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While many Americans are packing coolers for the beach, firing up the grill and turning on the sprinklers, EMS providers know all too well that 4th of July celebrations can often turn disastrous. Whether it’s heat-related illness, drownings or intoxicated drivers, there are several threats to warn communities about this month, in addition to the danger of fireworks.
Two-thirds of fireworks injuries reported in the U.S. occur in the 4 weeks surrounding Independence Day. [At the end of this article, download an infographic on fireworks injuries]
The number of fireworks injuries decreased slightly in 2023 (see table), according to the U.S. Consumer Product Safety Commission’s “Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities During 2023” report.
Year | Estimaged Injuries | Injuries per 100,000 People |
2023 | 9,700 | 2.9 |
2022 | 10,200 | 3.1 |
2021 | 11,500 | 3.5 |
2020 |
15,600 |
4.7 |
2019 |
10,000 |
3.0 |
2018 | 9,100 | 2.8 |
The CPSC report accounted for the following estimated data on fireworks injuries and death in the U.S. in 2023:
- 8 non-occupational fireworks-related deaths
- 9,700 injuries treated in U.S. hospital emergency departments
- 800 emergency department-treated injuries associated with firecrackers
- 700 emergency department-treated injuries associated with sparklers
Of the fireworks injuries in 2023, 6,400 (66%) were treated during the one-month period between June 16, 2023 and July 16, 2023.
Children (younger than age 15) accounted for 31% of the estimated injuries, with adults ages 25-44 accounting for another 31%.
Fireworks injuries: type and location
According to the CPSC report, the parts of the body most frequently injured by fireworks include:
- Hands and fingers (35%)
- Head, face, and ears (22%)
- Eyes (19%)
- Trunk/other regions (11%)
- Legs (8%)
- Arms (5%)
Listed causes of death from fireworks in 2023 include:
- Blunt force trauma to torso
- Blunt force chest trauma
- Blunt force injuries due to firework explosion
- Blunt force and thermal traumatic injuries from explosion
When responding to a fireworks-related injury, be prepared to treat the following.
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Amputation. When fireworks go off prematurely or unexpectedly, finger and hand amputation is not out of the question. Considerations include hemorrhage control, early tourniquet use and transportation to a trauma center.
Learn more: How to manage traumatic amputations and uncontrolled bleeding. Knowing the type of amputation, ways to quickly control bleeding, and proper body part preservation can lead to an increase in survival rates
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Burns/smoke inhalation. According to NFPA research into calendar year 2023, an estimated 32,302 fires were started in the U.S. by fireworks, including 3,760 structure fires and 849 vehicle fires, causing 15 deaths, 58 injuries and $142 million in property damage.
Burns accounted for 42% of the ED-treated fireworks injuries in 2023. Burns were the most common injury to hands, arms and legs.
Learn more: When body surface area matters in burn assessment. Triage burn victims for inhalation injury and fluid administration by putting these four pieces of the puzzle together.
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Contusions/lacerations. Contusions and lacerations account for many fireworks-related injuries. Look for bruising. In extreme cases, this can cause blood to seep, hemorrhage or extravasate into surrounding tissues. Stop-the-Bleed treatment for lacerations will depends on the type, cause and depth of the wound.
Learn more: How to pack a severely bleeding wound. Hemorrhage control guidelines direct paramedics to use hemostatic gauze but medics are often not formally trained in wound packing.
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Facial trauma. Trauma to the head, ears, eyes and face accounts for 41% of fireworks-related injuries. In head injuries, look for hypoxia, hyperventilation and hypotension and consider the risk for traumatic brain injury. One of the first concerns with significant facial trauma is whether the patient has a patent airway and will be able to maintain that airway.
Learn more: 5 tips for securing a patient’s airway. You are on scene with a patient who has suffered significant facial trauma; what are some strategies to improve your ability to manage his airway?
This Independence Day, be prepared, and stay safe with 10 safety tips for paramedics working on the 4th of July.
Read the report: U.S. Consumer Product Safety Commission’s “Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities During 2023”
This article, originally published in 2021, has been updated with new information.
