Bollettino epidemiologico nazionale

Fireworks Injuries

Elvira Lorenzo^, Antonio Barrecchia^ and Paolo D’Argenio* Epidemiology and the Prevetion Services of the Local Health Agencies of Campania: C. Bove (CE1), A. Caiazzo (SA1), R. Castello (SA3), A. Citarella (BN), M.A. Ferrara (AV2), F. Giugliano (NA5), G. Morra (NA4), C. Padula (AV1), A. Parlato (NA2), R. Parrella (SA2), F. Peluso (NA3), A. Simonetti (NA1), M. Trabucco (CE2)

*Epicentro, Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome ^Epidemiologic Observatory, Campania Region

In many parts of Italy, the New Year is celebrated with fireworks. Each year, more than a thousand fireworks injuries are reported, a substantial fraction of which occur in the Campania region of southern Italy.

Annual surveillance of fireworks injuries at New Years has been conducted since 1992-93 in the Province of Naples and since 1995-1996 in the entire Campania region. The surveillance, which is emergency-room based, is conducted each year between the 24^th of December and 6^th of January and provides information on the frequency and severity of fireworks-related injuries. For each injury due to fireworks, data are abstracted either from the emergency room logs or from logs maintained at the police posts on the grounds of the hospital (Ed. note: all cases of violent injury, including traffic accidents and domestic violence, as well as work-related injuries seen in emergency rooms must be legally notified to these police posts; data collected includes basic demographic information as well as the circumstances of the injury). Information collected includes the date and hour of arrival, the age and sex of the injured, their commune of residence, the estimated period to full recovery, and the type and site of the injury (1). This document presents temporal trends in fireworks injuries and describes the epidemiology of fireworks-related lesions during the past year.

Figure 1 shows the temporal trends in fireworks injuries from 1992-2001 for the province of Naples and for the Campania Region. In Naples, 350 cases were reported in 1992-93, with a sharp decline the following year that was partly attributed to a variety of public health interventions including seizure of illicit fireworks but was also partially due to heavy rains and the threat that year by local officials that any injury resulting from illegal fireworks would be reported to local law authorities (2). After a rebound in 1994-1995, a steady decline in injuries occurred during the late1990s, resulting in an overall 47% decrease between 1992-1993 and 1998-1999. More recently, however, there has been an upward trend, with 251 reported in 1999-2000 and 283 in 2000-2001 in Campania (of which 184 and 150, respectively, occurred in the province of Naples).

Of the 290 cases occurring between December 24, 2000 and January 7, 2001, 79% occurred between midnight and 2 AM on the 1st of January, while a second smaller peak occurred the following morning. The midnight peak involved primarily adults, while the smaller peak the following day consisted primarily of children (Figure 2). This pattern has been observed during all of the years studied, although the second peak on New Years day has gradually diminished in magnitude (3).

Although people of all ages were injured in 2000-2001, including an 83 year-old, the group that has been most heavily affected are pre-adolescents between the ages of 10-14 years, accounting for 24% of all injuries. Overall, those under 14 years accounted for 39% of the injuries. The male: female ratio was 9 to 1.

The location and type of injuries observed are shown in the Table. The most commonly affected areas include the hands, especially the right hand, the face, and the eyes. The most frequent types of lesions include contusions, burns, and lacerations. Nine third-degree burns, 47 traumatic avulsions involving the hands, and 2 severe eye injuries were reported; one additional person sustained major head trauma that resulted in coma and another received a gun shot wound.

Eighty of the 283 (28%) were hospitalised, with estimated duration of stays ranging from 1-40 days. Sixty-six were expected to remain in hospital greater than 10 days, of whom 25 (9%) were expected to remain more than 20. An estimated 25 (9%) were expected not to achieve full recovery and one was not expected to survive.

During New Years 1999-2000 and 2000-2001 in Campania, there was an increase in fireworks injuries, interrupting a long downward trend that had seemed destined to reduce the burden of surffering and disability resulting from these injuries.

Acknowledgements

The author wishes to thank Michela Cioffi of the Regional Epidemiologic Observatory of Campania and the directors of the Epidemiology and the Prevetion Services of the Local Health Agencies of Campania: C. Bove (CE1), A. Caiazzo (SA1), R. Castello (SA3), A. Citarella (BN), M.A. Ferrara (AV2), F. Giugliano (NA5), G. Morra (NA4), C. Padula (AV1), A. Parlato (NA2), R. Parrella (SA2), F. Peluso (NA3), A. Simonetti (NA1), M. Trabucco (CE2)

References

1.   D'Argenio P, Palumbo F, Saccone F, Taggi F, Binkin N. Fireworks-related injuries during the New Year’s Period – Naples, Italy, 1992-93 MMWR 42, 201-203, 1993.

2.   D'Argenio P, Cafaro L, Santonastasi F, Taggi F, Binkin N. Capodanno Senza Danno: the effects of an intervention program on fireworks injuries in Naples.
Am J Public Health 1996 Jan; 86(1):84-6

3.   D’Argenio P, Cafaro L, Palumbo, Taggi F, Binkin N. Incidenti causati da fuochi d’artificio. Medico e Bambino 1998; 1: 35-9.

Comment

Franco Taggi

Laboratory of Epidemiology e Biostatistics, Istituto Superiore di Sanità, Rome

Epidemiology operates at different levels, from the noble, where the underlying etiology of health conditions are studied, to the more modest from the conceptual point of view. This latter category includes the routine public health function of surveillance.

Both levels of epidemiologic endeavor are important, although often we tend to forget how surveillance can lead us to results of great public health importance. This is the case with the monitoring of fireworks injuries at New Years that was initiated in 1992-93 in Naples. The data collected demonstrated how the injuries to adults are concentrated at midnight, while the injuries among children occur primarily the following day. This finding may seem banal, but before surveillance was initiated, this phenomenon had never been described.

An examination of the data during the early years of the surveillance showed that many of the injuries in children were linked to unexploded fireworks (2), which, if reignited, may rapidly explode. On the basis of the data, a number of actions were undertaken in subsequent years, including the diffusion of recommendations for parents and the seizure of illegal fireworks. The consequence of these simple acts, born from the collaboration between epidemiologists, journalists, law enforcement officials, hospital-based physicians, the street-cleaning services, other communal officials, and the schools has resulted in the reduction of this “micro-epidemic” over time; in Naples, not only the number of overall injuries but also the severity of trauma has also diminished, falling from 64 amputations and major traumatic hand injuries to 13 in 1999 and 35 during the previous year.

Nonetheless, the data from recent years is of concern and demonstrates the necessity of continuing surveillance and applying appropriate preventive measures.