Fireworks are defined as small devices that explode to make a display of light and noise.* Entering “fireworks” into a search engine returns approximately 110 million results. The top banner will have beautiful images of aerial fireworks, followed by a definition of the word, local events with fireworks, and the top news stories relating to fireworks. This summer, several high-profile news stories pertained to firework injuries, including two National Football League players who suffered hand injuries with finger loss.

Consumer fireworks are regulated by the U.S. Consumer Product Safety Commission (CPSC) and are very safe when used in accordance with the instructions and safety warnings. They are packaged in bright colors, have safety warnings printed on the package, and display the country of origin. These typically include fountains, cones, sparklers, firecrackers, rockets, and multi-tube aerial devices. Illegal explosives, on the other hand, are often unpackaged, wrapped in brown paper, and lack safety warnings and the name of the country of origin. They go by names such as “quarter stick,” “cherry bomb,” and “M-80.” Professional-grade fireworks are only legal in the hands of licensed, trained pyrotechnicians. These materials are very powerful and are not meant for consumer use.

Too hot to handle

According to a study conducted by the CPSC, for the 30 days surrounding July 4, 2014, an estimated 230 fireworks-related injuries sent people to hospital emergency departments each day. Furthermore, nine people died in fireworks-related incidents, and at least two of these victims were not the users. Hand and finger wounds comprised the majority of these injuries in more than one-third (36 percent) of these incidents, followed by eyes (19 percent), and head/face/ears (19 percent). In 50 percent of the cases, the injuries were burns; 20 percent were related to use of firecrackers, and 19 percent involved the use of sparklers. Only 4 percent occurred at public displays. The demographic of the injured victim was male (74 percent) aged 25–44 (34 percent).

To examine the occurrence of firework-related injuries in the National Trauma Data Bank® (NTDB) research dataset for 2013, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses codes. Specifically searched were records that contained the following external cause of injury codes (E-code): E923.0 (injury caused by explosive material—fireworks). A total of 2,056 records were found; 1,599 records contained a discharge status, including 1,503 patients discharged to home, 47 to acute care/rehab facilities, and 28 to skilled nursing centers; 21 died. (See Figure 1.)

Figure 1. Hospital Discharge Status

Figure 1

These patients were 86 percent male, on average 27.8 years of age, had an average hospital length of stay of 4.7 days, had an intensive care unit length of stay of 5.5 days, had an average injury severity score of 5.6, and were on the ventilator for an average of 8.2 days. A total of 790 patients were tested for alcohol, and nearly half (49 percent) tested positive.

Think before you act

Ultimately, fireworks are explosives, so a little bit of common sense and respect for their power will go a long way in avoiding mishaps. Some fireworks safety tips that surgeons may want to share with their patients include the following:

  • Never allow children to play with or ignite fireworks
  • Never try to relight or pick up fireworks that failed to ignite fully
  • Keep a bucket of water or hose on hand to put out any unexpected fires
  • Light fireworks one at a time, and then step back
  • Do not hold in your hand fireworks that are intended to be placed on the ground and ignited

For a full list of consumer fireworks safety tips and safety video, visit the National Council on Fireworks Safety website and the CPSC’s Fireworks Information center.

Throughout the year, we will be highlighting these data through brief monthly reports in the Bulletin. The NTDB Annual Report 2014 is available on the ACS website as a PDF file.

Also available on the website is information about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at


Statistical support for this article has been provided by Chrystal Caden-Price, Data Analyst, NTDB.

*Firework. 2015. Available at: Accessed August 3, 2015.

What consumers need to know before buying fireworks. National Council on Fireworks Safety website. Available at: Accessed August 3, 2015.

CPSC Science: Fireworks Injuries 2015 Update. Consumer Product Safety Commission website. Available at: Accessed August 3, 2015.

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