Are you prepared for Independence Day incidents and injuries?

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 4^th 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. More than 1/4 of fireworks fires reported over a 4-year span by the NFPA occurred on the holiday itself. [At the end of this article, download an infographic on fireworks injuries]

The number of fireworks injuries decreased slightly in 2021 (see table), according to the U.S. Consumer Product Safety Commission’s “Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities During 2021” report. A similar analysis of injuries during the summer of 2020 identified an approximately 50% increase in injuries year over year, which the report attributed to the cessation of public firework displays during the COVID-19 pandemic, leading to an increase in consumers putting on their own displays, which may in part explain the sharp rise.

Year	Estimated Injuries	Injuries per 100,000 People
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 2021:

• 9 non-occupational fireworks-related deaths
• 11,500 injuries treated in U.S. hospital emergency departments
• 1,500 emergency department-treated injuries associated with firecrackers
• 1,100 emergency department-treated injuries associated with sparklers

Of the fireworks injuries in 2021, 8,500 (74%) were treated during the 1-month period between June 18, 2021 and July 18, 2021.

Children (younger than age 15) accounted for 29% of the estimated injuries, with adults ages 25-44 accounting for another 32%.

Fireworks injuries: type and location

According to the CPSC report, the parts of the body most frequently injured by fireworks include:

• Arms (8%)
• Eyes (14%)
• Hands and fingers (31%)
• Head, face, and ears (21%)
• Legs (15%)

Listed causes of death from fireworks in 2021 include:

• Anoxic-ischemic encephalopathy due to a face, neck, and chest blast injury
• Blood loss from damage to the femoral artery
• Complications of blunt head trauma
• Exsanguination
• Thermal and inhalation injuries

When responding to a fireworks-related injury, be prepared to treat the following.

• 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

• Burns/smoke inhalation. According to NFPA research into calendar year 2018, an estimated 19,500 fires were started in the U.S. by fireworks, including 1,900 structure fires and 500 vehicle fires, causing five deaths, 46 injuries and $105 million in property damage.
  
  Burns accounted for 32% of the ED-treated fireworks injuries in 2021. 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 21% of 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
• Facial trauma. Trauma to the head, ears, eyes and face accounts for 35% 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.

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Read the report: U.S. Consumer Product Safety Commission’s “Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities During 2021”

Fill out the form below to download a fireworks injury infographic.

This article, originally published in 2021, has been updated with new information.