When the rescuer becomes the patient: Reflections on accidental high-energy defibrillation during Code Blue

As physicians, we go to work each day with the intent to provide patient care and help others. Frankly, some days are better than others. But we don’t expect to get injured at work and urgently become patient ourselves.

Unfortunately, I found myself in that position – attending to a Code Blue, and shortly afterward suffering from accidental shock, becoming a patient in my own hospital’s emergency department.

In internal medicine and cardiology, physicians routinely participate in Code Blue resuscitation. External defibrillation has been a cornerstone of advanced cardiac life support (ACLS) algorithms since 1974. While lifesaving, high-voltage currents pose risks to health-care providers during resuscitation. A 200J accidental shock to healthcare providers during ACLS typically causes transient localized pain and neuropathy, resolving in minutes.

In the occupational health literature, electric shock injuries have also been well-documented, and typically categorized as low or high voltage, with 1,000V as the cutoff (see Table 1). Immediate symptoms include burns, loss of consciousness, respiratory arrest and arrhythmias. Short-term effects, such as motor weakness or acute respiratory distress syndrome, usually resolve, consistent with this case. Rare reports suggest potential long-term effects like movement disorders or amyotrophic lateral sclerosis. Cardiac sequelae are uncommon, with minimal long-term events in large cohorts, often linked to observation bias or pre-existing conditions.

As I was attending the Code Blue, our patient was in refractory ventricular fibrillation and administered double sequential defibrillation of high-voltage 400J. I was performing CPR and in contact with the patient. I did not lose consciousness. I immediately felt an electric sensation followed by complete loss of sensation (pain, temperature, touch, vibration, proprioception) in both upper extremities (hand to mid-forearm), which resolved spontaneously within 10 minutes.

Thirty minutes post-shock, I experienced intermittent chest pain radiating to the left midclavicular line, lasting five days. I also experienced transient fasciculations, most commonly in the gastrocnemius, biceps and triceps, resolving in one week, and a dull mid-frontal headache resolving within 24 hours.

Transitioned from a member of the Code Blue team to a patient of the Code team, I progressed through the healthcare system – first the emergency department and then serial assessments by cardiology and neurology specialists. EKGs at four hours, 36 hours and three weeks showed no abnormalities, nor did repeat echocardiography, stress echocardiography or 48-hour Holter monitoring. A nerve conduction study and electromyography at two weeks were normal. At six days post-incident, I was conservatively managed under concussion protocol after reporting significant fatigue, which eventually lasted two weeks, and subjective cognitive impairment up to four weeks, including word-finding difficulties and short-term memory deficits. Informal cognitive tests showed no deficits. Symptoms improved to baseline after four weeks.

There are several key takeaways from this incident.

Medically, this represents the first reported case of a health-care provider sustaining an accidental 400-J shock during active resuscitation. I was a 26-year-old male with no cardiovascular, cerebrovascular, metabolic or neuromuscular comorbidities, excellent baseline functional capacity, and no alcohol, tobacco or recreational drug use. One month prior to the event, two electrocardiograms obtained for transient non-cardiac chest pain demonstrated sinus rhythm with early repolarization, and both transthoracic echocardiography and exercise stress echocardiography (13.5 METs) were normal.

Compared with existing literature describing accidental 200-J shocks, the clinical course following a 400-J exposure appeared distinct. The higher-energy shock was associated with prolonged chest pain, myalgia, neuropathy and fasciculations, peaking at 24-48 hours and persisting for several days. In addition, I experienced fatigue, word-finding difficulties and short-term memory impairment – features not previously reported following accidental defibrillation exposure during resuscitation.

Beyond its clinical significance, this case invites broader reflection on physician safety during high-acuity care. As resuscitation strategies evolve and higher-energy defibrillation becomes more common, the occupational risks to healthcare providers – though rare – deserve renewed attention. Clear communication, strict adherence to safety protocols and institutional cultures that prioritize clinician safety alongside patient outcomes are essential. Accidental injury during resuscitation should be recognized as an occupational hazard, warranting structured evaluation, follow-up and support rather than informal reassurance alone.

More broadly, this experience highlights the need to normalize vulnerability within the medical profession. Physicians are trained to prioritize patient care, often at the expense of their own well-being. When injury occurs in the line of duty, stepping back to receive care should be viewed as professional responsibility rather than personal failure, of being unable to care for patients any further. Creating environments in which clinicians feel supported to acknowledge harm, seek care and recover fully is fundamental to sustaining a safe and resilient workforce.

Although rooted in resuscitation, my case reflects a broader truth of medical practice: physicians routinely work in environments where risk is inherent and often underrecognized. Recognizing occupational injury as a systems responsibility – and responding with care rather than minimization – strengthens not only clinician well-being, but also the safety, sustainability and integrity of health care itself.

Ed. Note: This article is based on Ronald Chow’s experience. Y. Max Jiang are residents who supported Ronald Chow after the incident. Shaheeda Ahmed was the cardiologist consulted on the case.

Table 1. Summary of Electric Shock Injuries from Occupational Health Literature