Trauma

June 11, 2024

As the Fourth of July holiday approaches, many look forward to seeing fireworks displays and setting off fireworks at home. However, wisdom, caution and child supervision must accompany this holiday fun, says Joseph T. Carroll, M.D., trauma surgeon at Mayo Clinic in Minnesota.

During his career in trauma care in Arizona, Nevada and Minnesota, Dr. Carroll says he's "seen a lot of fireworks injuries gone wrong." He says that in a region such as Southern Minnesota, Northern Iowa and Western Wisconsin, a more rural setting may lend itself to a higher number of fireworks-related injuries.

Patients Dr. Carroll has seen in trauma care have presented with injuries from both legal and illegal fireworks. Thermal burn and blast injuries are the most common, he says, especially with the extremity used to handle the fireworks. Denise B. Klinkner, M.D., M.Ed., a trauma surgeon at Mayo Clinic in Minnesota and colleague of Dr. Carroll, says fireworks blasts also pose an eardrum danger. Projectile injuries to the eye also occur frequently. If fireworks-related injuries involve 25% or more of the body, they can exacerbate existing medical issues, leading to systemic, inflammatory response syndrome, according to Dr. Carroll.

Fireworks injury background

Fireworks-related injuries typically occur in residential areas with consumer fireworks and do not involve commercial fireworks, where injuries are rare. Dr. Carroll calls consumer fireworks "more worrisome," especially if they are homemade.

According to Dr. Carroll, many fireworks injuries are preventable, especially in children. He says that supervised use is the biggest issue in preventing these injuries.

"I'm not advocating taking fireworks away from people, but you need to watch them," he says. "Injuries are mostly due to misuse."

The good news is that fireworks-related injuries often are not life-threatening, as the explosion involved is not usually that powerful, says Dr. Carroll. However, these injuries can be life-altering — people can lose a hand or their eyesight.

Those most often injured by fireworks are young people, especially teen males, Dr. Carroll says. He says children also are frequently injured due to improper handling.

Fireworks safety precautions

Trauma centers can spread these fireworks safety tips, including some from the American Burn Association (ABA) and others from Dr. Carroll:

• Storage. Keep fireworks dry and away from incendiary sources. Store them out of children's reach.
• Surface. When preparing to light fireworks, select a hard, flat surface. Concrete is ideal.
• Prepared setting. Clear the area in which you will light fireworks of dry brush or anything flammable.
• Eye protection. This helps prevent potential eye injury.
• Ignition. An extendable lighter is best to keep the user's body away from the firework.
• Disposal. Keep a bucket of water for initial disposal of used fireworks.
• Safety zone. Ensure anyone watching the fireworks stands well back when they are lit.
• Supervision. Watch children closely while anyone close by uses fireworks.

Two types of consumer fireworks are especially important for members of the public to consider, says Dr. Carroll:

• Mortar fireworks. These fireworks are more dangerous than other types due to a propensity for the unexpected, such as tipping over and shooting sideways.
• Sparklers. Although many think of sparklers as benign, this is a misconception. Sparklers' temperatures, proximity to the individual lighting them and the tendency of small children to move them near the face present injury potential.

Fireworks injury treatment

If an injury to an adult or child occurs from fireworks, Dr. Carroll suggests the following actions at home and at your trauma center:

• Home treatment. Apply cold water to fireworks burns. Remove any hot or burning clothing and rinse the burned body part with cold water. Wrap the burn in a dry, clean dressing, such as a cloth or bandage, or plastic wrap.
• At the trauma center. If a patient presents at your trauma center with a fireworks injury, Dr. Carroll suggests the following initial treatment:
  • Progress through the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach.
  • Ensure the patient does not have broken bones or internal bleeding, which can be life-threatening.
  • Expose the burn.
  • Remove any burned clothing, if still present.
  • Do not apply cream or other topical agents. Leave this to the burn center.
  • If the patient is experiencing extreme pain, establish an IV and administer narcotics.
  • If the patient's burn is large, considered more than 15% of body surface area for pediatric patients and more than 20% of body surface area for adults, administer IV fluid resuscitation for children based on the article by Dr. Romanowski and colleagues in the Sept. 4, 2017, issue of Burns & Trauma. For adult patients, administer IV fluid resuscitation based on the American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation.
  • Cover the burn with a clean, dry sheet and arrange for patient transfer to a burn center or other higher level of care.

Spreading the word in your community about fireworks safety

Trauma centers have a natural partner in the local fire department for fireworks injury prevention, says Dr. Carroll. This partnership can promote activities prior to the Fourth of July to convey messages about the use of fireworks at home:

• Booths. As county fairs start up for the season and pre-Fourth of July fireworks displays begin, set up a booth promoting fireworks safety — including demonstrations — at these locales. Other significant community gatherings before the July 4 holiday also provide settings for safety-related booths.
• Radio and TV public service announcements. Fire department representatives are best suited to this role, says Dr. Carroll. Trauma centers can assist with announcement writing or promotion, if desired.

For more information

Leave the show to the pros. American Burn Association.

Romanowski, KS, et al. Pediatric burn resuscitation: past, present, and future. Burns & Trauma. 2017; 5.

Cartotto, R, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. Journal of Burn Care & Research. 2023; 45:565.

Refer a patient to Mayo Clinic.