Treating and Preventing Firework Injuries

Firework injuries

A dangerous tradition

Like sunshine and summer, Americans have associated fireworks with the 4th of July since its first celebration in 1777. In all states except Massachusetts, some form of consumer fireworks are legal. Unfortunately, they constitute a dangerous form of festivity. In 2020, 18 Americans died from firework-related incidents, while 15,600 people were treated in hospital emergency departments for firework injuries.

Unsurprisingly, the largest percentage of these injuries affected victims’ hands. These accidental, albeit preventable wounds can be life-changing. The thumb and palm control approximately 50% of hand function, which are precisely the areas that fireworks tend to injure.

Traumatic injuries

Firework injuries are in a class of their own. Typical burns affect skin and tissue, which healthcare professionals can usually treat in a relatively short period of time. “The emergency department can evaluate and treat simple burns by ways of wound care and medication ointment,” explains Jennifer Oakley, FNP, MSN, BSN, trauma nurse at the Hospital of the University of Pennsylvania. “But with firework injuries, there’s the risk of extensive limb damage, soft-tissue concern or, in some cases, amputation. These injuries must be trauma-evaluated.”

Injuries caused by fireworks can include first-, second- or even third-degree burns. After healthcare professionals evaluate the wound and extremity in the trauma unit, they’ll often refer the patient to a specialized burn unit, which Oakley says rarely occurs with an “everyday mild” burn.

Beyond the initial trip to the trauma unit, these patients may require specialized rehabilitation treatments. “Because the hand is so specific and has so many ligaments, tendons and nerve endings, a specialized hand or plastic surgeon often needs to perform the evaluation and treatment,” Oakley says. “Afterward, because the injury can be so severe, patients might require physical therapy, occupational therapy or inpatient rehabilitation.”

Recommended: Essentials of Trauma Nursing, 3rd Edition

Treatment after the injury

For hand injuries as drastic and potentially life-changing as those caused by fireworks, it’s crucial for victims to continue their treatment after leaving the hospital. “Every single firework injury is different,” says MaryLynn Jacobs, MS, OTR/L, CHT, vice president of operations for ATI Physical Therapy and practice management chair of the American Society of Hand Therapists.

For therapists providing rehabilitation to those injured by fireworks, here are some important questions to consider:

  • Bones:
    • What bony structures were injured and repaired? How stable are the structures post-repair?
    • Is protection or splinting and orthosis management needed for healing?
  • Vessels:
    • Did the firework injure venous blood vessels, arterial, or both? Was vascularity repaired?
    • Are structures at risk due to poor or insufficient vascularity?
  • Tendons:
    • What tendons were injured and/or repaired?
    • What is the integrity of the repaired tendon(s)/pulley(s)?
  • Nerves:
    • Were motor or sensory nerves injured? Which ones?
    • Did a specialist repair them? If so, what was the type and integrity of the repair?
  • Skin/Wounds:
    • How much skin loss occurred?
    • Is it appropriate to apply compression dressings or garments? Will they compromise vascularity?
    • Is debridement necessary?

Preventing firework injuries

Although they can be devastating, firework injuries are entirely preventable. Jacobs emphasized the importance of educating patients about how dangerous these celebratory items  can be. “A sparkler can melt metal,” she says. “Getting that message out to consumers — and to other healthcare professionals — is crucial.”

Here are some additional firework safety tips from the National Safety Council.

  • Never allow young children to handle fireworks
  • Older children should only use fireworks under close adult supervision
  • Never use fireworks while impaired by drugs or alcohol
  • Anyone using fireworks or standing nearby should wear protective eyewear
  • Never hold lighted fireworks in your hands
  • Never light fireworks indoors
  • Only use them away from people, houses and flammable material
  • Never point or throw fireworks at another person
  • Only light one device at a time and maintain a safe distance after lighting
  • Never ignite devices in a container
  • Do not try to re-light or handle malfunctioning fireworks
  • Soak both spent and unused fireworks in water for a few hours before discarding
  • Keep a bucket of water nearby to fully extinguish fireworks that don’t go off, or use to douse in case of fire
  • Never use illegal fireworks