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PEDIATRICS Vol. 108 No. 1 July 2001, pp. 190-191
An estimated 8500 individuals, approximately 45%
of them children younger than 15 years, were treated in US hospital
emergency departments during 1999 for fireworks-related injuries. The
hands (40%), eyes (20%), and head and face (20%) are the body areas most often involved. Approximately one third of eye injuries from fireworks result in permanent blindness. During 1999, 16 people died as
a result of injuries associated with fireworks. Every type of legally
available consumer (so-called "safe and sane") firework has been
associated with serious injury or death. In 1997, 20 100 fires were
caused by fireworks, resulting in $22.7 million in direct property
damage. Fireworks typically cause more fires in the United States on
the Fourth of July than all other causes of fire combined on that day.
Pediatricians should educate parents, children, community leaders, and
others about the dangers of fireworks. Fireworks for individual private
use should be banned. Children and their families should be encouraged
to enjoy fireworks at public fireworks displays conducted by
professionals rather than purchase fireworks for home or private use.
ABSTRACT
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Abstract
Recommendation
References
Fireworks are devices designed for the purpose of producing
a visible or audible effect by combustion, deflagration, or
detonation.1 Every year, US residents celebrate the Fourth
of July and other festive occasions with fireworks. As a result, in
1999, an estimated 8500 individuals, approximately 45% of them
children younger than 15 years, sustained fireworks-related injuries
requiring emergency medical treatment.2,3 Since 1994, the
annual number of people receiving emergency medical treatment for
fireworks-related injuries has decreased by about one
third.3,4 The hands (40%), eyes (20%), and head and face
(20%) are the body areas most often involved.2 About one
third of eye injuries from fireworks result in permanent
blindness.5 Burns account for more than half of
fireworks-related injuries,2 and lacerations, contusions,
and abrasions are also common.1,26-8 During 1999, 16 people died as a result of injuries associated with
fireworks.2
Under regulations promulgated by the US Consumer Product Safety
Commission (CPSC) in 1976, any firecracker containing more than 50 mg
of explosive material is banned, although aerial devices may contain up
to 130 mg of powder charge. In addition, CPSC regulations include fuse
burn time limits, cautionary labeling requirements, and criteria to
prevent tipover and blowout of devices. Additional regulations address
requirements for certain reloadable tube and aerial shell fireworks and
the stability of multiple-tube devices.4
Consumer fireworks, formerly known as "Class C" fireworks and often
inappropriately referred to as "safe and sane" fireworks, include
fountains and candles that shoot out sparks or flaming balls, rockets
with sticks (called "bottle rockets," because it is customary to
stand them in a soda bottle for ignition), other rockets, firecrackers,
sparklers, and smoke devices. These are permitted under federal
regulation, and their sale is regulated by state and local
authorities.7 At present, 10 states ban all consumer
fireworks, and 5 additional states ban all consumer fireworks except
sparklers, "snakes," or other novelty items.9
In addition to ongoing injury surveillance, the CPSC conducts a special
study each year of fireworks-related injuries requiring emergency
medical care that occur around the Fourth of July.2,4,6 The 1999 CPSC study found that one third of the fireworks-related injuries were caused by firecrackers, approximately 10% of which were
illegal. Almost 20% of the injuries were from rockets. Notably, sparklers, which are mistakenly believed to be safe by many consumers, caused 10% of these fireworks-related injuries.2 Although most sparkler-related injuries are minor burns and corneal abrasions, sparklers can reach temperatures greater than 1000°F at the tip and
can cause serious burns by igniting clothing.1,5,8 One
study found that two thirds of injuries from sparklers occurred among
children 5 years and younger.8 A case-control study designed to control for the popularity of various devices found firecrackers and aerial devices to be associated with the greatest risk
of injury. It also found that the highest chance of injury requiring
hospitalization occurred with illegal and homemade
devices.7 Half of the fireworks-related eye injuries and
an even higher proportion of those resulting in permanent blindness or
enucleation are caused by bottle rockets.5 Every type of
consumer firework has been associated with serious injury or
death.1,8
Malfunctions of consumer fireworks account for only a small percentage
of injuries. In one study, the injured child was a bystander in 26% of
cases, and adult supervision was present in 54% of
cases.8 Therefore, not letting children ignite fireworks
and providing adult supervision while using fireworks are inadequate
injury prevention strategies.
In addition to medical and related costs directly and indirectly
attributable to fireworks injuries, fireworks cause significant property damage. In 1997, 20 100 fires, which resulted in $22.7 million in direct property damage, were caused by
fireworks.10 In a typical year, fireworks cause more fires
in the United States on the Fourth of July than all other causes of
fire combined on that day.10 The considerable losses of
life, health, and property are almost entirely preventable by the
removal of all fireworks from the hands of everyone except professional
pyrotechnicians. Injuries resulting from public fireworks displays are
rare. States that ban all consumer fireworks have significantly lower
rates of fireworks-related injuries and fires.1,5 Where
local jurisdictions ban fireworks, there is frequent crossover to
nearby communities that permit them, so the effectiveness of such local
regulation is limited.8 Education does not appear to
decrease the rate of injuries in states where consumer fireworks are
permitted.7
OVERVIEW
RECOMMENDATIONS
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Abstract
Recommendation
References
Committee on Injury and Poison Prevention, 2000-2001
Marilyn J. Bull, MD, Chairperson
Phyllis Agran, MD, MPH
H. Garry Gardner, MD
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Liaisons
Ruth A. Brenner, MD, MPH
National Institute of Child Health and Human Development
Stephanie Bryn, MPH
Health Resources and Services Administration/Maternal and Child Health Bureau
Cheryl Neverman, MS
National Highway Traffic Safety Administration
Richard A. Schieber, MD, MPH
Centers for Disease Control and Prevention
Richard Stanwick, MD
Canadian Paediatric Society
Deborah Tinsworth
US Consumer Product Safety Commission
Section Liaisons
Victor Garcia, MD
Section on Surgery
Robert R. Tanz, MD
Section on Injury and Poison Prevention
Staff
Heather Newland
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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CPSC, US Consumer Product Safety Commission.
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REFERENCES |
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Abstract
Recommendation
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Statement of reaffirmation:
The following policy statement has been revised:
This article has been cited by other articles:
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  R. J. Witsaman, R. D. Comstock, and G. A. Smith Pediatric Fireworks-Related Injuries in the United States: 1990-2003 Pediatrics, July 1, 2006; 118(1): 296 - 303. [Abstract] [Full Text] [PDF]
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