For many Americans, fireworks are a necessary part of any Fourth of July celebrations—but fireworks can cause serious, sometimes devastating, injuries. In a study, researchers at UW Medicine's Harborview Medical Center pinpoint the fireworks that pose the greatest danger.

Primer series: How to address avoidable ED utilization

Background

According to the U.S. Consumer Product Safety Commission, about 10,500 people every year seek emergency medical treatment for fireworks-related injuries.

For the study, researchers looked at the 294 patients at Harborview who required surgery or a hospital stay because of a fireworks-related injury between 2005 and 2015. The mean age of the patients was 24, and 90 percent of the people injured were male.

Key findings

Overall, the researchers determined that shell-and-mortar type fireworks posed the greatest danger, accounting for 39 percent of all fireworks-related injuries and 86 percent of such injuries among adults specifically. According to News Beat, shell-and-mortar type fireworks involve a shell—a spherical aerial explosive—that's thrown or launched from a tube called a mortar.

Among children, the researchers found rocket fireworks-related injuries were the most common, at 44 percent, while homemade fireworks-related injuries were most common among teenagers, at 34 percent.

Among all patients who suffered fireworks-related injuries, the researchers found:

• 61 percent had injuries to their hands, with 37 percent of those patients requiring "at least one partial or whole finger/hand amputation";
• 21 percent suffered an injury to the eye, with two-thirds experiencing permanent vision loss, and 11 individuals having to have an eye removed;
• Six patients suffered a brain injury, of which five stemmed from shell-and-mortar style fireworks; and
• Two people died from fireworks-related injuries.

According to the researchers, patients who presented with injuries from shell-and-mortar fireworks disproportionately had injuries to their face, hands, and brain.

Discussion

"This firework injury study is an excellent example of how real-world injuries treated at our trauma center contribute to our knowledge of injury causes and prevention," Monica Vavilala, study co-author and director of the Harborview Injury Prevention and Research Center, said. "The next step is to apply our new knowledge to health practices, policy decisions, and individual behavior."

"We know that lighting fireworks is an important rite of passage," Vavilala added, "but if you're going to a stand, try to use common sense and good safety techniques—and leave those shells-and-mortars behind."

Separately, Seattle Fire Lieutenant Joshua Pearson said sparklers are responsible for one-fourth of ED visits on the Fourth of July. "No fireworks are to be considered safe," he said. "Even children who are supervised experience significant injury. The awareness, the lessons learned from the studies, those should be taken to heart" (Cohen, Seattle PI, 6/25; Nodell, "NewsBeat," University of Washington, 6/28; Sandvall et. al, American Journal of Emergency Medicine, 4/25).

Primer series: How to address avoidable ED utilization

Are specific patient populations making up a significant proportion of avoidable ED visits at your organization? In each primer, we profile organizations who have set up targeted programs and feature operational, staffing, and funding information.

• Right-size ED utilization for acute behavioral health patients
• Right-size ED utilization for complex care patients
• Right-size ED utilization for geriatric patients

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