Preventing Injuries by Banning Consumer Use of Fireworks

Consumer fireworks cause serious but preventable injuries to both users and bystanders. In 2008, fireworks devices were involved in an estimated 7000 injuries treated in US hospital emergency rooms, with an estimated 5000 (70%) of these occurring during the 1-month period surrounding the Fourth of July (June 20–July 20).^[1] It is important to note that injury data are probably underestimated, as they include only those who reported to the emergency room whereas some may report to their local health care providers.

Children and young adults are disproportionately affected by fireworks-related injuries. In 2008, more than 4 of every 10 people injured were children aged younger than 15 years. Further, 25% of the estimated sparkler-related injuries were to children aged 4 and younger and 50% were to children younger than 15.^[1]

Multiple types of injuries result from the use of fireworks. Of those reported in 2008, more than half were burns to the skin.^[1] Eyes were the second most commonly injured part of the body, with an estimated 1000 fireworks-related eye injuries treated in the same 1-month period surrounding July 4.^[1] One study of 53 serious ocular fireworks injuries revealed that surgical intervention was required in 56.6% of the cases, with permanent residual vision loss occurring in over 92% (all but 4) of the cases.^[2]

Injuries result from a wide variety of fireworks. Again, in 2008, firecrackers accounted for 900 injuries, sparklers for 800, and bottle rockets, roman candles, and “novelty” fireworks for 300 each^.[1] Firecrackers and sparklers caused the greatest number of injuries in children aged 14 and younger.^[1]

Fireworks not only result in personal injuries, but also lead to property damage. An estimated 22|500 reported fires were started by fireworks in 2008, resulting in $42 million in direct property damage.^[1]

The economic impact of fireworks injuries is also significant. One independent epidemiological study found that direct costs for medical care associated with children’s fireworks-related injuries over a 22-year period averaged $1385 per patient, ranging from $44 to $15|071.^[3]

Currently, only 5 states (Delaware, Massachusetts, New Jersey, New York, and Rhode Island) ban the use of all fireworks for private use; 6 states allow only sparklers and novelties, and 39 states and the District of Columbia allow consumer fireworks as approved by an enforcing authority or as specified by law.^[4]

While state laws clearly vary across the country, there are currently a number of public health efforts to address the growing concern of injury and damage related to fireworks and sparklers. One study recommends that preventive measures should be strengthened, including public education and legal restriction on the sale and use of fireworks.^[5] Further, evidence shows that aggressive awareness campaigns by government and nongovernment organizations can decrease injury due to fireworks.^[6]

The American Academy of Ophthalmology, the American Academy of Pediatrics, the American Optometric Association, the Centers for Disease Control and Prevention, and Prevent Blindness America are among a few of the organizations that recommend that fireworks should be left to professional handlers. Further, the American Academy of Pediatrics and Prevent Blindness America strongly support legislation that bans the importation, general sale, and indiscriminate use of fireworks for private use.^[4,7–10]

The American Public Health Association therefore—

1. Recommends that federal, state, and local governments ban the importation, interstate transportation, sale, and use of all fireworks except by licensed operators; 
2. Urges that where such bans are not in place, government authorities should implement regulations limiting the access and use of fireworks; 
3. Urges health care practitioners and local authorities to consistently and accurately report any fireworks-related injuries, property damage, and deaths to the US Consumer Product Safety Commission; 
4. Encourages all organizations and agencies concerned with the safety of the American public to intensify community and school-based educational efforts to inform adults and children of the hazards associated with the use of all types of fireworks; and
5. Recommends that state and federal agencies should support surveillance efforts and other research aimed at the direct and indirect costs of fireworks-related injury and the identification of factors contributing to the recent decrease in the number of fireworks-related injuries so as to improve future education and prevention efforts.

References

1. US Consumer Product Safety Commission. 2008 Fireworks Annual Report: Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities During 2008. Bethesda, MD: US Consumer Product Safety Commission; June 2009.
2. Camesaca FI, et al. Ocular Fireworks Injuries: Tissue Damage, Surgical Therapy And Visual Outcome in 53 Cases. Birmingham, AL: US Eye Registry; 1989.
3. Smith GA, Knapp JF, Barnett TM, Shields BJ. The rockets’ red glare, the bombs bursting in air: fireworks-related injuries to children. Pediatrics. 1996;98(1):1–9.
4. Prevent Blindness America. Fireworks position statement. Available at: http://www.preventblindness.org/advocacy/fireworks.html. Accessed May 21, 2011.
5. Jing Y, Yi-qiao X, Nan-ning Y, Ming A, An-huai Y, Lian-hong Z. Clinical analysis of firework-related ocular injuries during Spring Festival 2009. Graefes Arch Clin Exp Ophthalmol. 2010;248(3):333–338.
6. Puri V, Mahendru S, Rana R, Deshpande M. Fireworks injuries: a ten-year study. J Plast Reconstr Aesthet Surg. 2009;62(9):1103–1111.
7. American Academy of Ophthalmology. Leave fireworks to professionals this Fourth of July [press release]. Available at: http://www.aao.org/newsroom/release/20090629.cfm. Accessed May 21, 2011.
8. American Academy of Pediatrics. Fireworks-related injuries to children. Pediatrics. 2001;108(1):190–191.
9. American Optometric Association. Protect your eyes and attend professional fireworks displays [press release]. Available at: http://www.aoa.org/x8331.xml. Accessed May 21, 2011.
10. Centers for Disease Control and Prevention. Fireworks-related injuries. Available at: http://www.cdc.gov/HomeandRecreationalSafety/Fireworks/index.html. Accessed May 21, 2011.

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