Explosions and burns and devastating blasts are the injuries most often heard about during the Fourth of July holiday. But the Level I trauma center at Methodist Hospital says injuries from falls are most common as people climb to set off fireworks.

Fireworks injuries can be disastrous. Blasts that cause horrific injuries and burns. Lost fingers. Damage to ears and eyes. Unseen internal organ injuries.

Yet, fireworks don’t cause most injuries surrounding the Fourth of July holiday.

Holidays bring an increase in falls, motor vehicle accidents (many related to alcohol), domestic violence and trauma caused by gun accidents, says Jennifer Hartwell, M.D., a trauma surgeon at IU Health Methodist Hospital. 

And even when it comes to fireworks injuries, it’s not explosions or burns that cause the most damage. 

“It is injuries sustained while preparing the fireworks, such as a fall,” says Dr. Hartwell. “At Methodist, we don’t see a large volume of fireworks-related injuries, but those that we do see can be devastating.”

Dr. Hartwell reveals the injuries seen inside Methodist around the July 4 holiday. Take a look. 

MOST COMMON INJURIES FROM FIREWORKS

Burns: Especially on the hands or arms. These can range from superficial burns — similar to what a person would get while cooking or touching a hot surface — to full thickness burns. The superficial burns require simple, local wound care. The more extensive burns require excision and grafting.

Explosions: Which affect hands, arms or face, including eyes and ears. “At Methodist, we have dedicated specialists who are experienced in managing even the most complex injuries to these areas,” says Dr. Hartwell. “We have oral and facial surgeons, plastic surgeons, ophthalmologists and specially trained hand and orthopedic surgeons, to name a few.” 

Blast effect explosions: They occur in closed spaces that can rupture eardrums, injure eyes or damage internal organs. “There may be injuries that cannot be seen from the outside,” Dr. Hartwell says. “As trained trauma surgeons, we have a heightened awareness and we actively look for these injuries.” 

Retained foreign bodies: Pieces of plastic, wadding, or even undetonated fireworks shells can become lodged in the soft tissues, especially if the firework malfunctions and does not light and shoot off as expected. This creates a dangerous situation for the treating medical team, as well. There have been instances where bomb experts have been called to assist in the safe removal of these types of explosives in the operating room, Dr. Hartwell says. 

Head injuries: Blasts in enclosed spaces or direct blows to the head can cause bleeding on the brain. Head injuries are identified with a CT scan. Mild head injuries, sometimes called a concussion, are also seen. Methodist has dedicated neurosurgeons available 24 hours a day to care for patients with these kinds of injuries. 

BEYOND FIREWORKS

Injuries around the Fourth of July go far beyond fireworks. The most common are falls — from trees, a roof or a ladder as people are decorating or cleaning. Methodist sees a number of patients fall from standing or down stairs, especially if they are intoxicated. 

Motor vehicles accidents are another major cause of injury, frequently related to alcohol use. Twenty-eight percent of all traffic accident fatalities involve alcohol. Impaired driving is more common during holidays, according to the Centers for Disease Control and Prevention. Methodist sees an uptick in alcohol-related car accidents during summer holidays, Dr. Hartwell says.

Interpersonal violence accounts for a small proportion of trauma patients during holidays. Dr. Hartwell says Methodist sees a mix of gunshot wounds and stab wounds, as well as victims of assault.

There are also a number of patients who accidentally shoot themselves, often while cleaning their gun, she says. These injuries frequently involve the thigh and lower leg, which can be fatal if the main artery going down the leg is injured.

“These injuries can be prevented by proper gun safety techniques,” Dr. Hartwell says, “and avoiding the use of guns while consuming alcohol.” 

July 4 Safety Tips From The Trauma Expert 

— Enjoy alcohol responsibly and always have a plan in place to get home. Choose a dedicated drive. Commit to not handling fireworks or firearms while drinking. 

— Purchase fireworks legally and read and understand instructions thoroughly before using them. Leave the big, extreme displays to the experts. Always keep fireworks away from children. 

— If there is an injury, seek medical care immediately. Injuries caused by fireworks can cause damage to internal organs that cannot be seen from the outside. 

— By Dana Benbow, Senior Journalist at IU Health.

   Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow.