Fire and Burn Injury Interventions

Interventions to Prevent Firework Burns

Background

Fireworks are commonly used during New Year’s Eve celebrations in Europe43,44  and Asia45  and during Independence Day festivities in the United States.46  The injury incidence in the United States ranges from 3.1 per 100,000 to 9.7 per 100,000.46,47  Children 5-12 and teens are the chief victims; the injured group is predominately male. Injuries can be severe resulting in hospitalization and permanent disability. Direct costs of fireworks injuries in the United States are conservatively estimated at $6.5 million (in 1981 dollars).48  The successful use of multifaceted community campaigns led to a reduction in fireworks injuries in Denmark and Italy.


Review of fireworks injury interventions:

Author

D’Argenio, 1996

Study design and target population

Nonequivalent control group design.

Children and young adolescents treated for fireworks injuries treated in the ER or hospitalized at the 18 area facilities in Naples, Italy.

Intervention

Multi-faceted intervention to reduce fireworks injuries during New Year’s celebration.

Enforced laws banning illegal fireworks including confiscation, cleaned streets after New Year’s celebration, and information campaign directed at the public, children, and teachers.

Outcomes

Fireworks injuries treated in the area emergency rooms or hospitalizations due to fireworks injuries.

Results

Injuries reduced by 48% (353 to 183) or 10.1 to 6.1 per 100,000, p<0.001 (RR=0.6, 0.22-1.65).

51% drop in injuries in the target age group, 10-12 year olds (45.9 to 22.3 per 100,000), RR=0.48, 0.29-0.79.

32% decline in severe injuries (third degree burns, avulsions or partial amputations).

Study quality and conclusions

Multi-faceted campaign with narrowly targeted messages successful.

Campaign targets based on previously identified risk factors for injury (illegal fireworks, unexploded fireworks).

Thorough pre- and post-intervention surveillance. Some injury reduction may have been due to depressed economy; no sales data and major rainstorm New Year’s Day which could have reduced children’s exposure.


Author

Sheller, 1995

Study design and target population

Interrupted time series design.

Children 9-16 years

Intervention

Multi-faceted campaign to reduce fireworks injuries during New Year’s celebration.

Legislation passed requiring safety fuses, enforced laws and confiscated illegal fireworks, school and media campaign emphasizing danger of carrying fireworks close to body.

Outcomes

All admissions to the 2 burn units in Denmark for fireworks related injury December, 1988-January, 1992 vs. December 1992-January 1994.

Results

Decrease in number and severity of fireworks injuries.

17 cases for 1991-92 New Year compared to 4 in 1992-93 and 3 in 1993-94 (p<0.01).

Injuries from fireworks carried in clothing eliminated.

Study quality and conclusions

Combined effect of information, new legislation and increased vigilance by police was effective.

Success highlighted by the fact that price of fireworks decreased and sales increased during intervention campaign.

Intervention designed to target previously identified risk factors.

Summary of firework burn interventions

These two successful campaigns used legislation to reinforce community and school based educational campaigns. In both cases the intervention was designed to target known risk factors in the individual communities and the campaigns employed a focused targeted message. Changes in product design (fireworks safety fuses) and the enforcement of legislation were the most important aspects of the campaigns.

Recommendations on firework burn interventions

Legislation banning the manufacture and sale of dangerous fireworks combined with enforcement is the most effective way to restrict the supply. States which restrict the sale of firecrackers, bottle rockets and sparklers have one-seventh the number of hospitalizations compared to states where these items are available.48  Educational campaigns are useful as supplemental efforts and can be used to build support for legislation.

Recommendations for future research

Manufacture of safer fireworks is needed.