Fireworks-Related Injuries During the New Year Period -- Naples, 1992-93

Celebrating the new year with fireworks is traditional in Italy. A national surveillance system maintained by police indicated that on New Year's Eve 1992, more than 1100 fireworks-related injuries and four deaths occurred in Italy (Ministry of the Interior, unpublished data, 1993). In many areas of the country, the use of fireworks begins several weeks before the new year and continues through the Epiphany (January 6). To characterize fireworks-related injuries in the province of Naples -- an area that contains less than 6% of the total population of Italy but accounts for 15% of the reported fireworks-related injuries in the country -- the Regional Health Observatory of Campania and the Italian field epidemiology training program implemented an active surveillance system in each of the 18 public emergency rooms (ERs) in the province (1992 population: 3.5 million). This report summarizes surveillance results for the new year period 1992-93.

A case was defined as an injury attributed to fireworks in a person who sought care in one of the 18 participating ERs from December 24, 1992, through January 6, 1993. Investigators abstracted data primarily from the legally required standardized reports of all injuries * entered in logs of police posts at each ER. These data included age, sex, residence, where the injury occurred, type of injury, and expected time of recovery. In addition, investigators interviewed patients directly or by telephone for detailed information on how the injury occurred.

During the study period, 351 persons with fireworks-related injuries were examined in participating ERs, representing an overall injury rate of 10.0 per 100,000 residents. Rates by district for the 21 health districts in the province varied more than eightfold, from 2.3 to 19.3 per 100,000 and were highest in low-income areas in urban Naples and on the slopes of Mount Vesuvius. One hundred fifty-three (44%) of those injured were aged less than or equal to 14 years; the rate was highest for children aged 10-12 years (45 per 100,000). The risk among males was ninefold greater than that among females.

More than three fourths (271 {77%}) of the injured persons were examined during December 31-January 1 (Figure 1). The first peak in the number of patients occurred from midnight through 3 a.m. on New Year's Day and consisted primarily of adults; the second peak occurred from noon through 3 p.m. and consisted primarily of children.

Ninety-six (27%) injured persons had multiple injuries. The most common sites of injury were hands (242 {69%}), face (95 {27%}), and eyes (90 {26%}). For the 341 persons for whom data on type of injury were available, the most common type of injuries were burns (143 {42%}) and lacerations and contusions (137 {40%}). Sixty-four (19%) sustained serious hand injuries associated with avulsion or partial or complete amputation; 39 (11%) persons incurred severe eye injuries. Nearly one third (111 {32%}) of the 351 persons injured were hospitalized.

Information about the cause of the injury was obtained from 92 (83%) of the 111 persons hospitalized and from 102 (42%) of the 241 who were treated as outpatients. Use of illegal fireworks accounted for 97 (66%) of all injuries and all 38 severe hand injuries among the 147 persons on whom information on the type of fireworks was available. The type of illegal fireworks most commonly implicated was a palm-sized cherry bomb -- known locally as cipolla (onion). Less frequently, injuries were caused by homemade explosive devices made with gunpowder obtained from other fireworks; all of the persons injured by these devices were children and adolescents. Fireworks that would be considered "Class C" legal devices (e.g., fountains, candles, rockets with sticks, and sparklers) in some areas of the United States accounted for 41 (28%) injuries.

For 67 (36%) of the 185 persons for whom data on the circumstances of injury were available, the injury occurred immediately after the fuse had been lit; 55 (30%) were associated with relighting of an unexploded firecracker; and 43 (23%) injuries resulted from firecrackers thrown by another person. Fifty-four (67%) of 81 children aged less than 13 years who were injured were not under adult supervision when injured.

Reported by: P D'Argenio, MD, F Palumbo, MD, P Saccone, T Zimmaro, P De Simone, A Pacchiano, L Cozzolino, A Giordano, E D'Ambrosio, MD, G Nasti, MD, R Ortolani, MD, A Gallo, L Valera, A Russo, A Greco, Regional Health Observatory of Campania, L Sembiante, MD, Santobono Hospital, Naples; F Taggi, PhD, G Salamina, MD, National Institute of Health, Rome. Global EIS Program, International Br, Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: The rate of fireworks-related injuries in Naples was similar to that in Seattle during the 1983 Independence Day holiday (1) but three times that of the U.S. national rate (3.2 per 100,000) for the 1991 Independence Day celebrations as estimated by the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission (2). Although the age distribution of persons injured in Naples was similar to that reported in the United States, the sex distribution differed: in Naples, the male:female ratio was three times greater than that in Seattle (1) and that reported for the NEISS (2) but was less than that reported in metropolitan Manila (3). When compared with the United States, lacerations, contusions, and serious hand trauma were more common in Naples; burns accounted for a lower percentage of injuries. The hospitalization rate in Naples was four times greater than that reported in Seattle and may have reflected more severe injuries (1).

Although the sale of most fireworks is banned in Italy, the black market for fireworks is large, and the legal ban is not consistently enforced. Many of the large explosive devices and other fireworks sold illegally are manufactured locally, have not been subjected to quality control, and lack the safety features (e.g., fuses of adequate length) of legal fireworks.

The findings in this report suggest three potential approaches for decreasing the occurrence of fireworks-related injuries in Naples. First, existing fireworks-related laws should be more rigorously enforced; evaluation of the impact of similar laws in the United States indicates that enforcement reduces the risk of this problem (4). Second, cleaning streets thoroughly early January 1 might prevent injuries that result when children relight fireworks found in the street or construct fireworks from remnants of partially exploded fireworks. Third, an education campaign should be initiated in the weeks before the new year, an approach that has helped to reduce fireworks-related injuries in the Philippines (3). The findings from this study have been shared in Naples with the local police, sanitation authorities, and participating hospitals; based on these findings, the Regional Observatory has initiated efforts to develop a "Capodanno Senza Danno" (New Year's Without Harm) program to prevent fireworks-related injuries.

References

1. McFarland LV, Harris JR, Kobayashi JM, Dicker RC. Risk factors for fireworks-related injury in Washington state. JAMA 1984;251:3251-4.

2. Smith L, Kelly S. Fireworks injuries, 1991. Washington DC: US Consumer Products Safety Commission, 1991.

3. Magpantay RL, Pascual L, Tayag EA, et al. Fireworks-related injury in metropolitan Manila, Philippines: a case-control study. Journal of the Philippine Medical Association 1991;67:72-4.

4. Berger LR, Kalishman S, Rivara FP. Injuries from fireworks. Pediatrics 1985;75:877-82.

• Police reports are required by law for all injuries resulting from causes or circumstances that could have legal ramifications (e.g., resulting from motor-vehicle crashes, gunshot wounds, and child abuse).

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