Introduction The July 4th holiday presents a seasonal hazard (fireworks) that impacts EDs throughout the U.S. Active surveillance of fireworks injuries treated by EDs should be useful in providing estimates of occurrence, nature of injury, identification of victims and types of fireworks involved, and the level of preventive action taken by injured victims. This project should help evaluate the effectiveness of an active surveillance methodology using ED data and the descriptive epidemiology of ED-attended fireworks injuries.
Methods Emergency department (ED) directors of EMS level 1 and 2 hospitals were contacted to report fireworks injuries occurring between July 1 and ending July 6 to our center. A total of 27 hospital EDs were notified. A reporting questionnaire was provided to each ED with instructions to complete and fax back to our center. The questionnaire included basic demographics of the injured patient, type of injury, firework involved, and severity of injury.
Results A total of 21 EDs (78%) reported injury data to our center. During the 5-day surveillance period, 40 injuries were reported. The injured victims included 31 (78%) males, 22 (55%) less than 10 years of age, 14 (35%) 11 to 20 years, and 4 (10%) were over 20 years. Most of these injuries (70%) occurred at home, while the remaining 30% occurred at a friend's residence or neighborhood. (None occurred at city or officially sponsored events.) The most common firework involved was the bottle rocket (55%), which resulted in 6 (27.3%) mild, 9 (40.9%) moderate, and 7 (31.8%) severe levels of severity. Among 7 total "severe " injuries, all involved bottle rockets. Preventive practices reported by injured victims included 26 (65%) had adult supervision, 0 (0%) used safety goggles, 4 (10%) had a watering can nearby.
Conclusions An "active surveillance of sentinel injuries " methodology utilizing ED data and reported by fax is productive, as evidenced by the 78% response rate. As expected, fireworks-related injury visits are prevalent during the July 4th holiday and often involve small children (55% under 10 years). As previously reported, bottle rockets are commonly involved (55%) and represent high rates (72.7%) of moderate to severe firework injuries seen in EDs. Preventive practices (safety goggles or fire safeguards) are not often used among injured victims reporting to EDs. These data provide support for continued awareness and education through local area media for fireworks injury prevention and for continued active surveillance of EDs.
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