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Thursday, January 1, 2015

Firework injuries (DRASTIC!)


Image courtesy of: satit_srihin at FreeDigitalPhotos.net


In the Gregorian calendar, New Year's Eve, the last day of the year is on December 31 (also known as Saint Sylvester's day). (Incidentally, it's also my birthday.) In many countries - including Poland, where I live - Saint Sylvester's day is a prime occasion for having fun. Celebrations start in the evening and evolve into a night of partying, with lots of laughter and alcohol (dancing is optional). At midnight, bottles of sparkling wine are opened and fireworks start to bloom in the sky. The flashes, bangs and multicolored stars are somehow mesmerizing even if you've already seen this sort of pyrotechnic display dozens of times. 

Unfortunately, while fireworks are spectacular and fascinating, they can also be extremely dangerous, especially in the hands of children or adolescents who underestimate the power of explosives. Every year, hundreds of unfortunate people spend the first days of January - and sometimes a much longer period - in hospital beds, recovering from injuries caused by a firework blast. Of course, this problem isn't limited to December 31. In different countries throughout the world, many holidays and festivities are celebrated with fireworks, always with similar consequences - a number of firework casualties land in hospital emergency rooms, or worse, end up dead. Common injuries include mangled hands, ruptured eyes, severe facial lacerations, fractures, and of course burns.

In Iran, the last Wednesday of the Persian year is known as “Charshanbeh Soori”. This traditional festival, dating back to ancient times, begins on the last Tuesday night of the year (based on the Persian calendar). During previous centuries, this celebration was mostly peaceful and only a simple bonfire was lit during festivities. However, nowadays the advent of new firework devices and dangerous hand-made grenades has changed this calm festival into a disastrous event. Below is a photo of an Iranian youth who lost his right hand to an exploding firework in 2006.


Another young Iranian male suffered numerous burns and contusions to his trunk and arms, also in 2006.




In the United States, Independence Day celebrations on July 4 (the Fourth of July) invariably involve fireworks - and the toll is high. In just one short case series, published in 2014, 4 adult men, all suffering from severe firework injuries to the face, were brought to one urban trauma center on July 4 within 5 hours of each other. The average age of these patients was 26.7 years. Two died from their injuries and two recovered; one required reconstructive surgery later on. Be warned - the photos are anything but pretty.


Image from: Tadisina et al. (2014)


This 23-year-old man was transferred from an outside hospital after being hit in the face from a firework blast. He had extensive facial fractures and a large wound on his forehead. His face was covered with abrasions and lacerations, his right cornea was burned, and the left eye was ruptured (it had to be removed surgically). Compuded tomography images show multiple broken facial bones (yellow arrows), mostly involving the sinuses. He survived.

The following case is rather more drastic. If your children are fascinated with fireworks and explosives, it might be a good idea to frighten them with this photo:



Image from: Tadisina et al. (2014)

The 30-year-old patient was brought to the emergency department with an extensive facial blast injury - most of his forehead and nose had been literally blown away. Both of the eyes were clinically ruptured. He had also sustained a severe head injury; computed tomography revealed diffuse cerebral edema (swelling of the brain), as well as multiple skull fractures and bone defects. The orbital bones, the hard palate and both jaws were all broken. He soon developed a persistent high fever, and was treated with antibiotics. He was unconscious, but able to move his arms and legs when stimulated. After seven days, his fever rose, while his responsiveness diminished, and it was thought that he progressed to brain death. He was in the middle of a brain death workup when he went into cardiac arrest, and after 3 cycles of cardiopulmonary resuscitation, he was pronounced dead.
To some degree, the type of injuries incurred depends on the kind of firework that caused them. A publication from 1961 describes that until 1956, the commonest cause of firework-related injuries in the United Kingdom was "bangers" held in the hand. They could cause blast or burn injuries, or a mixture of both; not infrequently, young patients would lose a finger or two. Towards the end of 1956, manufacturers voluntarily agreed to reduce the amount of explosives in "bangers". Another common cause of injury was bending over a firework to light it, or puffing at a smoldering fuse to make it burn. The subsequent explosion would cause flash burns and, often, severe eye injuries including perforation of the eyeball by fragments. Carrying fireworks around in one's pockets was also extremely risky, as this case shows:


Image from: Jackson (1961)

A 5-year-old boy was carrying a pocketful of rockets on November 5, 1956 and they exploded, causing deep burns to his abdomen and groin area. After primary excision and grafting, the wounds took two months to heal. A year later, the patient required additional surgery to correct contractures in his groin. The article doesn't specifically mention how severe the injury to his genitals had been. The final result after lots of treatment, in 1960, looked like this:

Image from: Jackson (1961)

So... The next time when you plan to set off some fireworks to celebrate a holiday, think twice! At the very least, read the safety instructions very carefully.Do not carry fireworks in your pockets, and never smoke while handling them! When lighting a firework, never lean over it, and never point or throw burning fireworks at other people. Also, never attempt to re-light a firework that has misfired (a dud).  Never set off fireworks under the influence of alcohol, and don't let children play with them! Have a good time, but stay safe!


Literature:


Jackson D. (1961) Injuries from Fireworks. Br Med J. Nov 4, 1961; 2(5261): 1184–1187.

Tadisina KK, Abcarian A, Omi E. (2014) Facial Firework Injury: A Case Series. West J Emerg Med. 15(4): 387–393.

Vaghardoost R, Ghavami Y, Sobouti B, Mobayen MR. (2013) Mortality and Morbidity of Fireworks-Related Burns on the Annual Last Wednesday of the Year Festival (Charshanbeh Soori) in Iran: An 11-Year Study. Trauma Mon. 18(2): 81–85.



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