This story was originally published on July 3, 2024. It has been updated with new data on fireworks injuries and deaths, as well as comments from the N.C. Office of State Fire Marshal.
By Jennifer Fernandez
Booker T. King, a surgeon and director of the North Carolina Jaycee Burn Center at UNC Health has seen some gruesome things in his career, but one case in particular sticks with him.
Booker T. King is chief of the Division of Burn Surgery and director of the NC Jaycee Burn Center at UNC Health.
Credit: Provided by UNC Health
King, an Army veteran, was stationed in San Antonio, Texas, when a child, about 10 or 11 years old, came in to the hospital. He had lost most of his fingers and injured his eye playing with fireworks.
“They were trying to see how long they can hold it … before they can throw it up in the air,” he said.
This time of year, emergency doctors see an uptick in burns and sometimes worse injuries related to fireworks.
Many of them involve children.
In North Carolina, 5- to 17-year-olds make up 20 percent of emergency department visits for fireworks-related injuries, state data shows.Burns are the most common fireworks-related injury; they made up about 37 percent of fireworks injuries treated in emergency rooms nationwide in 2024, according to the U.S. Consumer Product Safety Commission. Hands and fingers make up about 36 percent of those burn injuries, followed by head, face and ears at 22 percent.
“When there are injuries to the fingers and the hands and eyes in children, it definitely sticks with you,” Dan Park, medical director of UNC Health’s Pediatric Emergency Department, told NC Health News in 2024. “Those are the ones that I can’t unsee and the ones that I remember. And those are always good reminders on reminding parents and kids to be safe around fireworks.”
NC trends
North Carolina law permits residents to use what are considered novelty fireworks, such as fountains, smoke bombs, party poppers and sparklers. The list of illegal devices — anything that explodes or is projected into the air — includes firecrackers, ground spinners, bottle rockets, Roman candles, mortars, M-80s and aerial fireworks.
North Carolina law permits residents to use what are considered novelty fireworks, such as fountains, smoke bombs, party poppers and sparklers. The list of illegal devices — anything that explodes or is projected into the air — includes firecrackers, ground spinners, bottle rockets, Roman candles, mortars, M-80s and aerial fireworks. Credit: Anne Blythe / NC Health News
Professionals putting on public displays must have a license and obtain a permit.
Several pediatric doctors who spoke with NC Health News said that they believe the state’s restrictive fireworks laws help keep the number of deaths and injuries down in North Carolina.
Nonetheless, the state’s emergency departments treated an average of 192 fireworks-related injury victims annually between 2020 and 2024, the N.C. Office of State Fire Marshal said in a news release.
Not surprisingly, 72 percent of those injuries happen in July, the month we celebrate U.S. independence with family gatherings, grilling out and fireworks.
More than 1 in 10 fireworks-related injuries required hospitalization in North Carolina between 2020 and 2024, the state fire marshal’s office said.
Adults ages 25-49 accounted for 41 percent of fireworks-related emergency department visits during that time, followed by children ages 5 to 17 at 20 percent.
At ECU Health Medical Center, about 13 cases over the past five years have been serious enough to be activated as a trauma, meaning the victim had significant soft tissue injury or burns, Shannon Longshore, pediatric trauma surgeon and medical director of the pediatric trauma program, told NC Health News in 2024.
When to go to ER
Doctors told NC Health News that minor burns caused by fireworks can often be taken care of at home. Victims should be taken to an emergency room in the following instances:
If there is an eye injury.
If the flesh wound is large.
When pain control is an issue.
If the burn crosses over joints, especially in the hands.
If the burned skin starts bubbling up.
If a burn looks painful but there is no pain, which indicates a burn that’s deeper than surface nerves.
When you are not sure how serious the injury may be.
Common injuries
Shannon Longshore is a pediatric trauma surgeon and medical director of the pediatric trauma program at ECU Health Medical Center. Credit: Provided by ECU Health
Most fireworks-related burns are contact burns that are treated in the emergency department and the victim is sent home, Longshore said.
Minor burns are common with fireworks. When there are major burns, that’s usually not caused by the fireworks directly, but rather because clothing or something else caught fire and that caused the burns, King said.
King has seen children as young as 2 or 3 years old with injuries from fireworks. Often, those come from sparklers. He said adults wrongly see sparklers as something that children can handle.
“They look innocent, but they actually can cause a lot of injuries,” King said. “Don’t think these things are innocent, especially to young children.”
Sparklers can burn at up to 2,000 degrees Fahrenheit — hot enough to melt glass and some metals.
Emergency rooms across the country treated about 1,700 injuries from sparklers in 2024, according to the U.S. Consumer Product Safety Commission.
In North Carolina, over half of sparkler-related injuries are kids younger than 5 years old, said Rob Roegner, a chief deputy state fire marshal with the N.C. Office of State Fire Marshal.
Park said that glow sticks, while not as fun as sparklers, are a great alternative.
One of the more common misadventures with fireworks is someone trying to relight a dud, Park said.
Daniel Park is the medical director of UNC Health’s Pediatric Emergency Department. He is also an associate professor of pediatrics and emergency medicine at UNC School of Medicine. Credit: Provided by UNC Health
“Don’t be a hero. You’re not impressing anyone. Don’t relight dud fireworks,” Park said. “I don’t think that that ever goes well.”
King, a retired colonel with the U.S. Army Medical Corps, saw devastating injuries to children caused by improvised explosive devices, or IEDs, while serving in Iraq and Afghanistan.
Some happened when children were recruited by combatants to plant the devices, and others when children were going about their daily lives and stumbled across one, he said.
Fireworks can be just as damaging.
“Blast injuries are blast injuries,” King said. “They cause devastating-type trauma.”
Recommendations
NC Health News spoke with several doctors from across the state about fireworks safety around children. Their main recommendation is to leave fireworks to the professionals. However, if you plan to use them at home, here are some recommendations:
Don’t light fireworks in glass containers. The explosion could spray glass shards into bystanders.
Anyone setting off fireworks should remain sober.
Stay a safe distance away, even at public displays.
Make sure there’s nothing flammable nearby.
Never hold a child in your arms while using a sparkler or lighting a firework.
Never hold or light more than one sparkler at a time.
Have a bucket of water nearby to douse sparklers and spent or dud fireworks.
Don’t throw fireworks at other people.
Supervise children any time they’re around fireworks.
National trends
The number of people treated for fireworks-related injuries rose more than 50 percent between 2023 and 2024, according to the U.S. Consumer Product Safety Commission. Fireworks injured about 14,700 people last year, compared with about 9,700 the year before, the commission said.
The largest share of reported injuries occurred among adults ages 25 to 44 (32 percent), followed by people ages 15 to 24 (24 percent), the commission said.
About 22 percent of those injured required hospitalization, according to a report by the American Fireworks Standards Laboratory that analyzed the commission’s data. The group is an independent, nonprofit corporation focused on improving firework safety.
The group’s report showed that sparklers caused the most injuries among children 12 and younger, as well as young people ages 20 to 29. Teens were more frequently injured by Roman candles than any other firework last year, the American Fireworks Standards Laboratory report showed.
The industry group warned of two troubling trends in its 2024 report: more illegal fireworks devices sold as “legitimate consumer fireworks” and more fireworks intended to be used by professionals being obtained and used by the average consumer.
The illegal fireworks devices — such as reloadable aerial shells, multiple-tube devices, rockets, missiles and large firecrackers — often don’t have the name of the manufacturer or retailer listed, the industry group said. They also may not have the required warnings and instructions, and they may cost more than similar items.
Since they haven’t been tested and certified as meeting all federal requirements, these illegal fireworks “present an unreasonable risk of injury,” the American Fireworks Standards Laboratory said.
These types of devices are banned in North Carolina, but some can show up, especially in counties bordering states that allow them, Roegner said.
Injuries from illegal and homemade fireworks are growing. They accounted for 14 percent of injuries last year, an increase from 5 percent the year before, industry data show.
And more than half of those injured by an illegal/homemade device needed to be hospitalized, according to the American Fireworks Standards Laboratory report.
There’s an easy way to avoid injury while still enjoying a fireworks show, Roegner said.
“Leave it to the pros,” he said.
Not just injuries, but deaths
While injuries are the more common outcome, fireworks can also be deadly.
Nationally, there were at least 11 nonoccupational fireworks-related deaths in 2024 and eight the year before, according to the U.S. Consumer Product Safety Commission. The American Fireworks Standards Laboratory put last year’s death toll at closer to 19 after reviewing news stories, internet alerts, medical examiner reports and a death certificate database.
Roegner said he is unaware of any deaths in North Carolina last year. However, at least one death in 2022 was attributed to fireworks, according to media reports. Authorities responded on June 10 to a brush fire in the Lenoir County town of La Grange. The fire reached a structure that contained commercial-grade fireworks, which exploded, killing property owner Randy Herring and injuring three firefighters.
Herring’s death is not included in the 2022 national list of 11 deaths, which included two involving children 17 or younger. The death toll could be higher, as data collection and confirmation typically continue well after the calendar year.
It wasn’t clear from the American Fireworks Standards Laboratory report if any children were killed by fireworks in 2024. The report only offered details on seven cases, none of which involved children.
Two of the eight deaths in 2023 involved children.
In Amarillo, Texas, a 15-year-old boy died after being hit by a firework. He was leaning over a lit mortar-style firework at a public park when the mortar shell allegedly ignited from the tube and struck him in the chest, according to the national report. Police did not release his name.
Nick Layne, 17, died on July 4 after being struck by a mortar-style firework that he was lighting in his hand at a Fourth of July party at a home in Louisa County, Virginia. The firework exploded, burning his hands, face, chest and arms. The official cause of death was recorded as “blunt force trauma to torso,” according to the national report.
The grieving family told local media outlets that people should be aware of the potential danger with fireworks.
“A life-changing, no words kind of pain and emotion, just unreal,” Michael Layne said about losing his son.
‘Injury season’
While fireworks-related injuries tick up mostly around the July Fourth holiday, other injuries involving children pick up throughout the summer.
“Summertime in general is a high trauma time for our children, because they are not in school,” Longshore said. “So, they are out running around, riding bicycles, playing, swimming, all those things.”
Urgent care centers don’t see many fireworks injuries, which tend to end up at emergency rooms, but they do see a lot of strains, sprains and broken bones this time of year, said Chris Branner, specialty medical director of Urgent Care Services for Atrium Health.
Chris Branner is the specialty medical director of Urgent Care Services for Atrium Health, which has 30 urgent care centers in the Charlotte area.
“I call this season ‘injury season,’” Branner said. “In the wintertime, I call it ‘sick season.’”
Over the past year, the 30 urgent care centers in Atrium’s Charlotte area only handled a handful of fireworks-related injuries out of 400,000 adult and child patient visits, Branner said.
In general, Branner said urgent care centers see more injuries to arms and legs with children.
That can range from broken fingers or jammed fingers from catching a ball or playing basketball to kids riding scooters and not wearing shoes, leading to injuries to the toenails, toes and feet, he said.
Children walking around barefoot in the yard will come in with splinters.
“And then whenever a child falls, the natural inclination is to reach out with their hands and arms … and when you do that, that puts pressure either on the wrist or the elbow, and so we see wrist and elbow injuries as a result of that natural reflex to catch oneself from falling.”
Family gatherings provide opportunities for other injuries as well, he said.
“You don’t think about the danger of making s’mores,” Branner said. “But I’ve got fire and sharp pokey objects that come together. A melted marshmallow is a really hot sticky thing.”
He said parents need to be mindful and follow common sense. Be aware of surroundings to make sure they are safe for children. Get all of the protective gear if kids are going to be skateboarding, riding a bike or playing sports.
“All those things are recommended for a reason,” he said.
The post Leave fireworks to the professionals, say burn docs. How to celebrate the 4th safely with your kids. appeared first on North Carolina Health News.
