Stay Safe on July Fourth

June 30, 2023 — Ryan Katz, MD, a hand surgeon at the Curtis Hand Center at MedStar Union Memorial Hospital in Baltimore, has a patient who got a serious injury from fireworks. “My patient — I’ll call him ‘John’ because he doesn’t want his real name to be used — is a 23-year-old man based in Maryland,” Katz said. “He was lighting fireworks with his friends. He was holding a mortar — an explosive projectile that’s designed to be launched from a tube — and the device exploded in his hand, blowing his thumb away from his index finger.” John is still experiencing the trauma of the accident, so he was unwilling to tell the story himself. But was glad to have Katz share his story so others can remain safer during the upcoming Fourth of July holiday. John required a delicate and complicated surgery that takes 4 to 6 hours.  “The skin over his index finger was completely gone, so the index finger had to be amputated,” Katz said. “The soft, supple, fleshy space between the thumb and index finger was also gone, so we resurfaced this web space with skin from his thigh area, creating a free flap.”  Fireworks-Related Injuries: Common but Preventable Injuries related to fireworks are common, according to a Consumer Product Safety Commission report in 2022. The agency examined non-occupational fireworks-related deaths and injuries from 2021 and gathered information from news clippings and estimates of injuries treated in hospital emergency rooms, taken from its National Electronic Injury Surveillance System. Commission staff particularly focused on the time between June 18 and July 18, 2021, and found that about 74% of the annual fireworks-related injuries treated in emergency rooms happened that one month. According to the CPSC report, during 2021: There were nine fireworks-related deaths. Fireworks were involved in an estimated 11,500 injuries treated in U.S. hospital emergency rooms. Fireworks-related injuries have increased since 2006 by an estimated 274 per year.  More injuries occurred in males than in females (59% vs. 41%). The largest percentage of injuries took place in adults between ages 25 and 44 (32%). Children under age 15 were close behind at 29%. Young adults had the highest estimated rate of emergency room-treated injuries, followed by children ages 5 to 9. These injuries are preventable, Katz said, if you follow some simple but important precautions.  Do People Follow Fireworks Safety Measures? Unfortunately, according to a new 2023 report issued by MedStar Health, a health care system that services Maryland, Virginia, and Washington, DC, many people are not aware of the precautions they need to take when using fireworks. In advance of July Fourth, MedStar Health surveyed 1,000 people living in the Washington/Baltimore region to learn about their holiday plans and knowledge of fireworks safety.  Some disturbing findings emerged. Although more than one-third of respondents knew someone who had been injured by fireworks, three-quarters still said they were planning to celebrate the holiday with fireworks; 66% said they were planning to use firecrackers, and 61% were planning to use sparklers. Forty percent of respondents said they planned to use fireworks at home, and 40% said they were unfamiliar with their local fireworks laws. Perhaps most troubling, over a third (37%) let their children/grandchildren use sparklers, 29% allow them to use fireworks, and 15% allow them to use firecrackers. The No. 1 piece of advice Katz fashion offers is not  to try fireworks at home. “Leave it to the professionals,” he urges. “Where people get into trouble is that they don’t perceive these fireworks as a risk, so they let their guard down.” What Are the Risks? According to Consumer Product Safety Commission estimates, the most common parts of the body to be injured were hands and fingers (31%), followed by head, face, and ears (21%), legs (15%), eyes (14%), trunk/other regions (10%), and arms (8%). The most common injuries were burns, especially to the hands and fingers, followed by lacerations and bruises to the head, face, and ears. “Eye trauma is very common,” says Katz. So are burns to the arms and legs, face, and trunk. “Most people don’t wear eye protection, and if they get too close to the device and it explodes, it can damage their eyes.”  Often, homemade launching devices like bottles turn the device into a mortar. “If it explodes, it can send shrapnel to the immediate vicinity, causing all sorts of injuries.” And when people wear open-toed footwear and use sparklers, “the showers of sparks that come raining down can cause burns on the hands and the toes.” There are other types of injuries as well. Although Katz does not specialize in treating ears, he is aware of potential danger to the ears because of the loud booms and explosions of fireworks if a person stands too close. “The explosions take place at significant decibel levels and can damage the eardrum,” he said. Take Reasonable Precautions “One of the biggest problems I’ve seen is when people try to pick up an explosive device that they lit but that didn’t go off,” Katz said. “They chase it down and wonder if it needs to be relit. But sometimes, there’s a delay in the fuse and it goes off when they’re holding it in their hands.” He encouraged people to bring earplugs for young children and toddlers to public fireworks shows, and maybe safely swaddle babies in such a way that their ears are covered. Katz cautioned against drinking alcohol or any other mind-impairing substance (such as marijuana) around fireworks. “When alcohol is in the mix, we tend to see more injuries because people often take more risks.” And try to buy fireworks from reputable manufacturers. John believes that the mortar exploded in his hand because it malfunctioned. According to the commission’s report, about 31% of the products it selected and tested were found to contain fireworks that did not comply with the Federal Hazardous Substances Act. Violations consisted of fuse problems, the presence of prohibited chemicals, and an overload of pyrotechnic materials. A reputable manufacturer may not be a guarantee, but at least it’s a good start. More information can be found on the CPSC website . ‘Hidden’ Injury Emotional injury often accompanies the physical injuries caused by fireworks, Katz said. “Many people develop posttraumatic reactions, stress, anxiety, and even depression.” He encouraged people who are dealing with these types of injuries to get professional help for trauma and anxiety, if necessary. Not Just Fireworks July Fourth is often celebrated with outdoor cookouts and barbecue, but Katz urged caution around them as well. “Don’t assume that you automatically know how to use the grill,” he said. Make sure you read the instructions before you light it.” He said that using an accelerant – such as lighter fluid — is a “bad idea and very dangerous. It’s also not necessary if you know how to use the grill properly, per the manufacturer’s instructions.”  If you’re using a gas grill and smell gas, you should check for a gas leak before you light it because the grill could explode. Other areas of safety include watching children and toddlers around bodies of water such as swimming pools. According to 2023 data released by Cook Children’s Healthcare System in Fort Worth, TX, drownings are very common in young children, especially around July Fourth. And drownings can occur even when many adults are around, so it’s advisable to designate a “water watcher” — an adult specifically in charge of watching the children without any distractions. And make sure you and your children wear sunscreen or protective clothing when you’re outdoors, according to the American Academy of Dermatology . Getting sunburned can raise the risk of developing skin cancer. July Fourth is a wonderful time to enjoy with family and friends. Taking basic safety precautions is the best way to ensure that the day remains fun and festive and isn’t ruined by preventable tragedies.