Fireworks are a part of many American seasonal celebrations, but many people fail to realize just how dangerous they really are.
Many firework accidents each year result in life-altering injuries for people of all ages.
Firework injuries can be particularly difficult to treat because they involve both burn and blast injuries, which damage tissues from the skin through the bone, sometimes causing partial or complete hand amputation.
(Each year thousands of people are injured in fireworks accidents, and children are the most common victims. Now, officials are issuing new safety guidelines to help prevent injury or even death. Courtesy of TODAY and YouTube. Posted on Jul 3, 2017)
Fireworks caused over 11,000 injuries in 2016, most commonly damaging hands and fingers.
Sparklers, which many parents consider safe, burn at greater than 1,000 degrees F and can quickly cause serious injury. Sparklers resulted in 1,300 hand/finger reported injuries in 2016.
Injuries to the hand may include disfigurement and permanent disability, affecting jobs and life satisfaction.
Many states recognize the danger and limit the use of consumer fireworks at varying levels.
Each state has individual laws governing use of both consumer grade and commercial grade fireworks. Some states, such as Illinois, Ohio, Iowa, and Vermont, have restrictions banning all fireworks except for sparklers and other novelties.
Other states, including Delaware, Massachusetts, and New Jersey are even more restrictive and ban all consumer fireworks.
Most states have laws governing who can buy or sell fireworks and may require permits to ignite them, particularly in public places. Several studies have shown that stronger community awareness and governmental policies can reduce firework injuries. (Puri 2009 and Moore 2014).
(A Police chief and fireworks company owner, Michael Diebold, lost part of his arm in a mishap warns that accidents “can happen to anybody.” Courtesy of ABC News and YouTube. Posted on Jul 2, 2017.)
As hand surgeons who specialize in this type of injury, ASSH urges the public to understand that:
- All fireworks are inherently dangerous.
- Firework use should be limited to professional display; explosive materials should only be handled by professionals.
- Firework injuries to the hand can be devastating and have large personal and economic costs.
Fireworks are unpredictable, and even trained technicians are susceptible to injury.
Yet, we understand that consumers may continue to use fireworks, so we recommend additional safety precautions should always be taken:
- Use personal protective equipment, including eye protection, when handling any flammable material.
- Ensure that people nearby are aware of any plan to ignite fireworks and are in a safe area.
- If attending a public display, pay close attention and obey all rules and regulations established by the authorities and crew in charge of safety.
- Do not consume alcohol or use other drugs when choosing to use a firework, as it may impair judgment and dexterity.
- ASSH’s full position statement includes additional safety recommendations from the National Council on Firework Safety.
Hands are our primary tools for exploring the world; an injury can permanently impact your home and work life.
Please be safe this season!
(See the story of Michael Shannon, a three-year-old boy who was killed when a legal consumer firework struck him in the head during a July Fourth family celebration. Michael’s parents and sister talk about their memories of Michael, the pain they’ve endured in the years since his death, and their hope that parents will understand the danger of consumer fireworks. Courtesy of the National Fire Protection Association and YouTube. Posted on Jun 1, 2007)
“As a young child, I clearly remember asking my mother to buy fireworks for the 4th of July,” recalls hand surgeon Steven H. Goldberg, MD.
“She told me about her childhood classmate who lost an eye due to a firework injury and told me ‘no.'”
“Now, as a hand surgeon, I’ve had to treat multiple patients with injuries so severe that their fingers required amputation or were already missing.”
“It is not easy news to share, and it’s not easy for patients to hear.”
“In a split second, their hand, their life, their employment is changed forever. Listen to my mom and say ‘no’ to the personal use of fireworks this summer.”
Hand surgeons care for people after a large variety of traumatic injuries.
Firework injuries pose unique and significant challenges due to burns and blast injuries that may result in visible, extensive scarring.
Additionally, firework injuries are responsible for soft tissue and bone damage that may require amputations, multiple surgeries, and hospitalizations.
The hand and fingers represented the most common region of the body injured at 33% of all injuries, with the head and face being the second most common body region.
A large number of injuries (22%) occur in children under 9 years of age, with many of these injuries in unsupervised children.
In people of all ages, a firework injury to the upper extremity can have functional, economic, and psychological impact that is often underestimated.
Thermal and blast injuries from fireworks are largely avoidable.
Injuries most frequently occur to people using fireworks directly, but injuries also occur to unadvised bystanders.
Many people are surprised to learn that simple fireworks, such as sparklers, burn at greater than 1000 degrees F and can quickly cause serious injury.
Explosive fireworks are unpredictable and can cause serious burns as well as blast injuries, which can involve loss of portions of the extremities or damage to other vital organ systems such as the eyes and ears.
Consumer grade (class C) fireworks by definition contain less than 50 milligrams of powder and include devices such as sparklers, Roman candles, firecrackers, shells, snakes, and party poppers.
The impact of a firework injury on a person’s life can be profound, particularly when involving a hand or finger injury.
Employment is frequently negatively affected after a firework injury. Injury and surgery often require time away from work, resulting in loss of wages and productivity.
The economic impacts of firework injuries are seen both at the personal and societal level through loss of productivity and increased healthcare cost.
Beyond the economic impact, the psychological and emotional distress that can result from loss or change of function is unquestionably impactful to both the injured individual and his or her family.
Expanded safety precautions Include:
Understanding that fireworks continue to be used by consumers currently, some additional safety recommendations should be followed in order to mitigate some of the inherent danger they cause.
- Personal protective equipment, including eye protection, should be used with all flammable material.
- Care must be taken when using any flammable material as serious injury to the skin and other vital structures can occur.
- People nearby who are not participating in firework ignition can be accidentally injured.
- The person using the fireworks should take care that others are aware of the plan to ignite fireworks and should always point them in a safe direction.
- If attending a public display, pay close attention and obey all rules and regulations established by the authorities and crew in charge of safety.
- People should not consume alcohol or use other drugs when choosing to use a firework as it may impair judgment and dexterity.
- In addition to the above recommendations, further safety recommendations advised by the National Council on Firework Safety should be followed.
- Do not permit children to handle fireworks.
- Direct supervision of teenagers by parents should occur at all times.
- Only use fireworks outdoors.
- Do not mix fireworks and alcohol.
- Have a designated single shooter for firework ignition. Read all labels/warnings/instructions.
- Never hold a firework that is not meant to be held.
- Light only one firework at a time.
- Never relight a firework that does not go off.
- Wait 20 minutes before handling it and place it in bucket of water.
- Have a bucket of water and hose ready to put out any fires.
- Used fireworks should be soaked in water, placed in nonflammable trashcan away from any flammable objects.
- Do not use homemade fireworks.
- Obey all laws
Hand and upper extremity injuries can be devastating.
After hand and upper extremity injury, chronic pain and permanent disability are among many factors that individuals encounter on a daily basis.
Thermal burns and explosive injuries from fireworks are common and can be disfiguring.
The hand is one of our primary tools for exploring the world and for many people is required for their employment.
Any injury to the hand and upper extremity can permanently impact your home and work life.
(Safety Tips from the National Council on Fireworks Safety. Courtesy of Gorilla Fireworks)
Please read the entire position statement on fireworks from the American Society for Surgery of the Hand (ASSH).
REFERENCES
Smith GA, Knapp JF, Barnett TM, Shields BJ (1996) The rockets’ red glare, the bombs bursting in air: fireworks-related injuries to children. Pediatrics 98:1–9
Billock, R. M., et al. (2017). “Pediatric Firework-Related Injuries Presenting to United States Emergency Departments, 1990-2014.” Clin Pediatr (Phila) 56(6): 535-544.
Fogarty, B. J. and D. J. Gordon (1999). “Firework related injury and legislation: the epidemiology of firework injuries and the effect of legislation in Northern Ireland.” Burns 25(1): 53-56.
McCauley, R. L., et al. (1991). “Class C firework injuries in a pediatric population.” J Trauma 31(3): 389-391.
Moore, J. X., et al. (2014). “The epidemiology of firework-related injuries in the United States: 2000-2010.” Injury 45(11): 1704-1709.
Philipson, M. R. and S. J. Southern (2004). “The blast component of firework injuries–not to be underestimated.” Injury 35(10): 1042-1043.
Puri, V., et al. (2009). “Firework injuries: a ten-year study.” J Plast Reconstr Aesthet Surg 62(9): 1103-1111.
Saadat, S., et al. (2012). “Higher education does not protect against firework-related injuries: a review of the economic burden and the risk factors of firework-related injuries in the capital of Iran.” Public Health 126(1): 40-46. Saadat, S., et al. (2010). “Perceived risk and risk-taking behavior during the festival firework.” Am J Health Behav 34(5): 525-531.
Saucedo, J. M. and N. B. Vedder (2015). “Firework-related injuries of the hand.” J Hand Surg Am 40(2): 383-387; quiz 387.
Wang, C., et al. (2014). “Firework injuries at a major trauma and burn center: A five-year prospective study.” Burns 40(2): 305-310.
Yasmeh, S., et al. (2017). “Firework-related hand injuries: A novel classification system.” Am J Emerg Med.
Zohdi, T. I. (2016). “On firework blasts and qualitative parameter dependency.” Proc Math Phys Eng Sci 472(2185): 20150720.
Approved by ASSH Council in May 2018.
