1 mA

500 mA '
Threshold of perception

Figure 16.2. Physiological effects of electrical current from

1 -second external contact with the body (60 Hz ac).

434
16. 1 Physiological Effects of Electrical Current 435

above about 75 mA, 1 or 2 A can cause

while currents in excess of about
contraction of the heart, which may normal rhythm if current is
revert to
discontinued in time. This condition may also be accompanied by respira-
tory paralysis.
Data on these effects are rare for obvious reasons and are generally
limited to accidents in which the magnitude of the current could be recon-
structed, or to experimentation with animals. From the data available it

appears that the current required to cause ventricular fibrillation increases

with the body weight and that a higher current is required if the current
is applied for a very short duration. From experiments in the current range
of the perception threshold and let-go current, it is known that the effects
of the current are almost independent of frequency up to about 1000 Hz.
Above that limit, the current must be increased proportionally with the
frequency in order to have the same effect. It can be assumed that, at

higher current levels, a similar relationship exists between current effects

and frequency.
In the foregoing considerations, the electrical intensity is always
described in terms of electric current. The voltage required to cause the
current flow depends solely on the electrical resistance that the body offers
to the current. This resistance is affected by numerous and can vary
factors
from a few ohms to several megohms. The largest part of the body resistance
is normally represented by the resistance of the skin. The inverse of this
resistance, the skin conductance, is proportional to the contact area and

also depends on the condition of the skin. Intact, dry skin has a conductivity
of as low as 2.5 /i i; cm^ This low conductivity is caused mainly by the
horny, outermost layer of the skin, the epithelium, which provides a natural
protection against electrical danger. When this layer is permeated by a con-
ductive fluid, however, the skin conductivity can increase by two orders of
magnitude. If the skin is cut, or if conductive objects Uke hypodermic
needles are introduced through the skin, the skin resistance is effectively
bypassed. When measured between the
this situation occurs, the resistance
contacts is determined only by the tissue in the current path, which can be as
low as 500 ^2 Electrode paste used in the measurement of bioelectric
.

potentials (see Chapters 4, 6, and 10) reduces the skin resistivity by elec-
trolyte action and mechanical abrasion. Many medical procedures require
the introduction of conductive objects into the body, either through natural
openings or through incisions in the skin. In many instances, therefore, the
hospital patient deprived of the natural protection against electrical
is

dangers that the skin normally provides. Because of the resulting low resis-
tance, dangerously high currents can be caused by voltages of a magnitude
that normally would be rendered safe by the high skin resistance.
 . —

438 Electrical Safety of Medical Equipment

In certain medical procedures, a direct contact to the heart may even

be established. This contact can occur in three different ways:

1 Electrically conductive catheters are inserted through a vein into

the heart to apply stimulating signals from an externally worn
pacemaker. Such pacing catheters provide a connection with a
resistance of only a few ohms. Patients with such catheters are
normally located in the coronary-care or intensive-care unit
of the hospital.
2. Fluid-filled catheters provide a conductive pathway only inci-
dentally because the insulating catheter wall retains the current
in the conductive fluid that fills the catheter lumen. These
catheters provide a current path with a much higher resistance
than that of a pacing catheter (0.1 to 2 M
n depending on the ,

size and length of the catheter). Fluid-filled catheters are used

for a number of medical procedures. For cardiac catheterization
normally performed in a specially equipped X-ray suite pres- —
sures in the heart are measured and blood samples are withdrawn
through similar catheters. Similarly, dyes or saline solution are
injected and blood samples are withdrawn to determine the
cardiac output (see Chapter 6), a procedure that is sometimes
even performed at the bedside of patients. In (selective) angio-
cardiography, catheters are used to inject a radiopaque dye into
the heart or the surrounding blood vessels to facilitate their
visuahzation on a series of X-ray photos, often taken in rapid
succession (see Chapter 14). This procedure is often performed
in the regular X-ray suite.
3. While in the procedures described, a conductive path is created
either intentionally or incidentally, a contact to the heart can
also be established accidentally without the physician being
aware of that fact. This situation can occur when an electrical
device (e.g., a thermistor catheter, which is supposed to be
insulated, see Chapter 6) has an insulation failure, or when a
fluid-filled catheter is inadvertently positioned inside the heart
rather than in one of the major veins.

Information on the current necessary to cause ventricular fibrillation

when applied directly to the heart was obtained mainly from experiments
with dogs, since human data are very limited. While fibrillation has occa-
sionally been observed at currents as low as 20 ^ A, in most cases the neces-
sary current is much higher.
 16.2. SHOCK HAZARDS FROM ELECTRICAL
EOUIPMEIMT
An example of a typical hospital electric-power-distribution system,
is shown in somewhat simplified form in Figure 16.3. From the main hospital

substation, the power is distributed to individual buildings at 4800 V, usually

through underground cables. A stepdown transformer in each building has
a secondary winding for 230 V that is center-tapped and thus can provide
two circuits of 115 V each. This center tap is grounded to the earth by a
connection to a ground rod or water pipe near the building's substation.
Heavy electrical devices, such as large air conditioners, ovens, and X-ray
machines, operate on 230 V from the two ungrounded terminals of the
transformer secondary. Lights and normal wall receptacles receive 115 V
through a black **hot" wire from one of the ungrounded terminals of the
transformer secondary and a white **neutral*' wire that is connected to the
grounded center tap, as shown in Figure 16.3.
In order to be exposed to an electrical macroshock hazard, a person
must come in contact with both the hot and the neutral conductors simul-
taneously, or with both hot conductors of a 230-V circuit. However, because

Figure 16.3. Electric power distribution system (simplified).

Conduit

Equipment ground
connected to conduit

4800 V
from main substation

437
 Ground (Earth)

115V (a)

Figure 16.4. Ground shock hazards.

\\\\\\\\\^
Ground (Earth)

(b)

438
16.3 Methods of Accident Prevention 439

the neutral wire is connected to ground, the same shock hazard exists
between the hot wire and any conductive object that is in any way connected
to ground. Included would be such items as a room radiator, water pipes,
or metallic building structures. In the design of electrical equipment, great
care is taken to prevent personnel from accidentally contacting the hot
wire by the use of suitable insulating materials and the observation of safe
distances between conductors and equipment cases. Through insulation
breakdown, wear, and mechanical damage, however, contact between a
hot wire and an equipment case can accidentally occur.
Figure 16.4(a) shows the scenario of such an accident. A defect in
the equipment has caused a short between the hot wire of the line cord and
the (conductive) equipment case, placing the case at a potential of 115 V ac
with respect to ground. A user whose body is in contact with ground (the
first contact of Figure 16.1) will be placed in jeopardy when a (second) con-

tact between his body and the case of the faulty equipment is established.
The generalized model for electrical accidents, shown in Figure 16.1(b),
permits a more detailed analysis of the situation. The model represents a
network consisting of a voltage source and six resistances. The fault resis-
tance (or leakage resistance), Rf, represents the short between the hot con-
ductor and the case of the equipment. The first and second contact resistance,
Rc\ and Rqz, represent, respectively, the resistances of the first and second
contacts to the body of the accident victim. Together with the body resis-
tance, Rgy they form the resistance of the current path through the victim's
body. The grounding resistance, Rq (which in Figure 16.4 is infinitely large),
is connected in parallel with the current path through the body. The ground

return resistance, Rj^, is essentially the resistance between ground and the
center tap of the transformer shown in Figure 16.3. This resistance is

normally very small.

An electrical accident can occur when the six resistances shown in the
figureassume any combination of values such that the resulting current
through the body of the victim reaches a dangerous magnitude. All measures
taken to reduce the probability of electrical accidents are, in effect, attempts
to manipulate the value of one or more of the resistances.

16.3. METHODS OF ACCIDENT PREVENTION

In order to reduce the likelihood of electrical accidents, a number of
protective methods have evolved. Some are used universally, some are
required in areas that are generally considered especially hazardous, and
still others have been developed essentially for use in hospitals.
440 Electrical Safety of Medical Equipment

16.3.1. Grounding

The protection method used most frequently is proper grounding of equip-

ment. The principle of this method is to make the grounding resistance
Rq in Figure 16.1(b) small enough that for all possible values of the fault
resistance Rf, the majority of the fault current bypasses the body of the
victim and the body current remains at a safe level even if contact and
body resistances are small. The practical implementation of this method is
shown in Figure 16.4(b), where the metal case of the equipment is connected
to ground by a separate wire. In cord-connected electrical equipment this
ground connection is established by the third, round, or U-shaped contact
in the plug. If a short occurs in a device whose case has been grounded in
this way, the electric current flows through the short to the case and returns
to the substation through the ground wire. Ideally, the short circuit will
result in sufficient current to cause the circuit breaker to trip immediately.
This action would remove the power from the faulty piece of equipment
and thus limit the hazard.
Protection by grounding, however, has several shortcomings. Obviously,
it is effective only as long as a good ground connection exists. Experience
has shown that many receptacles, plugs, and line cords of the conven-
tional type do not hold up under the conditions of hospital use. Many
manufacturers now make available Hospital Grade receptacles and plugs
which are designed to pass a strict test required by the Underwriters Labora-
tory for devices to qualify for this specification. Hospital Grade plugs and
receptacles are marked by a green dot.
A second disadvantage is that in the case of a short, protection is

provided by removing the power from the defective device by tripping the
circuit breaker. This action, however, also removes the power from all other
devices connected to the same branch circuit. In a hospital setting, one
defective device could disable a number of other devices, which might
include Hfe-saving instruments,

16.3.2. Double Insulation

In double-insulated equipment the case is made of nonconductive material,

usually a suitable plastic. If accessible metal parts are used, they are attached
to the conductive main body of the equipment through a separate (pro-
tective) layer of insulation in addition to the (functional) insulation that
body from the electrical parts.
separates this
The method is to assure that the fault resistance Rf
intention of this
is always very large. Double-insulated equipment need not be grounded,

and therefore it is usually equipped with a plug that does not have a ground
pin. Equipment of this type must be labeled ** Double Insulated." Double
16.3 Methods of Accident Prevention 441

insulation is now widely used as a method of protection in hand-held power

toolsand electric-powered garden equipment such as lawn mowers. However,

double insulation is of only limited value for equipment found in a hospital
environment. Unless the equipment is also designed to be waterproof, the
double insulation can easily be rendered ineffective if a conductive fluid
such as saline or urine is spilled over the equipment or if the equipment is
submerged in such a fluid.

16.3.3. Protection by Low Voltage

In the generalized accident model of Figure 16.1(b) it was assumed that

the voltage source was the line voltage (1 15 or 230 V ac). If, instead, another
voltage source were used, and if the voltage of this source could be made
small enough, the body resistance Rb would be sufficient to limit the body
current to a safe value, even if the fault and contact resistances become
very small. One way of creating this situation is to operate the equipment
from batteries. Aside from its lower voltage there is the additional advantage
that battery-operated equipment does not have to be grounded. Normally,
battery operation is Umited to small devices such as flashlights and razors,
but occasionally equipment as large as portable X-ray machines may use
this method of protection. A low operating voltage can also be obtained
by means of a step-down transformer. In addition to lowering the voltage
the transformer provides isolation of the supply voltage from ground.
Where power requirements are small, the transformer can be made an
integral part of the line plug, a design now frequently employed in small
electronic equipment as well as in such medical devices as ophthalmoscopes
and endoscopes.

16.3.4. Ground-Fault Circuit Interrupter

Statistical evidence indicates that most electrical accidents are of the type in
which the body of the victim provides a conductive path to ground, as
shown in Figure 16.4. Normally all current that enters a device through the
hot wire returns through the neutral wire. However, in the case of such an
accident, part of the current actually returns through the body of the victim
and through ground. In the ground fault circuit interrupter, the difference
between the currents in the hot and neutral wires of the power Une is mon-
itored by a differential transformer and an electronic ampHfier. If this
difference exceeds a certain value, usually 5 mA, the power is interrupted
by a circuit breaker. This interruption occurs so rapidly that, even in the
case of a large current flow through the body of a victim, no harmful
effects are encountered.
 Signal out

Power in

Current limiters

Signal out

Power

Voltage

Figure 16.5. Current limiters. (a) Input

circuit of older ECG machine or ECG
monitor; (b) The same circuit modern-

Limiting
ized by the addition of current limiters;
Limiting
range Operating range (c) Electrical characteristics of current
range
^^^ limiter.

16.3.5. Isolation of Patient-Connected Parts

Many types of medical equipment require that an electrical connection be

established to the body of the patient, either to measure electrical potentials,
such as in ECG machines, or to apply electrical signals, such as in electrical
pacemakers. These however, could also serve as a
electrical connections,
path for dangerous should the equipment malfunction.
electrical currents
For example, in older ECG machines and patient monitors, it was common
practice to connect one of the patient leads (the RL lead) to a power-line
ground. This effectively grounded the patient and established one of the
two connections necessary for an electrical accident. Modern technology
makes it possible to design circuits that isolate the patient leads from
442
16. 3 Methods of A ccident Prevention 443

ground. For patient leads that connect to an amplifier, this isolation is

most commonly achieved by the use of an isolated input amplifier, as shown
of amplifier is completely isolated from the rest of
in Figure 16.5. This type
the equipment, with the power provided through a low-capacitance trans-
former. A second transformer is used to couple the amplified signal to the
rest of the equipment. Because signal transformers are difficult to design
for the frequency range of biological signals, a modulation scheme is

normally employed. The amplifier shown in the figure uses amplitude

modulation of the carrier signal used to provide power for the isolated
ampHfier. Other designs use frequency modulation.

Figure 16.6. Input circuit of modern ECG machine or ECG monitor

with isolated patient leads achieved by the use of a carrier amplifier.

Isolation transformer
for signal

Patient
leads
444 Electrical Safety of Medical Equipment

Occasionally, isolation protection is provided by connecting a current

limiter into each patient lead. The characteristics of these devices are
shown in Figure 16.6. For low currents these devices act as resistors, but
when a certain current level is approached they change their characteristics
and prevent the current from exceeding a predetermined limit. Although
current limiters are less desirable than isolated amplifiers, they are never-
theless used where many patient leads have to be protected, such as in
EEG machines.
In biomedical devices that provide electrical energy to the body of a
patient, such as pacemakers or electrosurgical devices, protection is achieved
by isolating the patient leads from ground. In pacemakers, this is now
normally accomplished by using only battery-operated types. Modern elec-
trosurgical devices use output transformers to isolate patient leads.
Every one of the methods described in this section is concerned with
making the contact resistances Rqi and Rc2 in Figure 16.1(b) very large.

16.3.6 Isolated Power Distribution Systems

As mentioned earlier, the ground return resistance of a normal power dis-

tribution system is very low. If this resistance could be made large by
operating the substation transformer of Figure 16.3 without grounding its

center tap, all electrical accidents involving ground contact of the victim
could be avoided. Unfortunately, it is not possible to operate general
purpose electrical distribution systems in this way. Special power distribu-
tion systems which serve a limited number of devices and receptacles can be
operated through transformers with ungrounded secondaries, however, and
an increased safety margin can result from their use. As a matter of fact,
in the United States, safety standards require that all ** anesthetizing loca-
tions'' (operating rooms and other rooms in which gaseous anesthetizing
agents are used) be equipped with such power distribution systems.
In an isolated distribution system, the power is not supplied from the
transformer substation directly, but is obtained from a separate isolation
transformer for each operating room. This transformer, together with the
associated circuit breaker and the Une isolation monitor described below, is
mounted in a separate enclosure, either in the operating room or adjacent to
it. The panel of such an installation is shown in Figure 16.7.

If a short between the case and one of the two wires occurs in a piece
of equipment powered from am isolated system, the result will be quite dif-
ferent from that of the grounded system described earlier. Even if the case
of the equipment is not grounded properly, someone touching the equip-
ment and a grounded object simultaneously will not receive a shock, for
neither of the power conductors is connected to a ground. Nevertheless, a
small current can flow through the body of such a person because of the
Figure 16.7. Panel of isolated power
distribution system. (Courtesy of
Sorgel Electric Corporation, sub-
sidiary of Square D Company, Osh-
kosh, WI.)

capacity between the conductors of the system and ground. This current,
however, will be of a magnitude of at most 1 or 2 mA, which may be per-
ceived without being harmful. If the equipment in which the short occurs
is properly grounded, this leakage current will return through the ground
connection. In this case, however, the short in the faulty equipment effec-
tivelygrounds one of the conductors of the isolated distribution system.
As a result, the isolated system is changed back to a grounded distribution
system and all the protection provided by the isolated system is obviated.
In order to provide a warning in the event that this situation occurs, isolated
power systems employ line isolation monitors (LIM). This device alternately
checks the two wires of the distribution system for isolation from ground.
The degree of isolation, expressed as the risk current or fault hazard cur-
rent, is indicated on an electric meter.
In addition to the meter, two warning lamps are provided. When the
system is adequately isolated, a green lamp (sometimes labeled ''SAFE")
willbe on. If the isolation begins to deteriorate or if a short occurs between
one of the wires and ground anywhere in the system, a red lamp (sometimes
446 Electrical Safety of Medical Equipment

labeled **HAZARD'*) will light up. At the same time, an acoustical alarm
will begin to sound. This hazard alarm merely indicates that the system
has lost its protective properties. It still requires a second fault before an
actual hazard can arise. If the alarm occurs while an operation is in progress,
it is therefore possible to complete the procedure before attempting to
find the cause of the alarm. For this situation, the Une isolation monitor
has a button with which the acoustical alarm can be silenced. Even if the
acoustical alarmis turned off, the red warning lamp remains on, indicating

the continued presence of an alarm condition. The line isolation monitor

also has a button that allows it to be tested for proper functioning. Pressing
this button simulates a short.
Receptacles powered from an isolated system are not always the
common three-prong type but may be a special locking type, shown in
Figure 16.8.

Figure 16.8. Locking plug for isolated power dis-

tribution system. (Courtesy of Veterans Administra-
tion Biomedical Engineering and Computing Center,
Sepulveda, CA.)

In addition to the isolated distribution system, a special high-quality

grounding system is also required for all anesthetizing locations. This system
not only protects the patient and staff by shunting all leakage currents to
the ground but is also necessary for the proper functioning of the line
isolation monitor. The special grounding system is called an equipotential
grounding system because it keeps all metallic objects in the area that could
possibly come in contact with staff or patients at the same electrical potential.
For this purpose, not only the enclosures of electrical equipment but also all

other metal objects — operating tables, anesthesia machines, and instru-

ment tables — that might come in contact with electrical equipment must be
interconnected by the grounding system. Portable items of this kind may
require the use of separate ground wires connected to a common grounding
point near the head of the operating table. Special bayonet-type plugs are
used on this ground wire. Similar equipotential grounding systems are also
required in intensive-care units. Such a system is shown in Figure 16.9.
t

Figure 16.9. Principle of an equipotential grounding system in

one room or cubicle of an intensive care or cardiac care unit.

447