ASSH Position Statement on Fireworks

June 4, 2018

Fireworks are often used during holidays and celebrations and are associated with excitement and fun. However, the use of these displays and devices can be dangerous and can result in life-altering injuries and dramatic negative long-term impact. 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 re-sponsible for soft tissue and bone damage that may require amputations, multiple surgeries, and hospitalizations. According to the U.S. Consumer Product Safety Commission, over 11,000 fire-work injuries occurred in 2016. 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. Sparklers, which are often thought of as a safe and simple firework, caused a reported 1,300 hand/finger injuries in 2016. 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. 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, Massachu-setts, 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).

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.

As hand surgeons and a healthcare community often involved in the care of patients with firework injuries, we have developed several consensus positions regarding firework safety and management.

It is the position of the American Society for Surgery of the Hand that:

  • All fireworks are inherently dangerous.
  • Firework use should be limited to professional display; explosive materials should only be handled by professionals.
  • Firework injury has large personal health impacts and economic cost. Firework injuries to the hand and upper extremity are the most common injury site and can be devastating.

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.

  1. 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.
  2. 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.
  3. People should not consume alcohol or use other drugs when choosing to use a firework as it may impair judgment and dexterity.
  4. In addition to the above recommendations, further safety recommendations advised by the National Council on Firework Safety should be followed. They include:
    1. Do not permit children to handle fireworks.
    2. Direct supervision of teenagers by parents should occur at all times.
    3. Only use fireworks outdoors.
    4. Do not mix fireworks and alcohol.
    5. Have a designated single shooter for firework ignition. Read all labels/warnings/instructions. Never hold a firework that is not meant to be held.
    6. Light only one firework at a time.
    7. Never relight a firework that does not go off. Wait 20 minutes before handling it and place it in bucket of water.
    8. Have a bucket of water and hose ready to put out any fires.
    9. Used fireworks should be soaked in water, placed in nonflammable trashcan away from any flammable objects.
    10. Do not use homemade fireworks.
    11. 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.

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.