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1.  Facial Firework Injury: A Case Series 
Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth. The use of fireworks within the context of celebrations and holidays presents the ideal environment for accidents that lead to severe and dangerous injuries. Injuries to the face from explosions present a challenging problem in terms of restoring ideal ocular, oral, and facial function. Despite the well documented prevalence of firework use and injury, there is a relatively large deficit in the literature in terms of firework injury that involves the face. We present a unique case series that includes 4 adult male patients all with severe firework injuries to the face that presented at an urban level 1 trauma center. These four patients had an average age of 26.7 years old and presented within 5 hours of each other starting on July Fourth. Two patients died from their injuries and two patients underwent reconstructive surgical management, one of which had two follow up surgeries. We explore in detail their presentation, management, and subsequent outcomes as an attempt to add to the very limited data in the field of facial firework blast injury. In addition, the coincidence of their presentation within the same 5 hours brings into question the availability of the fireworks involved, and the possibility of similar injuries related to this type of firework in the future.
PMCID: PMC4100840  PMID: 25035740
2.  Post-disaster health effects: strategies for investigation and data collection. Experiences from the Enschede firework disaster 
Background: Public health policy is increasingly concerned with the care for victims of a disaster. This article describes the design and implementation of an epidemiological study, which seeks to match care services to the specific problems of persons affected by a large scale incident. The study was prompted by the explosion of a firework depot in Enschede, the Netherlands.
Study population: All those directly affected by this incident (residents, emergency services personnel, and people who happened to be in the area at the time), some of whom suffered personal loss or injury. The project investigates both the physical and psychological effects of the disaster, as well as the target group's subsequent call on healthcare services.
Study design: A questionnaire based follow up survey of those directly affected and an ongoing monitoring of health problems relying on reports from healthcare professionals. The follow up survey started three weeks after the incident and was repeated 18 months and almost four years after the incident. The monitoring is conducted over a four year period by general practitioners, the local mental health services department, occupational health services, and the youth healthcare services department. It provides ongoing information.
Results and Conclusions: The results of the study are regularly discussed with healthcare professionals and policy makers, and are made known to the research participants. The paper also explains the considerations that were made in designing the study to help others making up their research plans when confronted with possible health effects of a disaster.
PMCID: PMC1732652  PMID: 15547056
3.  Extent, nature and hospital costs of fireworks-related injuries during the Wednesday Eve Festival in Iran 
Fireworks are commonly used in local and national celebrations. The aim of this study is to explore the extent, nature and hospital costs of injuries related to the Persian Wednesday Eve festival in Iran.
Data for injuries caused by fireworks during the 2009 Persian Wednesday Eve festival were collected from the national Ministry of Health database. Injuries were divided into nine groups and the average and total hospital costs were estimated for each group. The cost of care for patients with burns was estimated by reviewing a sample of 100 patients randomly selected from a large burn center in Tehran. Other costs were estimated by conducting semi structured interviews with expert managers at two large government hospitals.
1817 people were injured by fireworks during the 2009 Wednesday Eve festival. The most frequently injured sites were the hand (43.3%), eye (24.5%) and face (13.2%), and the most common types of injury were burns (39.9%), contusions/abrasions (24.6%) and lacerations (12.7%). The mean length of hospital stay was 8.15 days for patients with burns, 10.7 days for those with amputations, and 3 days for those with other types of injury. The total hospital cost of injuries was US$ 284 000 and the average cost per injury was US$ 156. The total hospital cost of patients with amputations was US$ 48 598. Most of the costs were related to burns (56.6%) followed by amputations (12.2%).
Injuries related to the Persian Wednesday Eve festival are common and lead to extensive morbidity and medical costs.
PMCID: PMC3591727  PMID: 21964162
Fireworks; Chaharshanbe Soori Injury; Health care costs; Injury prevention
4.  Injuries associated with fireworks in Victoria: an epidemiological overview 
Injury Prevention  1998;4(4):272-275.
Objectives—To determine the epidemiological features of injuries associated with fireworks.
Design—A retrospective study of reported cases.
Subjects—Subjects were those who attended selected Victorian hospital emergency departments (n=17) and those admitted for firework related injuries (n=16).
Results—The mean (SD) age of attenders at emergency department between January 1988 and June 1996, was 8.9 (6.2) years and most (88%) were under 18 years of age. Males accounted for 71% of the cases. The most common anatomical sites and types of injury were head (47%) and burns (88%), respectively. About 53% of the injuries were caused by firecrackers, the remainder by sparklers and penny bangers. Among those admitted to hospital between July 1987 and June 1996, the mean (SD) age was 22.9 (14.8) years and 50% were under 18 years of age. Males accounted for 87% of the cases. There was a significant difference in mean age between those admitted and not admitted to hospital, the former being significantly older.
Conclusions—Although relatively rare, injuries from fireworks still occur in Victoria after legislative restrictions on their sale in 1985. Consequently, there is a potential risk for injuries among children, particularly from firecrackers. More enforcement of the regulations, education, and parental supervision are needed to prevent injuries from fireworks.
PMCID: PMC1730423  PMID: 9887417
5.  Mortality and Morbidity of Fireworks-Related Burns on the Annual Last Wednesday of the Year Festival (Charshanbeh Soori) in Iran: An 11-Year Study 
Trauma Monthly  2013;18(2):81-85.
Management of firework-related injuries is costly for the patient, society, and government.
Evaluating effective factors yielding to such injuries may lead to better management of patients and decreased costs and morbidities.
Patients and Materials
This retrospective cross-sectional study was performed on burn patients referred to Shahid Motahari Burns Hospital on Charshanbeh Soori day festival during the period extending from March 2000 to March 2011 (11 days in an 11-year period). Demographic data, causes of burn injury, severity, and affected body parts were recorded. Data were analyzed using SPSS version 16.
There were164 patients in the study with a mean age of 18.34 ± 9.31 years; 87% (145/164) were male. Homemade grenades were the most frequent cause of injury. Hand injury was reported in 56% (92/164) of the cases. Amputation was executed in 7 (4.3%) cases, and 6 (3.7%) patients died due to severe burn injuries and facial damage.
Fireworks- related injuries during Charshanbeh Soori ceremony causes significant morbidities and damage to different body parts (especially upper limbs and face), and some of these injuries will lead to life time disabilities, amputations, and even death. As most of the injured patients are young teenagers and children, special consideration must be taken into account to prevent long term morbidities.
PMCID: PMC3860670  PMID: 24350158
Costs and Cost Analysis; Morbidity; Burns
6.  Acute Barium Toxicity from Ingestion of “Snake” Fireworks 
Ingestion of fireworks has been infrequently reported in the medical literature. We describe a case of acute, severe barium poisoning following firework ingestion.
Case Report
A 35 year-old male with a history of severe mental retardation presented with vomiting and diarrhea following ingestion of 16 small fireworks (“color snakes” and “black snakes”). His condition rapidly deteriorated and he developed obtundation, wide complex dysrhythmias and respiratory failure. Approximately 12 hours following ingestion his serum potassium level was 1.5 mmol/L with a serum barium level of 20, 200 mcg/mL (reference range < 200 mcg/L). The patient eventually recovered with ventilatory support and potassium supplementation.
Although firework ingestion is uncommon, clinicians should be prepared for potentially severe complications. In the case of barium poisoning, treatment consists of potassium supplementation and respiratory and hemodynamic support.
PMCID: PMC2845971  PMID: 19876854
fireworks; barium; hypokalemia
7.  Acute barium toxicity from ingestion of “snake” fireworks 
Journal of Medical Toxicology  2009;5(4):209-213.
Ingestion of fireworks has been infrequently reported in the medical literature. We describe a case of acute barium poisoning following firework ingestion.
Case Report
A 35-year-old male with a history of severe mental retardation presented with vomiting and diarrhea following ingestion of 16 small fireworks (“color snakes” and “black snakes”). His condition rapidly deteriorated and he developed obtundation, wide complex dysrhythmias, and respiratory failure. Approximately 12 hours following ingestion, his serum potassium level was 1.5 mmol/L with a serum barium level of 20,200 μg/mL (reference range<200 μg/L). The patient eventually recovered with ventilatory support and potassium supplementation.
Although firework ingestion is uncommon, clinicians should be prepared for potentially severe complications. In the case of barium poisoning, treatment consists of potassium supplementation, along with respiratory and hemodynamic support.
PMCID: PMC2845971  PMID: 19876854
fireworks; barium; hypokalemia
8.  A peculiar case of a retained inert piece of fireworks as an intraocular foreign body in the anterior chamber 
Saudi Journal of Ophthalmology  2013;28(3):225-227.
This is a descriptive case report of a seven-year-old boy presented in January 2007 with decreased vision in the right eye, for 2 months after sustaining a trauma while he was playing with fireworks during the Eid holiday. He was treated in a suburban hospital for corneal laceration and was prescribed a topical antibiotic and a topical steroid. When the child presented to us, a slit lamp examination revealed a thread in the anterior chamber, his un-aided visual acuity was 6/60 on a Snellen chart. Surgery to remove the foreign body was scheduled, but the patient never attended. The patient was lost to follow-up and returned in January 2011 with an un-aided visual acuity of 6/12, although the foreign body was retained in the anterior chamber (AC) with a quiet eye and good vision. At that time, we decided to follow the patient without any surgical intervention. Again, the patient was lost to follow-up and returned with almost full vision in September 2012, with a visual acuity of 6/6 without correction. Thus, we concluded that thread like IOFBs in the AC can be considered inert materials that may not need any surgical intervention in a quiet eye that does not show any signs of inflammation and where the IOFB is non-mobile and located away from the endothelium.
PMCID: PMC4181438  PMID: 25278802
Conservative management; Firework; Intraocular foreign body; Trauma
9.  Mapping Wintering Waterfowl Distributions Using Weather Surveillance Radar 
PLoS ONE  2012;7(7):e41571.
The current network of weather surveillance radars within the United States readily detects flying birds and has proven to be a useful remote-sensing tool for ornithological study. Radar reflectivity measures serve as an index to bird density and have been used to quantitatively map landbird distributions during migratory stopover by sampling birds aloft at the onset of nocturnal migratory flights. Our objective was to further develop and validate a similar approach for mapping wintering waterfowl distributions using weather surveillance radar observations at the onset of evening flights. We evaluated data from the Sacramento, CA radar (KDAX) during winters 1998–1999 and 1999–2000. We determined an optimal sampling time by evaluating the accuracy and precision of radar observations at different times during the onset of evening flight relative to observed diurnal distributions of radio-marked birds on the ground. The mean time of evening flight initiation occurred 23 min after sunset with the strongest correlations between reflectivity and waterfowl density on the ground occurring almost immediately after flight initiation. Radar measures became more spatially homogeneous as evening flight progressed because birds dispersed from their departure locations. Radars effectively detected birds to a mean maximum range of 83 km during the first 20 min of evening flight. Using a sun elevation angle of −5° (28 min after sunset) as our optimal sampling time, we validated our approach using KDAX data and additional data from the Beale Air Force Base, CA (KBBX) radar during winter 1998–1999. Bias-adjusted radar reflectivity of waterfowl aloft was positively related to the observed diurnal density of radio-marked waterfowl locations on the ground. Thus, weather radars provide accurate measures of relative wintering waterfowl density that can be used to comprehensively map their distributions over large spatial extents.
PMCID: PMC3402430  PMID: 22911816
10.  Bird migration flight altitudes studied by a network of operational weather radars 
A fully automated method for the detection and quantification of bird migration was developed for operational C-band weather radar, measuring bird density, speed and direction as a function of altitude. These weather radar bird observations have been validated with data from a high-accuracy dedicated bird radar, which was stationed in the measurement volume of weather radar sites in The Netherlands, Belgium and France for a full migration season during autumn 2007 and spring 2008. We show that weather radar can extract near real-time bird density altitude profiles that closely correspond to the density profiles measured by dedicated bird radar. Doppler weather radar can thus be used as a reliable sensor for quantifying bird densities aloft in an operational setting, which—when extended to multiple radars—enables the mapping and continuous monitoring of bird migration flyways. By applying the automated method to a network of weather radars, we observed how mesoscale variability in weather conditions structured the timing and altitude profile of bird migration within single nights. Bird density altitude profiles were observed that consisted of multiple layers, which could be explained from the distinct wind conditions at different take-off sites. Consistently lower bird densities are recorded in The Netherlands compared with sites in France and eastern Belgium, which reveals some of the spatial extent of the dominant Scandinavian flyway over continental Europe.
PMCID: PMC3024816  PMID: 20519212
bird migration; radar ornithology; weather radar; altitude profile; verification
11.  Smoking predicts posttraumatic stress symptoms among rescue workers: A prospective study of ambulance personnel involved in the Enschede Fireworks Disaster 
Drug and alcohol dependence  2008;94(1-3):267-271.
Examining whether smoking is a risk factor for posttraumatic stress disorder (PTSD) symptoms among rescue workers affected by a disaster.
Ambulance personnel (N=66) participated in surveys 2–3 weeks (T1) and 18 months after a fireworks disaster (T2). Hierarchical multiple regression analyses were conducted with cigarette consumption at T1 as a predictor of PTSD symptoms at T2. Demographic characteristics, disaster experiences, peritraumatic dissociation, intrusions and avoidance, psychological distress and alcohol consumption assessed at T1 were included as covariates.
Regression analyses showed that smoking at T1 independently predicted intrusions, avoidance, hostility, and depression symptoms at T2. Results were not affected by controlling for post-disaster critical incidents at work.
This is the first prospective study among rescue workers demonstrating that smoking soon after a disaster predicts PTSD symptoms in the intermediate term. Findings substantiate results of previous studies indicating that smoking is a relevant risk factor. Future research on how changes in cigarettes consumption post-trauma affect risk of PTSD is required.
PMCID: PMC2759324  PMID: 18093750
Disaster; Prediction; PTSD symptoms; Smoking; Ambulance personnel
12.  Firework related ocular injury. 
PMCID: PMC1291793  PMID: 3184083
13.  Fireworks and the eye. 
A prospective study involving all casualty departments in Trent Region and 81% of the major eye units in UK was performed to determine ocular morbidity from the use of fireworks during 1986. A serious injury was defined as involving admission to hospital and/or intraocular damage. Of all the injuries from fireworks, 16.7% seen at major eye units were serious and were caused by rockets or exploding fireworks (P less than 0.001). Only 53% of all injuries and 12.5% of serious injuries involved children, and in contrast to the 1950s and early 1960s, young adults appear at greatest risk in the 1980s. Legislation to reduce ocular morbidity should concentrate on restricting the use of rockets and exploding fireworks and encouraging the use of suitable eye protection.
PMCID: PMC1291798  PMID: 3184088
14.  Fireworks and the eye. 
PMCID: PMC1292099  PMID: 2716025
15.  Microbial diversity in firework chemical exposed soil and water samples collected in Virudhunagar district, Tamil Nadu, India 
Indian Journal of Microbiology  2009;50(1):46-49.
Microbial diversity of soil and water samples collected from pyrochemicals exposed areas of Virdhunagar district (Tamil Nadu, India) was studied. Soil and water samples from cultivable area, waste land and city area of the same region were also studied for a comparative acount. There is a remarkable reduction in total heterotrophic bacterial population (THB) in pyrochemicals exposed soil and water samples (42 × 104 CFU/g and 5.6 × 104 CFU/ml respectively), compared to the THB of cultivable area soil and water samples (98 × 107 CFU/g and 38.6 × 107 CFU/ml). The generic composition the THB of the pyrochemicals exposed samples too exhibited considerable change compared to other samples. Pseudomonas sp. was the predominant one (41.6%) followed by Achromobacter sp. (25%) in pyrochemical exposed soil and Pseudomonas sp. was the predominant one (25%) in pyrochemical exposed water samples followed by Bacillus sp. (25%) and Micrococcus sp. (16.6%). It was observed that Cornybacterium sp. and Micrococcus sp. were absent completely in pyrochemical exposed soil and Achromobacter sp. was missing in the pyrochemical exposed water samples, which were present in the other samples. The outcome of this study clearly demonstrates that pollutants such as chemicals used in pyrotechniques affect the microbial biodiversity and suitable measures have to be taken to control the pollution level and to save biodiversity.
PMCID: PMC3450278  PMID: 23100806
Pyrochemicals; Microbial diversity; Bacterial genera; Total heterotrophic bacterial population
18.  Potential impact of fireworks on respiratory health 
The world-wide use of fireworks with their consequent detrimental effect on the air quality is widely recognized with elevated ambient air levels of particulate matter and its several metallic components and gases identified in several studies carried out during such events. Exposed individuals may be at risk following inhalation of such produced pollutants. This review focuses on the impact of fireworks on air quality and the potential effect of fireworks on the respiratory system of healthy individuals as well as those suffering from underlying respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). This applies not only to spectators including children but also to pyrotechnicians themselves. An extensive Medline search revealed that a strong evidence of the impact of fireworks on respiratory health is lacking in susceptible as well as healthy individuals with no formal studies on COPD or asthma, other than a few case reports in the latter. The implementation of global strategies to control the use of fireworks and hence improve air quality could possibly reduce their likely detrimental effect on human respiratory health in exposed individuals, but clearly a more targeted research is needed.
PMCID: PMC4220320  PMID: 25378846
Air quality; fireworks; respiratory health
19.  Fireworks. 
PMCID: PMC1443240  PMID: 6435810
22.  Firework Injuries 
British Medical Journal  1949;2(4638):1236.
PMCID: PMC2051793
23.  Firework Accidents 
British Medical Journal  1961;2(5267):1649.
PMCID: PMC1970698
24.  Firework Accidents 
British Medical Journal  1961;2(5264):1434.
PMCID: PMC1970507
25.  Firework Accidents 
British Medical Journal  1961;2(5263):1357.
PMCID: PMC1970384

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