Fireworks-Related Injuries -- Marion County, Indiana, 1986-1991

Based on data from the Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System, fireworks-related injuries accounted for an estimated 12,400 emergency room visits during 1990 in the United States (1); two thirds of fireworks-related injuries occur during the 4-week period surrounding Independence Day. Since 1986, to better characterize fireworks-related injuries and to improve local health education and prevention efforts, the Marion County (Indiana) Health Department (MCHD) has conducted surveillance of fireworks-related injuries. This report summarizes surveillance results for 1986-1991.

Marion County (1990 population: 797,159) includes metropolitan Indianapolis. Each year, the MCHD collects data on demographic characteristics of injured persons, nature of the injury, type of device, and circumstances surrounding the incident (e.g., adult presence at time of injury) from all eight area hospital emergency rooms from June 27 through July 11.

During the 6-year period, 159 persons were reportedly injured by fireworks in Marion County. Fewest injuries (16) occurred during 1988; injuries peaked (37) during 1990. Most injuries (76 (48%)) occurred among children and adolescents aged less than 15 years; 32 (20%) occurred among adolescents and young adults aged 15-24 years, and 45 (28%), among adults aged 25-44 years. Males accounted for 74% of the injuries.

Burns were the most common (127 (72%) of 177) type of fireworks-related injury reported; 11% of injuries were lacerations, 9%, abrasions, 2%, puncture wounds, and 6%, other injuries. By site of injury, hands/fingers were most commonly involved (61 (34%) of 177) followed by eyes (17%) and the face (12%); however, during 1988, eyes (seven (44%) of 16) were the most frequently reported site of injury.

Fireworks devices most often associated with injuries varied by age group. Among children less than 5 years of age, sparklers were the leading cause of injury (54%), followed by firecrackers (23%), bottle rockets (11%), twisters or "jumping jacks" (8%), and other devices (4%). Of all sparkler-related injuries, 42% occurred among children aged less than 5 years. For children aged 5-14 years, firecrackers (34%) ranked first, followed by twisters (18%), sparklers (16%), bottle rockets (14%), and other devices (18%); most injuries involving twisters (53%) occurred among persons in this age group. For young adults aged 15-24 years, bottle rockets (35%) and firecrackers (16%) combined caused more than half of the injuries. Adults aged 25-44 years were injured most frequently by bottle rockets (33%), firecrackers (28%), and sparklers (23%). Of the five persons aged greater than or equal to 45 years, three were injured by firecrackers.

The most frequent injury-causing event reported involving other fireworks-related devices was lighting gunpowder, which accounted for injuries to eight persons aged 15-24 years. During the 6-year period, 53% of minors injured by fireworks were under adult supervision at the time of the injury.

Reported by: DS Joseph, MS, Marion County Health Dept; ML Fleissner, DrPH, State Epidemiologist, Indiana State Board of Health. Unintentional Injuries Section, Epidemiology Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Although use of commercial fireworks rarely results in injuries, the private use of fireworks during the Independence Day holiday period has been associated with an increasing trend of substantial injuries. The National Fire Protection Association (NFPA) used CPSC data to estimate that, in the United States, the average annual number of emergency room visits resulting from fireworks use increased at least 48% during 1986-1990, compared with 1974-1978 (1). The NFPA also characterized the substantial economic and public health impact resulting from fireworks: during 1988, fireworks accounted for an estimated 44,500 fires that resulted in 20 deaths and $41 million in direct property damage.

The demographic characteristics of persons most frequently injured by fireworks in Marion County are consistent with national findings and with previous studies from Washington state (2-4). Young males were most frequently injured; however, for fireworks -- as well as for most other injury causes -- it is not possible to determine whether young males are at increased risk for injury or whether their injury patterns reflect increased exposure to injury-causing events.

In Marion County, injuries were associated with every category of fireworks. The relation of age of person injured to type of fireworks device was also consistent with national findings. For example, sparkler injuries were a substantial problem for young children (2); adults were more likely to be injured by aerial devices such as bottle rockets. A previous report from Washington indicated that, among all age groups, fireworks-related injuries were associated with firecrackers and aerial devices and with a variety of misuse behaviors (e.g., relighting, throwing, holding in hand, and bending over to light). For children aged less than 16 years, lack of adult supervision was a significant risk factor for injury (odds ratio=11.5; 95% confidence interval=2.8-100.6) (3).

Current federal, state, and local laws regulating sales of fireworks to private persons are inconsistent and, therefore, undermine enforcement. For example, fireworks can be transported easily from legal to illegal jurisdictions. Increased availability of fireworks, legally or illegally, can increase related injuries. For example, during 1982, Washington standardized restrictions on fireworks sales to provide uniform availability of firecrackers and aerial devices statewide (5). Before the law change, explosive ground devices, aerial devices, and exploding firecrackers containing less than 50 mg of gunpowder were available only on American Indian reservations; the new law made these devices available outside reservations as well. As a consequence following the change in law, surveillance conducted by the Washington Department of Health documented a significant increase in the number of fireworks-related injuries reported by 15 hospitals in nine counties (from 39 in 1981 to 88 in 1982; p less than 0.001) (5).

Both legal and illegal fireworks are associated with injuries. During 1989, 73% of fireworks-related injuries reported through the CPSC system were associated with devices legally acquired under federal law (2). However, illegal fireworks may cause more severe injuries; during 1989, two thirds of injuries requiring hospitalization were associated with fireworks illegal under federal law (2).

In addition to stronger and more uniform restrictions on the availability of certain fireworks, educational efforts should also be employed to reduce injuries. For example, during the 1988 Independence Day holiday period, Marion County had the fewest number of fireworks-related injuries for 1986-1991; at the same time, however, a severe drought in Indiana prompted local public safety officials to discourage fireworks use -- a message that was well publicized by the local media.

No fireworks should be considered completely safe for children. Educational efforts directed toward parents of young children have been effective in support of other injury-prevention campaigns such as the use of child safety seats. The American Academy of Pediatrics' Committee on Injury Prevention and Control recommends similar efforts to reduce injuries associated with sparklers and other fireworks that have special appeal to children (6). The CPSC has developed guidelines for parents living in areas that allow the sale of fireworks for personal use (see box) (4).

The MCHD provides its surveillance data to local media and interest groups (e.g., state and local fire marshals and state legislators) concerned with fireworks safety. In addition, all Marion County hospitals receive an overall report on the incidence of fireworks-related injuries and associated health-care concerns.

References

1. National Fire Protection Association. NFPA: fire facts. Quincy, Massachusetts: National Fire Protection Association, April 1991.

2. National Fire Protection Association. NFPA: fire facts. Quincy, Massachusetts: National Fire Protection Association, April 1990.

3. McFarland LV, Harris JR, Kobayashi JM, Dicker RC. Risk factors for fireworks-related injury in Washington state. JAMA 1984;251:3251-4.

4. Berger LR, Kalishman S, Rivara FP. Injuries from fireworks. Pediatrics 1985;75:877-82.

5. CDC. Fireworks-related injuries -- Washington. MMWR 1983;32:285-6.

6. Committee on Injury Prevention and Control, American Academy of Pediatrics. Children and fireworks. Pediatrics 1991;88:652-3.

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