Fireworks Injuries
During the summer months many patients are treated on an emergency basis with hand injuries associated with various recreational activities. These may include sprains and fractures from softball injuries, cuts and lacerations from gardening or workshop projects, fishhook or knife injuries to the hand sustained while camping, and even the severe lacerations and complete amputations that result from lawn mowing or boating accidents.
One seasonal type of hand injury that has not often been discussed at length is the hand injury associated with common consumer fireworks. We will review some of these injuries and related epidemiological data in an effort to increase awareness of how devastating these injuries can be.
Prevention of fireworks injuries to the hand is of the utmost importance. It is our hope that an increase in public awareness will concentrate attention on precautionary measures to prevent these "recreational" accidents. If and when accidents do occur, hand surgeons and therapists attempt to provide patients with the best possible return of hand function with a minimum of disability and disfigurement.
Fireworks Case Study
A 15-year-old-male was attempting to construct a homemade fireworks device from a short piece of plumbing pipe and raw gunpowder. He sustained a massive blast injury to his left, non-dominant hand. This occurred while the individual was attempting to close the pipe ends and preparing to connect the wires to a battery. The electrical circuit was prematurely triggered and the device detonated while it was being held. The explosion caused traumatic amputation of the thumb, middle, and ring fingers, as well as a fracture/avulsion of the index finger that required subsequent surgical amputation. The small finger was completely devascularized and was severely fractured. Surgical reconstruction of this hand required microsurgical arterial repair with vein grafts and fracture fixation. Secondary soft tissue coverage was accomplished with split-thickness skin grafts. In addition to this extremity injury, the patient suffered severe facial burns.
The majority of fireworks-related injuries occur around the July 4th holiday, but it is not uncommon to see these injuries throughout the month of July and on Flag Day, Veteran's Day, New Year's Eve, etc. Although few in number, these injuries represent an additional type of trauma to the hand that receives little public attention. It is our intent to acquaint you with these injuries and the specific types of fireworks associated with the more severe hand and upper extremity lesions.
The Marion County (Indiana) Health Department (MCHD) has provided us with fireworks injury data compiled from past surveys of Marion County hospital emergency rooms. During an eight day period in 1986 (June 29 to July 6), 6 participating emergency rooms recorded data from 20 patients, ages ranged from 2 to 41 years. During the similar period in 1987 (June 29 to July 9), 8 participating emergency rooms recorded data from 36 patients, ages ranged from 6 months to 48 years. Subsequent statistical information has allowed epidemiological evaluation of these specific injuries.
Children are the most likely victims of fireworks injuries. The MCHD statistics for the period in 1987 showed that children 14 years of age and younger, sustained nearly half (47%) of the reported injuries. The age groups of 15 to 24 years and 25 to 44 years had 22% and 25% respectively. However, only 6% of the reported fireworks injuries occurred in the 45 year and older group of patients.
Injuries to the fingers and hand were the most frequently reported injury in the 1986 study comprising 64% of all the fireworks injuries. These injuries most often will occur while attempting to light the fuse of the explosive device. The non dominant hand (usually holding the device) is most likely to be injured, and the dominant hand (usually holding the match, lighter, etc.) is most likely to be spared from severe injury. Injured patients often report that the fuse simply burned too quickly and ignited the device before the firework could be released or thrown.
Homemade Fireworks
Home-made fireworks devices, M-80's, M-100's, M-1000's, Cherry Bombs, and Silver Salutes were federally banned in 1966 under the Child Protection Act. As such, they have been classified as "forbidden explosives", or "illegal fireworks device," and are to be considered as illegal explosive devices. While some have indicated that these devices are not typical "consumer fireworks," and that they should not be included in articles such as this one. We have elected to include them in this discussion, because we feel that these devices, or similar ones, may still be obtained or manufactured. While it is unlikely that these fireworks are still available to the average consumer, severe injuries from these devices continue to be reported. Most of the reported injuries from these illegal fireworks have occurred from the device's premature explosion while being hand held. Class C devices containing less gunpowder are more readily available for purchase, decreasing the severity, but increasing the frequency of these injuries.
PHOTO CAPTION: A Cherry Bomb can produce injuries and severe burns if detonated while being held.
Fireworks Burn
Burns are the most common type of fireworks-related injury comprising 59% of the total injuries in the 1987 study. The degree and level of contamination of this type of burn are all too frequently underestimated. The likely presence of tetanus spores in the paper or cardboard of the exploding device necessitates a course of systematic antibiotic (penicillin). Gunpowder residue, cardboard fibers, and ash are often tattooed into the burned area and makes these injuries likely candidates for surgical debridement and treatment. Appropriate follow-up of these patients is recommended to prevent possible burn contractures, infections, etc.
Sparklers may seem to be a safe form of patriotic celebration, but statistics show that sparklers accounted for the greatest number of injuries (36%) in the 1986 MCHD study. The greatest majority of these injuries are burns occurring to hand, leg, and facial area. Firecrackers were the second most common cause of injury, comprising 27 percent of total injuries.
Fireworks Safety
In an attempt to promote safety and reduce fireworks hand trauma, The Indiana Hand Center offers the following safety rules.
 1.Fireworks should be unpacked from any paper packing out-of-doors and away from any open flames.
2. Follow all warning labels and read precautionary information (if any) included in fireworks package.
3. Do not smoke when handling any type of "live" firecracker, rocket, or aerial display.
4. Keep all fireworks away from any flammable liquids, dry grassy areas, or open bonfires.
5. Take note of any sudden wind change that could cause sparks or debris to fall on a car, house or spectator.
6. Small children should be kept a safe distance from the fireworks; older children that use fireworks need to be carefully supervised.
7. Keep buckets of water nearby and/or a "working" garden hose for any fire emergency that may occur.
8. Never attempt to pick up and relight a "fizzled" fireworks device that has failed to light or "go off".
9. Do not use any aluminum or metal soda can or glass bottle to stage or hold fireworks before lighting.
10. Do not use any tightly closed container for these lighted devices to add to the exploding effect or to increase noise.
11. Never attempt to make your own exploding device from raw gunpowder, or similar flammable substance. The results are too unpredictable.
12. Never make use of mail-order fireworks kits. These do-it-yourself kits are simply unsafe.
Acknowledgements
The author would like to thank Carol Ryan, Manager, Injury Control Program, Marion County Health Department, for allowing us to reproduce data obtained from their 1986 and 1987 surveys. In addition, we would like to thank Stan Gibson, Deputy State Fire Marshall, State of Indiana, for providing us with additional information.
References
Fireworks, SAS Estimates Report: National Electronic Injury Surveillance System Hazard Identification and Analysis. US Consumer Product Safety Commission, National Injury Information Clearinghouse, 1982.
Kale D. Harwood B: Fireworks Injuries: 1979-1980. US Consumer Product Safety Commission, Division of Program Analysis, 1980.
Conkling JA: New federal standards for class C fireworks. Fire May 1977, p. 27.
Rules and regulations 22931, part 1507: Fireworks devices. Federal Register, 41 (June 8): 111.
National Fire Protection Association: The 1984 Fire Almanac. Quincy, MA, NFPA, 1983, pp. 778-779.
Kale D. Hardwood B: Fireworks Injuries: 1981. US Consumer Product Safety Commission, Division of Hazard Analysis, Table 2.
Hazard Analysis of Fireworks Injuries. US Consumer Product Safety Commission, Bureau of Epidemiology, 1973.
Wilson RS: Ocular fireworks injuries and blindness: an analysis of 154 cases and a three-state survey comparing the effectiveness of model law regulation. Ophthalmology 1982; 89:291-297.
Fireworks incidents and injuries in California. Fire J 1983; 77:70-73.
Berger LR: The pediatricians role in child advocacy. Adv Pediatr 1982; 29: 273-291.
Berger LR: Injuries from Fireworks. Pediatrics 1985; 75: 877-882.
Ryan C: Marion County Health Department, "Public Health Update,' Fall 1986 and Summer 1988.
Schnitz G: MANUS Newsletter, Vol. 5, No. 1, July 1989.
© 2008 MANUS, All Rights Reserved.
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