June 30, 2023 – Ryan Katz, MD, a hand surgeon on the Curtis Hand Center at MedStar Union Memorial Hospital in Baltimore, treats a patient who was severely injured by fireworks.
“My patient — I'll call him 'John' because he doesn't want to use his real name — is a 23-year-old man from Maryland,” Katz said. “He was setting off fireworks with his friends. He was holding a mortar — an explosive projectile fired from a tube — and the device exploded in his hand, ripping his thumb off his index finger.”
John remains to be affected by the trauma of the accident and didn't need to share the story himself, but he was glad Katz shared his story with us so others can navigate the upcoming Fourth of July holiday with more confidence.
John required a fragile and sophisticated operation that lasted 4 to six hours.
“The skin over his index finger was completely dead, so the index finger had to be amputated,” Katz said. “The soft, pliable, fleshy area between his thumb and index finger was also dead, so we re-covered that space with skin from his thigh area, creating a free flap.”
Injuries brought on by fireworks: common but preventable
Injuries brought on by fireworks are common, in response to a Consumer Product Safety Commission Report in 2022. The agency examined non-occupational fireworks deaths and injuries from 2021, collecting information from newspaper clippings and estimates of injuries treated in hospital emergency rooms taken from its National Electronic Injury Surveillance System.
Commission staff focused particularly on the period between June 18 and July 18, 2021, and located that roughly 74% of fireworks injuries treated in emergency departments every year occurred during that month.
According to the CPSC report, in 2021:
- There were nine deaths related to fireworks.
- An estimated 11,500 injuries treated in American hospital emergency rooms were brought on by fireworks.
- The variety of injuries brought on by fireworks has increased by an estimated 274 per 12 months since 2006.
- Injuries occurred more incessantly amongst men than women (59% versus 41%).
- The largest proportion of injuries occurred in adults between 25 and 44 years of age (32%). Children under 15 were close behind at 29%.
- The rate of injuries treated within the emergency department was highest amongst young adults, followed by children ages 5 to 9 years.
These injuries are preventable, Katz said, by following some easy but essential precautions.
Are safety precautions observed during fireworks displays?
Unfortunately, many individuals are unaware of the precautions they should take when handling fireworks, in response to a latest report from MedStar Health, a health system that serves Maryland, Virginia and Washington, D.C. In the lead-up to the Fourth of July holiday, MedStar Health surveyed 1,000 people within the Washington/Baltimore area to find out about their holiday plans and knowledge of fireworks safety.
Some disturbing results emerged. Although greater than a 3rd of those surveyed knew someone who had been injured by fireworks, three quarters said they planned to have fun the vacation with fireworks. 66 percent planned to make use of firecrackers and 61 percent planned to make use of sparklers.
Forty percent of respondents said they desired to set off fireworks at home and 40 percent said they were unfamiliar with local fireworks laws.
Perhaps most worryingly, over a 3rd (37%) allow their children/grandchildren to make use of sparklers, 29% allow them to make use of fireworks and 15% allow them to make use of firecrackers.
Katz’s most vital advice is not Trying out fireworks at home. “Leave it to the professionals,” he urges. “People get into trouble because they don't see these fireworks as a risk and are therefore careless.”
What are the risks?
According to estimates by the Consumer Product Safety Commission, hands and fingers (31%) were essentially the most commonly injured body parts, followed by head, face and ears (21%), legs (15%), eyes (14%), trunk/other regions (10%) and arms (8%).
The commonest injuries were burns, especially to the hands and fingers, followed by cuts and bruises to the pinnacle, face and ears.
“Eye injuries are very common,” says Katz. The same goes for burns to the legs and arms, face and torso. “Most people don't wear eye protection, and if they get too close to the device and it explodes, their eyes can be damaged.”
Often, homemade launchers reminiscent of bottles transform the device right into a mortar. “When it explodes, shrapnel can be thrown into the immediate area, causing all kinds of injuries.”
And when people wear open shoes and use sparklers, “the falling sparks can cause burns to hands and toes.”
There are other sorts of injuries, too. Although Katz just isn't an ear specialist, he's aware of the potential danger to the ears that may be brought on by the loud bangs and explosions of fireworks if an individual stands too close. “The explosions are at a significant decibel level and can damage the eardrum,” he said.
Take appropriate precautions
“One of the biggest problems I've seen is when people try to pick up an explosive device that they've detonated and it doesn't go off,” Katz said. “They chase after it, wondering if it needs to be re-detonated. But sometimes there's a delay in the fuse and the device goes off when they have it in their hands.”
He urged people to bring earplugs for young children and infants to public fireworks displays and maybe swaddle babies securely to cover their ears.
Katz warned against drinking alcohol or other mind-altering substances (reminiscent of marijuana) near fireworks. “When alcohol is involved, there tends to be more injuries because people often take more risks.”
And try to purchase fireworks from reputable manufacturers. John believes the mortar exploded in his hand since it wasn't working properly. According to the commission's report, about 31% of the products it chosen and tested were found to contain fireworks that didn't comply with the Federal Hazardous Substances Act. Violations included problems with the fuse, the presence of banned chemicals, and an overload of pyrotechnic materials. While a good manufacturer is not any guarantee, it's an excellent start. For more information, visit found on the CPSC website.
“Hidden” injury
The physical injuries brought on by fireworks are sometimes accompanied by emotional injuries, Katz said. “Many people develop post-traumatic reactions, stress, anxiety and even depression.”
He encouraged people fighting such injuries to hunt skilled help to combat the trauma and fear if needed.
Not just fireworks
The Fourth of July is commonly celebrated with outdoor barbecues and grills, but Katz urged caution here too.
“Don't assume you automatically know how to use the grill,” he said. Be sure to read the instructions before you light it.”
He said using an accelerant – such as lighter fluid – was a “bad idea and really dangerous.” “It's also not needed if you happen to know learn how to use the grill properly in response to the manufacturer's instructions.”
If you are using a gas grill and smell gas, you should check for a gas leak before lighting it, otherwise there is a risk of the grill exploding.
Other safety considerations include supervising children and infants near bodies of water such as swimming pools. Data for 2023 published According to Cook Children's Healthcare System in Fort Worth, Texas, drowning accidents are very common among young children, especially around the Fourth of July. And drowning accidents can happen even when there are many adults around, so it's wise to designate a “water watcher” — an adult who is specifically responsible for keeping an eye on the children without distraction.
And make sure you and your children wear sunscreen or protective clothing when outdoors. in response to the American Academy of DermatologySunburn can increase the danger of skin cancer.
The 4th of July is an excellent day to spend with family and friends, and taking basic safety precautions is the most effective strategy to make sure the day stays fun and festive and just isn't ruined by preventable tragedies.