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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.
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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.
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