During the summer months many Indiana patients are treated on an emergency basis with hand and wrist injuries associated with various recreational activities. These may include sprains and fractures from sports injuries, cuts and lacerations from gardening or workshop projects, injuries to the hand sustained while camping, and even severe finger lacerations and complete amputations that may result from lawn mowing or power tool accidents.
One seasonal type of injury that has not often been discussed is the hand injury associated with common consumer fireworks. The following serves as a brief background for some of the newer terminology relating to fireworks. In order to be classified as “consumer fireworks,” the item must be tested by the Consumer Product Safety Commission, and meet the requirements for composition, quality, and stability. Once classified as a consumer fireworks device (Class 1.4G), the item is legal and approved under Federal law for consumer use. If the device fails to meet these safety requirements, the firework could be termed “display fireworks.” Display fireworks are usually categorized as being in Class 1.3G and are intended to be used only in professional fireworks displays. The term “illegal fireworks” is not an actual class designation, but rather is a term often used by law enforcement to describe those fireworks illegally imported or manufactured. These products may contain large or unapproved amounts of explosive compounds and are generally thought to be unsafe to handle and use. Illegal fireworks may be more sensitive to heat, shock, friction, and even spontaneous detonation.
Prevention of fireworks-related injuries to the hand is important, as even a minor injury or burn from an ordinary sparkler may cause pain and discomfort for weeks as the injury heals. This may interrupt an individual’s work schedule and temporarily affect the patient’s wage earning ability. It is our hope that an increased public awareness will focus attention on precautionary measures to help prevent these “recreational” accidents. If and when accidents do occur, the hand surgeons at the Indiana Hand to Shoulder Center are available 24 hours a day to provide patients with the best possible return of hand function with a minimum of disability and disfigurement. We will review some of these injuries and related epidemiological data in an effort to increase awareness of how devastating these injuries can be.
The majority of fireworks-related injuries occur around the July 4th Holiday weekend, but it is not uncommon to see these injuries throughout the month of July and on Memorial Day, Flag Day, Veteran’s Day, at weddings, and on New Year’s Eve. Although few in number, these injuries represent one 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 injuries.
The Marion County (Indiana) Health Department (MCHD) has provided us with fireworks injury data compiled from past surveys of local hospital emergency rooms. During one eight-day period (June 29 to July 6), 6 participating emergency rooms recorded data from 20 patients, ages ranged from 2 to 41 years. During another period (June 29 to July 9), 8 participating emergency rooms recorded data from 27 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 statistics for one period of the study 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 23% and 21% of the injuries respectively. However, only 9% 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 study comprising 53% 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 device could be released or thrown.
Homemade fireworks devices, as well as older products know as M-80s, 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 devices,” and are to be considered illegal. Some have indicated that these devices are not typical consumer fireworks, and as such, these devices should not be included in articles describing injuries from legally purchased fireworks. However, we have elected to include them in this discussion, as we feel that these devices, or similar ones, may still be obtained or manufactured. While it is unlikely that these fireworks are available to the general public, severe injuries from these devices still continue to be reported in the literature. Most of the injuries from these illegal fireworks have occurred from the device’s premature explosion while being held. Consumer fireworks devices that contain less gunpowder are more readily available for purchase, decreasing the severity, but often increasing the frequency of these injuries.
Burns are the most common type of fireworks-related injury comprising 57% of the total injuries. The degree and level of contamination of this type of burn are all too frequently underestimated. The likely presence of bacteria and tetanus spores in the paper or cardboard of the exploding device may necessitate a course of systematic antibiotics and appropriate tetanus prophylaxis. Remnants of the explosion including gunpowder residue, cardboard fibers, charcoal, sulfur dust, and ash are often tattooed into the burned area and make these injured patients likely candidates for surgical debridement and treatment. Appropriate follow-up of these patients is recommended to prevent possible burn contractures, infections, etc.
Sparklers and similar wire stick devices may seem to be a safe form of patriotic celebration. However, once lighted, these may burn for nearly a minute producing showering sparks that may reach temperatures of 1800 to 3000 degrees Fahrenheit. Statistics show that sparklers accounted for the greatest number of reported injuries (34%). The greatest majority of these injuries are burns occurring to hand, leg, and facial area. Bottle rockets and firecrackers were the second and third most common cause of injury, comprising 24% and 15% respectively of the total injuries.
As Hoosiers plan their patriotic celebrations this summer, we urge all fireworks users to prioritize fireworks safety. If and when an accident does occur, please contact our office immediately for evaluation and treatment.
In an attempt to promote safety and reduce fireworks-related injuries, The Indiana Hand to Shoulder Center offers the following safety rules.
For further information on firework safety please visit the American Society for Surgery of the Hand website at http://www.assh.org/handcare/hand-arm-safety/fireworks-injury-prevention
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