Fire Works Injuries

Objectives
Discuss the extent of the problem of fire works injuries Identify who is most likely to be injured by fire works. Identify when and where this injuries are most likely to be encountered. Discuss what kind of injuries occur.

Objectives
Recognize what types of fireworks are most commonly associated with injuries. Given a scenario discuss the appropriate assessment and treatment of the patient. Identify ways that EMTs can reduce fireworks injuries.

How extensive is the problem?

In 2003, four persons died and an estimated 9,300 were treated in emergency departments for fireworksrelated injuries in the United States. An estimated 5% of fireworks-related injuries treated in emergency departments required hospitalization

Who is most likely to be injured?

About 45% of persons injured from fireworks are children ages 14 years and younger. Males represent 72% of all injuries. Children ages 5 to 9 years have the highest injury rate for fireworks-related injuries . Persons who are actively participating in fireworks-related activities are more frequently injured, and sustain more severe injuries, than bystanders.

When and where do these injuries happen?

Injuries occur on and around holidays associated with fireworks celebrations, especially July 4th and New Year's Eve. Most of these injuries occur in homes. Other common locations include recreational settings, streets or highways, and parking lots or occupational settings.

What kinds of injuries occur?

Fireworks-related injuries most frequently involve hands and fingers (26%), eyes (21%), and the head and face (18%). More than half of the injuries are burns (63%); contusions and lacerations were the second most frequent injuries (18%). Fireworks also can also cause lifethreatening residential fires

What kinds of injuries occur?

What kinds of injuries occur?

What types of fireworks are associated with the most injuries?

Illegal large firecrackers represent 2% of all firecracker injuries. Firecrackers (24%), rockets (18%), and sparklers (11%) accounted for most of the injuries seen in emergency departments during 2003. Sparklers were associated with the most injuries for children under five. For children ages five to 14 years and people ages 15 to 24 years, firecrackers, rockets, and other devices (including sparklers) were the source of most injuries.

What types of fireworks are associated with the most injuries?

How and why do these injuries occur?

Availability Fireworks type Being too close Unsupervised use Lack of physical coordination Curiosity Experimentation

Injury #1
This person was using black powder to assist in lighting a "Sparkler Fountain" on the 4th of July. What he did not know was that the fountain was smoldering. When the black powder exploded, it drove the container into his knee. The black cloth is where it drove his pants into his knee. He received several burns in addition to this injury.

Injury #2
This person was attempting to burn off the protective wax coating on the fuse of an M-80 type of firework. Injuries to the hands and face are the most common types of fireworks injuries.

Repairs Can be made

This is another hand after they sewed up the remnants

Injury #3
This is what happens when a person tries to make an M-80 and it goes off while they are holding it. He also suffered shrapnel wounds to his body. He lost his job, his hand and his freedom (he is currently serving time in prison for this offense)

Injury #4
This is what happens when your hand gets too close to fireworks when they go off. This is second and third degree burns to a hand. It probably hurts less to have your hand blown off than it does to have it burned.

Injury #5
Fireworks burn at very high temperatures. If your hand gets too close to them while they are burning, you can expect your hand to look similar to this.The appearance does not even come close to showing how much it hurts.

Public displays
Professionals are not immune from Fireworks injuries. During a 4th of July show in Alton Illinois and Explosion ripped through the barge that the fireworks were being shot from. One man was killed and several more injured.

Alton, Illinois

Scenario
A 15-year-old male was attempting to construct a homemade fireworks device from a short piece of plumbing pipe and raw gunpowder. He sustained a massive blast injury to his left hand. This occurred while the individual was attempting to close the pipe ends and preparing to connect the wires to a battery. The electrical circuit was prematurely triggered and the device was detonated while being held.

Scenario
The explosion caused traumatic amputation of the thumb, middle and ring fingers,as well as a fx/avulsion of the index finger. The small finger is obviously fx. In addition to the extremity injury the patient has severe facial burns.

15-year-old child
Appearance
Crying, scared,

Work of Breathing
Labored, retractions and stridor.

Circulation to Skin
Pale

Initial Assessment
Airway - Open, clear Breathing - RR 42 breaths/min, labored with retractions, stridor Circulation - HR 140 beats/min; CRT 4 seconds, B/P 78/52 Disability - AVPU=A Exposure Multiple open wounds to the left hand, superficial and partial thickness burns to the face

Management Priorities
Injuries
Traumatic hand injury Inhalation injury Burns

BLS Management Priorities

Open airway and consider spinal immobilization Suction as needed Assist ventilation with BVM Control external bleeding Immobilize injured extremity Transport

Management Priorities
BLS priorities plus Airway management continue BVM ventilation, consider ETI Obtain IV access en route Fluid resuscitation with 20 ml/kg normal saline or Lactated Ringers Consider pain management.

 During transport, the childs condition deteriorates despite initial interventions.. What additional treatment measures are indicated at this point?

Scenario
The patient was transported to MDH and then Flown to MMC. Surgical reconstruction of his hand required microsurgical arterial repair with vein grafts and fracture fixation. Secondary soft tissue coverage was accomplished with skin grafts.

Prevention
An ounce of prevention is worth a pound of cure. What can we, as EMS Providers do to make this fourth of July safer?

Conclusion
Most firework injuries will be seen around the Fourth of July Holiday. Most firework injuries will be seen in children. Most will be burns. Almost all if all are not accidents, but preventable injuries.

Questions? Comments.