COLUMBUS, Ohio -- Children who live in communities with lenient fireworks laws are seven times more likely to be injured than are kids living where laws are stricter, a new study reports.
This finding, coming on the eve of what is historically the most fireworks-active holiday -- the Fourth of July -- has the study's authors calling for a total ban on the personal use of fireworks.
Public fireworks displays by communities got a strong endorsement from the same researchers as a safer alternative for celebrating the Fourth.
In a paper to be published in this month's issue of the journal Pediatrics, Gary Smith, director of emergency services at Children's Hospital in Columbus and assistant professor of pediatric medicine at Ohio State University, traced the 22-year history of fireworks-related injuries that passed through a Kansas City hospital's pediatric emergency department. This is the first study to look at the evolution of such injuries over a long period and to detect patterns that may lead to prevention of such accidents in the future.
The study found that 42 percent of the injuries were caused by firecrackers and another 12 percent were traced to shooting bottle rockets. Towards the later part of the period studied, more than half of the injuries (54 percent) occurred while children were under adult supervision. Smith says that these numbers prove that having a parent oversee fireworks use by children is not safe enough to prevent injury.
According to the paper, more than 12,600 people were treated in the nation's emergency rooms for fireworks-related injuries in 1994. Half of these injuries were to children and two-thirds of them occurred during one four-week period before and after the July 4th holiday.
More importantly, two-thirds of those injuries are caused by Class C fireworks that are legally available in many communities. These include small firecrackers, bottle rockets, Roman candles, sparklers, jumping jacks and fountains. Sale of the more powerful Class B fireworks, such as cherry bombs and M-80s, was banned by federal law in 1966 and therefore cause fewer injuries.
Smith; Brenda Shields, research coordinator at Children's; and Jane Knapp and Theodore Barnett, both of Children's Mercy Hospital in Kansas City, MO, looked at emergency department records from the Kansas hospital to harvest their data.
Nearly all of the injuries occurred during an annual three-week period from June 22 until July 14 for each of 22 years ending in 1993. From emergency room reports and patient records from that period, they were able to study 316 cases and build a statistical picture of who was injured by fireworks and, in most cases, what the specifics were for each case.
The average age of the fireworks-injured child was 8.5 years, although patients ranged from one month to 17 years old. Most of them -- 71 percent -- were boys. In three-fourths of the cases, the injured child was actively involved in handling the fireworks. A quarter of the cases were kids who were mere bystanders.
Eleven percent of those injured were admitted to the hospital. In those cases, the average stay was almost eight days and the cost of treatment ranged from nearly $870 to more than $14,000. In 5 percent of the total cases, the injuries were severe enough to require surgery.
Only one case resulted in the death of a child, but one of every 10 children suffered some permanent injury.
The most common injuries (72 percent) were burns, in many cases quite severe. Twenty-nine percent of the trauma cases affected the eyes, 22 percent were to the hands and fingers, 18 percent to the head and face, and 16 percent to the legs. Two percent of the injuries in the study led to partial or total vision loss in one eye and most of those cases were linked back to trauma due to rockets.
The researchers were surprised to find that sparklers, often considered "safe" fireworks by parents, caused 67 percent of the injuries to children five and under. Only 9 percent of the injuries in the study were the result of an intentional act by another person.
Smith and his colleagues worry that what they discovered in this study may be just part of the picture. "We only looked at cases that came through the emergency department of one major urban children's hospital," he explained. "We are certain that there are many more children who probably sought treatment from their personal physicians or from urgent care centers during the same period as our study." There are others who don't show up requesting treatment until several days later, Smith said.
The researchers are arguing for "a nationwide ban on all fireworks, except for licensed public displays," saying that it is "the approach with the highest likelihood of success in preventing such injuries." The American Academy of Pediatrics and the World Health Organization have called for such a ban.
"Each year at this time, we experience a national disaster. We sit and watch thousands of people get injured annually," Smith said. "The parents who bring their injured kids in are great parents. They never expected anything like this could happen to their child. In just a moment, something horrible occurs."
"The problem is reinforced each year when parents see the excitement in their children's eyes, anticipating shooting off their own fireworks. I see them at the other end of the equation, after the damage is done, with their eyes now filled with pained tears, not excitement. That's what the public seems to forget," Smith said.