July Fourth Holiday Is One Of The Deadliest Holiday Weekends -- But It Doesn't Have To Be

Those of us who treat these devastating injuries do not want to see more. Please think carefully and work on prevention. And have a safe and happy Fourth of July celebration.
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Fourth of July holiday celebrations are an American tradition. The commemoration of our independence day is a time for travel, barbecues and enjoying fireworks displays, especially when it falls on a long weekend, as it does this year.

Unfortunately, those of us who work in hospital emergency departments know that the longer the holiday weekend, the more prepared we need to be to handle the influx of accidents, injuries, and inevitable deaths. We see firsthand that the Fourth of July holiday weekend is one of the deadliest holidays in the United States.

Having worked in numerous urban and suburban trauma centers over many years, I have seen first-hand some of the devastating injuries that can occur. I have seen severe burns and loss of fingers from fireworks exploded in the hand; facial and eye injuries resulting in loss of vision and burns from examining a "dud" firework too closely; and the loss of life and permanent disability from drunk driving injuries that inevitably occur.

Traffic-related deaths are the leading cause of death and injury during Fourth of July holiday period. In large part, this is due to the increase in vehicles on the roads. AAA estimates that 43 million Americans will travel this holiday, the highest on record. But another factor is the fact that the Fourth of July is the number one holiday for beer sales. In fact, Americans buy more than 68 million cases of beer over the holiday.

So, with the increase in travelers combined with the increase sale of beer and other alcohol, it is no wonder there is an increase in traffic-related injuries and fatalities. According to the National Highway Traffic Safety Administration (NHTSA) in 2014, there were 197 traffic fatalities between 6pm on July 3rd and 5:59 am July 7th -- and 41 percent were caused by drivers who were legally intoxicated.

Neighborhood and backyard fireworks displays bring in some of the most devastating injuries to the Emergency Department (ED). An average of 230 people per day come to EDs for firework-related injuries. In 2013, there were eight deaths and more than 11,000 injuries around the holiday. My colleagues and I have all seen terrible injuries resulting from improper use of fireworks. The hand is the most common site of injury caused by fireworks mishaps, accounting for 36 percent of all injuries. The face and eyes each account for almost 20 percent of injuries seen. More than 50 percent of fireworks-related injuries are from burns exclusively or burns combined with the blast injuries. Of course, illegal fireworks are the cause of a large number of these injuries and their production standards cannot even be monitored.

Sparklers are frequently given out at backyard parties as a safe alternative to fireworks and are often given to young children. Who hasn't been mesmerized by the dancing sparklers and children running and waving with them? Many would be surprised to learn that a sparkler may burn at temperatures higher than 2000 degrees. Children under 5 using sparklers and other "safer" options accounted for more than 40 percent of the injuries in 2013.

The final cause of preventable death and injury over this holiday weekend is "celebratory gun fire," which is an increasing problem. Several times I have stood outside to catch a glimpse of a fireworks display only to realize how difficult it is to distinguish "celebratory gunfire" from a neighborhood fireworks display.

The actual incidence of these injuries likely goes underreported because they are difficult to track, but police departments around the country report an increase in calls during the holidays. In 2015, the amount of illegal gunfire over at three day period that included July 3rd and 4th was five times that of the period leading up to it. This practice is often associated with urban settings, but it has been reported worldwide in many different settings.

Unfortunately, as one classic study demonstrated, the most common site of injury is the head and the wounds can be devastating and even fatal. Women, children and elderly are increasingly injured in stray bullet shootings, of which celebratory shootings are one, because there is little anticipation or warning. These types of shootings are difficult to track, account for, and prosecute because bullets fired at an angle below vertical can travel a great distance making its origin and shooter much more difficult to detect.

Fortunately, each of these leading causes of accidents and injuries over the holiday are all preventable with careful planning and preparation.

1. Plan ahead and don't drink and drive. Have a designated driver. Take a cab, Uber or Lyft.
2. Review the Consumer Product Safety Commission's helpful tips for firework safety.
3. Never allow children to handle fireworks and watch them carefully if they have a sparkler.
4. Follow good gun control and gun safety practices.
5. Don't use guns, fireworks or your car while or after drinking.
6. Some cities have seen a reduction in celebratory gunfire with the use of SpotShotter technology, which could be a resource for other areas.

As Ben Franklin once said, an ounce of prevention is worth a pound of cure.

Those of us who treat these devastating injuries do not want to see more. Please think carefully and work on prevention. And have a safe and happy Fourth of July celebration.

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