Study: Firework injuries in Iowa spike post-legalization

IOWA CITY — Fireworks-related injuries at Iowa’s two largest trauma systems spiked after lawmakers legalized their sale in 2017 — including a fourfold increase in injured kids, hit especially hard by the surge.

Between Iowa’s legalization of consumer fireworks in May 2017 and the end of 2019, the University of Iowa Hospitals and Clinics and Iowa Methodist Medical Center-UnityPoint Health in Des Moines treated a combined 107 patients for fireworks-related injuries, according to newly-released data examined by the UI Injury Prevention Research Center.

For all of 2014, 2015, 2016, and 2017 through May — a longer period of time before legalization — those same centers saw a combined 43 fireworks-related injuries, indicating legalization provoked at least a 150 percent spike.

The escalation has health care providers promoting legislative recommendations — like adding protections for children and prohibiting people under the the influence of drugs or alcohol from setting off the explosives. It also has the medical professionals interested in launching safety campaigns, while also establishing a fireworks-related injury database reporting statewide numbers annually.

“We are now talking with the fire marshal about annual funding so that we could eventually think about maybe a firework-injury registry,” UI Health Care Associate Research Scientist Colette Galet told The Gazette. “It’s really in discussion. We’re still thinking about how to do it best.”

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Pediatric injuries

While fireworks injuries at the trauma centers had been fairly consistent in the years before they were legalized — with seven in 2014, 13 in 2015 and 19 in 2016 — annual injuries about doubled to more than 30 in 2017, nearly 40 in 2018 and 37 in 2019, the most recent year analyzed.

The number of those patients under age 18 more than quadrupled — jumping from eight total in the three years before legalization to 33 between May 2017 and 2019, according to the data. Where just two pediatric patients were handling the fireworks when injured before legalization, 18 of the children injured after legalization reportedly were “handlers.”

Another 11 of the kids under age 17 who were injured post-legalization were “bystanders,” with four marked as “unknown,” according to the research.

UIHC Emergency Medicine Clinical Professor Michael Takacs said every person near a firework handler is considered a bystander.

“They’re like a family member or a friend who are at a party, and maybe an adult was using the firework — like a bottle rocket — and it got close to their proximity, and they got injured,” he said. “They weren't the one initially using the fireworks.”

Amputations

The severity of fireworks injuries has worsened, too, with 18 percent of patients following the legalization requiring amputation. Before the law change, those trauma centers recorded no fireworks-related amputations, according to the research.

Although most of the amputations were not fully described in the new data, according to Galet, those that were involved fingers. Of the 19 amputations, 18 involved adults and one involved a child.

Six of the pediatric patients needed surgery after legalization, while one did before. Among adults, 29 needed surgery after the legalization, compared with 10 in the period studied before.

Amputations and surgeries can mean longer hospital stays, higher health care costs and long-term disabilities. Overall, according to the research, fireworks-related hospital admissions jumped from 3.6 annually before legalization to nearly 15 after.

Fatalities

The research found no patient died “in the hospital setting from fireworks,” but it also noted data didn’t include out-of-hospital fireworks-related deaths — like patients who died on scene — or those who died at other hospitals.

In July 2018, an 18-year-old in Waverly died after trying to set off fireworks from a football helmet strapped to his head. According to a report from the U.S. Consumer Product Safety Commission, an adult friend taped a tube to a helmet using duct tape and had launched several fireworks without incident or injury.

When the victim loaded the tube atop the helmet on his head, an ignited mortar shell became stuck in the tube and didn’t launch.

“The mortar exploded in the tube atop of the victim’s head a few seconds later and caused the victim to fall to the ground,” according to the commission’s report. “The victim was taken to a local hospital and later transported to a medical center where he died the next day due to his injuries.”

When and where

When assessing type of injuries, researchers found half of all injuries were to the hands; 32 percent were to the eyes; 27 percent to the face; and 20 percent involved the torso. About 58 percent of patients suffered from burns.

Among the kids, 27 suffered burns after legalization, where six did before. Only five of those pediatric burns after legalization involved sparklers.

“Those were superficial burns,” Galet said.

Although Iowa’s Senate Bill 489 legalized the sale of fireworks between June 1 and July 8 and also from Dec. 10 to Jan. 3, fireworks injuries predominantly have occurred in June and July. Of the 107 reported post-legalization, 98 came in those two months — with a combined five in May and August and just one each in January, February, March and April.

Drugs and alcohol

While most fireworks-related patients who presented at the trauma centers weren’t screened for drugs or alcohol, a higher number of those who were tested positive, according to the data.

Where just two tested positive for alcohol pre-legalization, health care providers found 13 had alcohol in their systems after. Where only one patient tested positive for drugs before fireworks became legal, 18 of those injured tested positive after.

“Drinking alcohol or using drugs is highly correlated with injury, compared to not,” Takacs said.

National picture

The consumer safety commission last year reported tallying about 10,000 injuries treated in U.S. hospital emergency rooms during the 2019 calendar year — or about 3.1 per 100,000 people. About 7,300 fireworks-related injuries in 2019 — or 73 percent of the total — were treated between June 21 and July 21.

The UI research found Iowa’s recent increase is far higher than national trends, which Takacs speculated is due to its 2017 fireworks legalization.

“I'm guessing it’s because we were the last to legalize,” he said. “And so there's a learning process. And it probably takes years — as the data shows — before the general public gets smarter in handling fireworks.”

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