The Rockets' Red Glare: Tips For Firework Safety

Author: Matt Klein, MD (EM Resident Physician, PGY-3, NUEM) // Edited by: Michael Macias, (EM Resident Physician, PGY-4, NUEM) // Expert Commentary: Christopher Richards, MD

Citation: [Peer-Reviewed, Web Publication] Klein M, Macias M (2016, June 30). The Rockets' Red Glare: Tips For Firework Safety. [NUEM Blog. Expert Commentary by Richards C]. Retrieved from

For many Americans, the Fourth of July holiday brings parades, cookouts, and of course, fireworks. While the colorful displays are enjoyed across the country, fireworks can be dangerous and require a special attention to safety.

Though data suggests that firework-related injuries are decreasing, from 2006 to 2010 firework-related injuries led to an estimated 25,691 emergency department (ED) visits - two thirds of which occurred during the month of July [1,2].

Those injured are overwhelmingly male, frequently under 20 years old, and commonly sustain wounds to the head, eyes, and extremities [1,2,3]. Among children, firework-related injuries are most likely to occur on the Fourth of July, but account for a minority of pediatric ED visits on the holiday [6]. Rates of firework-related injury are higher in states with less restrictive firework laws [4], and have been associated with improper handling and use of illegal fireworks [3]. One survey found that the incidence of firework-related injury is associated with lower perceived injury risk and higher perceived ability of managing an injury [5].

Tips for firework safety

  • Never use illegal fireworks
  • Never allowing children to ignite fireworks
  • Never point a firework at another person
  • Never try to reignite a firework
  • Always keep a bucket of water or a hose nearby while using fireworks

There are many helpful resources on firework safety. For more information, consult your local fire department, the National Council on Fireworks Safety, or the United States Consumer Product Safety Commission.


Happy Fourth of July!

Expert Commentary

This is a very timely and well-referenced quick review on the epidemiology and nature of firework injuries in the U.S., as well as some pertinent safety tips. I’ll highlight that 3 out of 4 firework injuries affect the head, eyes, or hands, and 50% of injuries can be classified as burns (USCPSC). Interestingly, the source that Dr. Klein references from the US Consumer Product Safety Commission on firework safety reports that sparklers are one of the most common type of fireworks associated with injury (USCPSC).  Perhaps this is related to the perceived low risk of injury with sparklers or the prevalence of their use, even in areas with more restrictive firework laws. Illinois is a state with relatively strict fireworks regulations.  Deputy District Chief Joseph Roccasalva, Coordinator of Fire Awareness and Public Education for the Chicago Fire Department, reminds us that fireworks, including sparklers, are illegal in Illinois unless authorized by local jurisdictional permits for supervised public displays.

A review of firework injuries presents a good opportunity to review basic principles of blast injuries. As for other illness and injuries treated in the prehospital setting – and also in the Emergency Department – scene safety is of paramount importance.  Particularly with fireworks, emergency medical services provider safety must first be considered.  Fireworks are capable of detonating in a delayed fashion: - “duds” can explode without warning when a responder approaches an intact firework.  We saw this recently when flares were launched onto the pitch during EURO 2016. 

 A discussion of blast injuries also provides an opportunity to review the five types of injuries from a blast mechanism, a favorite question for boards exams.  Primary blast injuries result from the concussive force of the blast wave, causing small particles to be liberated into gas in a process called “spall.”  These types of injuries include tympanic membrane rupture, lung injury, and hollow viscous injuries.  Secondary blast injuries are caused by projectiles from the explosion, either flying debris caught up in the explosion or embedded projectiles in an improvised explosive device, for example.  Secondary injuries are the most common types of blast injuries.  Tertiary injuries are traumatic impact injuries suffered by the blast victim as they are thrown into the ground or against walls.  Quaternary injuries are other injuries caused by the explosion, such as burns and inhalation injuries, that are caused by the thermal effects of the blast or exacerbation of underlying medical conditions.  Authors now describe quinary injuries as well – these are injuries and illnesses related to radiologic, biologic, or chemical contaminants in explosive devices.  An example would be radiation sickness from a dirty bomb [7].  The CDC actually has a nice app that reviews blast mechanisms and injuries if you want to download a reference for these types of injuries. 

Enjoy a happy and safe Fourth!

Christopher T. Richards, MD, MS

Instructor; Department of Emergency Medicine and Center for Healthcare Studies; Associate EMS Medical Director, Chicago EMS/Illinois Region XI EMS Central System; Northwestern Feinberg School of Medicine

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  1. Moore, J. et al. The epidemiology of firework-related injuries in the United States: 2000-2010.  Injury. 2014;45:1704-1709.
  2. Canner, J. et al. US emergency department visits for fireworks injuries, 2006-2010. Journal of Surgical Research. 2014;190:305-311.
  3. Wang, C. et al. Firework injuries at a major trauma and burn center: A five-year prospective study. Burns. 2014;40:305-310.
  4. Berger, L. et al. Injuries from fireworks. Pediatrics. 1985;75(5):877-82.
  5. Saadat, S. et al. Perceived risk and risk-taking behavior during the festival firework. American Journal of Health Behavior. 2010;34(5):525-531.
  6. D’Ippolito, A. et al. Epidemiology of pediatric holiday-related injuries presenting to US emergency departments. Pediatrics. 2010;125(5):931-937.
  7. McManus J & Schwartz RB. “Blast Injury.” In Emergency Medical Services: Clinical Practice and Systems Oversight, Volume 1: Clinical Aspects of EMS, 2nd edition.  Ed in Chief Cone D. Eds Brice JH, Delbridge TR, Myers JB. NAEMSP: Wiley, West Sussex, UK. 2015.