The health and economic impact of fireworks-related injuries in Iran: a household survey following the New Year's Festival in Tehran

When prohibition works: Comparing fireworks and cannabis regulations, markets, and harms

BACKGROUND

Nations wrestle with whether to prohibit products that can harm consumers and third parties but whose prohibition creates illegal markets. For example, cannabis is banned in most of the world, but supply for non-medical use has been legalized in Uruguay, Canada, and much of the United States and possession restrictions have been liberalized in other countries. Likewise, supply and possession of fireworks have been subject to varying degrees of prohibition in multiple countries, with those bans prompting significant evasion.

METHODS

Current and past history of fireworks regulations, sales, and harms are reviewed and contrasted with those for cannabis. The focus is on the United States, but literature from other countries is incorporated when possible and appropriate. This extends the insightful literature comparing drugs to other vices (such as gambling and prostitution) by comparing a drug to a risky pleasure that is not seen as a vice but which has been subject to prohibition.

RESULTS

There are many parallels between fireworks and cannabis in legal approaches, harms to "users", harms to others, and other externalities. In the U.S. the timing of prohibitions were similar, with prohibitions on fireworks being imposed a little later and repealed a little sooner. Internationally, the countries that are strictest with fireworks are not always those that are strictest with drugs. By some measures, harms are of roughly similar magnitude. During the last years of U.S. cannabis prohibition, there were about 10 emergency department (ED) events per million dollars spent on both fireworks and illegal cannabis, but fireworks generated very roughly three times as many ED events per hour of use/enjoyment. There are also differences, e.g., punishments were less harsh for violating fireworks prohibitions, fireworks consumption is heavily concentrated in just a few days or weeks per year, and illegal distribution is primarily of diverted legal products, not of illegally produced materials.

CONCLUSIONS

The absence of hysteria over fireworks problems and policies suggests that societies can address complex tradeoffs involving risky pleasures without excessive acrimony or divisiveness when that product or activity is not construed as a vice. However, the conflicted and time-varying history of fireworks bans also show that difficulty balancing freedoms and pleasure with harms to users and others is not restricted to drugs or other vices. Use-related harms fell when fireworks were banned and rose when those bans were repealed, so fireworks prohibitions can be seen as "working" from a public health perspective, but not well enough for bans to be employed in all times or places.

Impact of 4th of July Fireworks on Spatiotemporal PM2.5 Concentrations in California Based on the PurpleAir Sensor Network: Implications for Policy and Environmental Justice

Fireworks are often used in celebration, causing short term, extremely high particulate matter air pollution. In recent years, the rapid development and expansion of low-cost air quality sensors by companies such as PurpleAir has enabled an understanding of air pollution at a much higher spatiotemporal resolution compared to traditional monitoring networks. In this study, real-time PM2.5 measurements from 751 PurpleAir sensors operating from June to July in 2019 and 2020 were used to examine the impact of 4th of July fireworks on hourly and daily PM2.5 concentrations at the census tract and county levels in California. American Community Survey (ACS) and CalEnviroScreen 3.0 data were used to identify correlations between PM2.5 measurements and socioeconomic status (SES). A two-step method was implemented to assure the quality of raw PM2.5 sensor data and sensor calibration against co-located reference instruments. The results showed that over 67% and 81% of counties experienced immediate impacts related to fireworks in 2019 and 2020, respectively. Relative to 2019, the peak PM2.5 concentrations on July 4th and 5th 2020 were, on average, over 50% higher in California, likely due to the COVID-19-related increase in the use of household-level fireworks. This increase was most pronounced in southern counties, which tend to have less strict firework-related regulations and a greater use of illegal fireworks. Los Angeles County experienced the highest July 4th daily PM2.5 levels both in 2019 (29.9 µg·m-3) and 2020 (42.6 µg·m-3). Spatial hot spot analyses generally showed these southern counties (e.g., Los Angeles County) to be regional air pollution hotspots, whereas the opposite pattern was seen in the north (e.g., San Francisco). The results also showed PM2.5 peaks that were over two-times higher among communities with lower SES, higher minority group populations, and higher asthma rates. Our findings highlight the important role that policy and enforcement can play in reducing firework-related air pollution and protecting public health, as exemplified by southern California, where policy was more relaxed and air pollution was higher (especially in 2020 when the 4th of July coincided with the COVID-19-lockdown period), and in disadvantaged communities where disparities were greatest.

Developing Public Health Initiatives through Understanding Motivations of the Audience at Mass-Gathering Events

This report identifies what is known about audience motivations at three different mass-gathering events: outdoor music festivals, religious events, and sporting events. In light of these motivations, the paper discusses how these can be harnessed by the event organizer and Emergency Medical Services. Lastly, motivations tell what kinds of interventions can be used to achieve an understanding of audience characteristics and the opportunity to develop tailor-made programs to maximize safety and make long-lasting public health interventions to a particular "cohort" or event population. A lot of these will depend on what the risks/hazards are with the particular populations in order to "target" them with public health interventions. Audience motivations tell the event organizer and Emergency Medical Services about the types of behaviors they should expect from the audience and how this may affect their health while at the event. Through these understandings, health promotion and event safety messages can be developed for a particular type of mass-gathering event based on the likely composition of the audience in attendance. Health promotion and providing public information should be at the core of any mass-gathering event to minimize public health risk and to provide opportunities for the promotion of healthy behaviors in the local population. Audience motivations are a key element to identify and agree on what public health information is needed for the event audience. A more developed understanding of audience behavior provides critical information for event planners, event risk managers, and Emergency Medical Services personnel to better predict and plan to minimize risk and reduce patient presentations at events. Mass-gathering event organizers and designers intend their events to be positive experiences and to have meaning for those who attend. Therefore, continual vigilance to improve public health effectiveness and efficiency can become best practice at events. Through understanding the motivations of the audience, event planners and designers, event risk managers, and emergency medical personnel may be better able to understand the motivation of the audience and how this might impact on audience behavior at the event. Hutton A , Ranse J , Munn MB . Developing public health initiatives through understanding motivations of the audience at mass-gathering events. Prehosp Disaster Med. 2018;33(2):191-196.

Firework-related injury in the Top End: a 16-year review

BACKGROUND

On July 1st on 'Territory Day', the public in the Northern Territory are permitted to purchase and operate consumer fireworks without a licence. Serious permanent injuries from fireworks are well described, leading to their banning in many other jurisdictions. This study describes those seriously injured by fireworks in the Top End of the Northern Territory, with the aim of identifying opportunities for prevention and harm minimization.

METHODS

This is a retrospective audit of all admitted patients with an injury from fireworks at the Royal Darwin Hospital between 2000 and 2015. The variables collected included demographic data and the circumstances around injury (operator versus bystander, alcohol involvement and day of device operation). The consequences such as injuries, operating theatre visits, length of stay and outpatient visits are described.

RESULTS

Fifty-five patients (including 17 children) suffered 67 injuries over the study period, resulting in 68 operating theatre visits, 322 hospital days and 380 outpatient appointments. Burns, hand and eye injuries predominate. Females (P = 0.000) and children (P = 0.029) were more likely to be injured as bystanders. Injuries on a day other than Territory Day were more likely to have alcohol involvement (P = 0.01), and occur in the operator (P = 0.017).

CONCLUSION

Consumer firework usage results in a small number of life altering injuries annually. Previous prevention campaigns focusing on device user safety should be expanded to include the safety of bystanders and children and reduce firework usage outside of the Territory Day.

Fireworks-Related Injuries in Iran: A Survey Following the 2014 New Year's Festival in Tabriz

BACKGROUND

Iranian people celebrate the last Wednesday eve of the year as Chaharshanbe Suri and use explosives and firecrackers as part of this festival.

OBJECTIVES

This study concerned fireworks injuries related to the Chaharshanbe Suri festival in Tabriz, a provincial capital in East Azerbaijan, Iran, to evaluate the epidemiology and provide data to prevent and manage these accidents.

PATIENTS AND METHODS

This study was comprised of patients who were treated at the emergency department of Tabriz Sina hospital with burn injuries related to fireworks. The patients' demographics, time of the accidents, locations of the burns, and the type of explosive were recorded. Descriptive statistics were used to analyze the data.

RESULTS

Forty-nine patients were seen in the emergency department. The mean age was 17.16 ± 9.1, ranged from 3 to 36. Forty patients were male (81.6%) and 9 were female (18.4%). Twenty-one patients had second degree burns (47.7%), 10 patients had first degree burns (22.7%), 9 patients had third degree burns (20.5%), and 4 patients had first and second degree burns (9.1%).

CONCLUSIONS

The study shows that walking in the streets or driving with open windows can be dangerous in Iran during Charshanbe suri.

Injuries due to fireworks use: A surveillance data analysis in Colombia, 2008-2013

PURPOSE

To describe the injuries due to fireworks use in Colombia during the period 2008-2013 and to identify factors associated with hospitalization and death due to this cause.

METHODS

A descriptive study from surveillance data was carried out. Incidence rates and relative risks were calculated. The incidence rate trend was modeled with a joint point regression model. Multivariate logistical models were implemented to identify the associated factors with hospitalization and mortality due to firework injuries.

RESULTS

A total of 6585 people were reported to be injured by fireworks during the 2008-2013 period. An upward trend in the incidence rate during this period was observed, with an annual percentage of change of 28% (95% CI 27.7-28.3) during 2008-2011 and 3.5% (95% CI 3.0-3.9) during 2011-2013. The factors associated with hospitalization were injury occurrence at the workplace (odds ratio (OR) 2.62, 95% CI 1.97-3.47), storage (OR 2.40, 95% CI 1.54-3.73), transport (OR 1.63, 95% CI 1.20-2.21), multiple trauma (OR 1.49, 95% CI 1.31-1.70), and injury occurrence at home (OR 1.26, 95% CI 1.07-1.50). The factors associated with mortality were storage (OR 19.52, 95% CI 4.62-82.44), transport (OR 13.37, 95% CI 3.29-54.3), injury occurrence at the workplace (OR 4.88, 95% CI 1.69-14.13), and ethnicity (OR 3.37, 95% CI 1.12-10.12).

CONCLUSION

These results provided information for revising the public policies and intersectorial interventions to reduce the avoidable burden due to firework injuries at all times and not just during the high injury occurrence season.

Missed Diagnosis of an Intraorbital Foreign Body of Homemade Fireworks Origin: A Case Report

Purpose

We report a rare case of traumatic injury to the eye caused by homemade fireworks in a Chinese juvenile patient with a metal ring left in the orbit after having been sutured at the Emergency Department.

Methods

An 11-year-old boy presented with a traumatic injury to the right eye from homemade fireworks. Following initial assessment involving maxillofacial computed tomography (CT) and suturing at the Emergency Department, he was transferred to our department for further evaluation because of his poor sight 1 day later. On examination, a skin laceration beneath the right eyebrow was noted, but the superior orbit was not fully visible on the maxillofacial CT performed 1 day previously. Therefore, an orbital CT scan was carried out on the second day, which showed a hyperdense ring embedded in the superior border of the orbital wall; the ring was surgically removed. On postoperative day 7, a fundus examination revealed resolving vitreous hemorrhage, blunt traumatic retinal detachment, and a large retinal tear superior to the macula. The patient refused to take surgery for retinal detachment into consideration. Therefore, we opted for oral steroids and careful observation.

Results

After 2 months’ observation, the large retinal tear had healed and white fibrous scar tissue had developed, and the retinal detachment superior to the macula had reattached itself spontaneously. The patient's vision had further improved to 20/200. During 1 year of follow-up, he remained clinically stable.

Conclusion

To avoid missing the diagnosis, a complete history of the mechanism of injury and accurate imaging still prove most useful. Complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron-containing foreign body. As evidenced by the current case, oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children.

Firecracker injuries during chaharshanbeh soori festival in iran: a case series study

On the last Wednesday of every year Iranians celebrate the sanctity of fire in the annual festival of Chaharshanbeh Soori. Each year many cases of firecracker-related injuries (FRI) are reported during this festival. The aim of this study was to assess the pattern of injuries and the frequency of disabilities during this period. In 2011, a cross-sectional study was conducted at the emergency departments (EDs) of three educational hospitals in Tehran, to assess the extent and demographics of FRI. The age and sex of the patient, type of referral to the hospital, type of injury, its region and treatment process were recorded for each patient by the physicians. Data were analyzed by SPSS version 20. Thirty-five patients suffering from FRI were admitted to the hospitals during the festival. The majority of patients were under 30 years-old and most of them were male (83% male and 17% female). The injuries were mostly lacerations and cuts (n = 17, 49%) and scratches (n = 12, 34%). One patient suffered amputation. The most common site of the injuries were the hands (n = 13, 37%) followed by the face (n = 10, 29%). There were 10 patients (29%) with more than one site of injury. Twenty-one patients were hospitalized, 12 patients (34%) received outpatient treatment and two patients were referred to other hospitals. There are still many victims during Chaharshanbeh Soori festival despite efforts and legislations by the government. Education and raise of awareness among people especially for youth are the most important ways to prevent and reduce Red Wednesday injuries.

Mortality and morbidity of fireworks-related burns on the annual last wednesday of the year festival (charshanbeh soori) in iran: an 11-year study

BACKGROUND

Management of firework-related injuries is costly for the patient, society, and government.

OBJECTIVES

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.

RESULTS

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.

CONCLUSIONS

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.

Exploring Culture: Audience Predispositions and Consequent Effects on Audience Behavior in a Mass-Gathering Setting

Introduction

The purpose of this critical review is to look at the current literature regarding mass gatherings and to create further understanding of this area with a particular focus on what the audience brings with them to the event, particularly in a planned event with a cultural theme or focus. Through an understanding of these predispositions and consequent effects on audience behavior in a mass-gathering setting, a more complete understanding of motivation factors of crowds and audiences can also be found.

Methods

A critical review of mass-gathering literature was undertaken by searching various online academic databases. Peer-reviewed scholarly articles relevant to the cultural aspects associated with religious, sporting and music mass gatherings were also analyzed.

Results

Results from the review show that the word “culture” is often used to explain what happens at the event without reflecting how the motivations or behaviors of audiences at an event are influenced by the cultural predispositions of the audience.

Conclusions

By understanding the cultural predispositions of the audience, event planners and designers, event risk managers and event safety personnel are able to better understand the motivation of the audience and how this might impact on audience behavior at the event. Further work needs to be done, however, to investigate the broader range of predispositions. The ultimate aim of developing this understanding is to better inform the health promotion and public health messages that can be developed for a particular type of event based on the likely composition of the audience in attendance.

HuttonA, BrownS, VerdonkN. Exploring culture: audience predispositions and consequent effects on audience behavior in a mass-gathering setting. Prehosp Disaster Med. 2013;28(3):1-6.

Birds flee en mass from New Year's Eve fireworks

Anthropogenic disturbances of wildlife, such as noise, human presence, hunting activity, and motor vehicles, are becoming an increasing concern in conservation biology. Fireworks are an important part of celebrations worldwide, and although humans often find fireworks spectacular, fireworks are probably perceived quite differently by wild animals. Behavioral responses to fireworks are difficult to study at night, and little is known about the negative effects fireworks may have on wildlife. Every year, thousands of tons of fireworks are lit by civilians on New Year's Eve in the Netherlands. Using an operational weather radar, we quantified the reaction of birds to fireworks in 3 consecutive years. Thousands of birds took flight shortly after midnight, with high aerial movements lasting at least 45 min and peak densities measured at 500 m altitude. The highest densities were observed over grasslands and wetlands, including nature conservation sites, where thousands of waterfowl rest and feed. The Netherlands is the most important winter staging area for several species of waterfowl in Europe. We estimate that hundreds of thousands of birds in the Netherlands take flight due to fireworks. The spatial and temporal extent of disturbance is substantial, and potential consequences are discussed. Weather radar provides a unique opportunity to study the reaction of birds to fireworks, which has otherwise remained elusive.