Deborah Howell (Host): As fireworks light up the sky this 4th of July, emergency departments across the country brace for one of their busiest times of the year. In this episode, Tassia Trink Trauma Service PI coordinator at Long Beach Medical Center and Miller Children's and Women's Hospital will talk about firework safety, the most common injuries seen in the ER and trauma department when fireworks are handled at home, and what every parent should know before handing their child a sparkler.

Welcome, Tassia.

Tassia Trink, BSN, RN, PHN, MICN: Thank you guys for having me.

Host: Oh, I used to love sparklers so much. But let's get into the topic at hand. Do you have any recent statistics on how many children are injured by fireworks each year, especially around 4th of July?

Tassia Trink, BSN, RN, PHN, MICN: I could tell you in 2023, approximately 9,700 people were treated in emergency rooms for firework related injuries. Two thirds of those actually occurred in the month around July. So a little bit of June to past the end of the month. I don't exactly know how many children, but that's a fair amount of people.

Host: What kinds of injuries does the emergency room and trauma department typically see from fireworks?

Tassia Trink, BSN, RN, PHN, MICN: So we can see a variety of different things. About 30% of the injuries that we see are hands and finger injuries, so that actually also involves a traumatic amputation, which is life changing and altering. About 15% of the injuries are eyes which also is horrible. Children under 15 years old account for 30% of those injuries. And then the next group of, young adults, 20 to 24, also are the most common.

Host: So that begs the question, at what age is it safe, if ever, for children to be involved in lighting or handling fireworks?

Tassia Trink, BSN, RN, PHN, MICN: Well, I'll tell you, most people aren't going to like this answer, but children should never be involved in lighting fireworks. Not at all. Not even the older kids. According to fire safety experts and, uh the other US consumer product safety, only 18 and years older should light and handle any fireworks.

A lot of the injuries do happen because older kids are assumed to be capable, but many of them don't necessarily understand the risks and they don't follow the safety rules. You know, and children have that lack of experience and coordination. If something goes awry, they may panic or react in an unpredictable fashion when something goes wrong and that can cause more injuries to not only them, but the bystanders around them.

Host: Right, because their brains aren't fully developed.

Tassia Trink, BSN, RN, PHN, MICN: Right, right.

Host: Let's go a step further. Can you explain why even small fireworks like sparklers can be dangerous?

Tassia Trink, BSN, RN, PHN, MICN: I think sparklers, are taken for granted. They're surprisingly dangerous, especially for kids. Because most of the time the parents and adults around them hand the sparklers to kids because it's fun. But sparklers burn at actually 1,200 degrees to even over 2000 degrees. That's hotter than a blowtorch that melts metals, so super high. And then all those little sparks fly around. They may not understand that danger. They might touch that burning end or wave it near their face, which can involve burns to their face or eyes, drop it. As it burns down, it can hit their hands, get on their flammable clothing or materials. So it's very easy and common for burns to hands, arms, faces, and eye injuries when those sparks fly into the eyes. Not a very good thing. Also, if it's dropped on the ground, it can start a fire.

Host: Especially in dry places like California. You know, our parents used to just hand us the sparklers and we would just go running off. And I shudder to think of that now because those sparks were probably heading right for our faces.

Tassia Trink, BSN, RN, PHN, MICN: Running around with your hair blowing and yeah.

Host: Yeah. Okay, so not going to do that anymore. So what are some of the most common mistakes families make when using fireworks at home?

Tassia Trink, BSN, RN, PHN, MICN: I think some of the most common mistakes are allowing children to handle the fireworks, including sparklers. Sometimes they alter, modify the fireworks, or if they don't explode originally, they relight them, pointing at people or being playful with him. Or possibly consuming drugs or alcohol prior or having a party, you know, not being the most sober, holding them in your hands, not having a safe distance around people, lighting multiple at a time. I can go on and on.

Host: Yeah, throwing them at people, which is not great. They're not snowballs.

Tassia Trink, BSN, RN, PHN, MICN: No, they aren't.

Host: All right, so what precautions should families take if they still plan to use fireworks at home?

Tassia Trink, BSN, RN, PHN, MICN: I know that a lot of neighborhoods do sell the safe and sane fireworks, so, which is also important to follow the rules with those. But always important to start off with having a sober adult light all of the legal fireworks and follow the local and state laws. Some of the things you should do are light one firework at a time and move away quickly.

Keep the children and all the other observers at a safe distance, preferably behind some sort of protective barrier. Keep a bucket of water close. So after they are detonated, you can dispose of the fireworks. Don't allow children to handle the fireworks. Never relight them.

And one really big thing is don't allow children or anyone to really pick up the spent fireworks. Sometimes they still may be active. We do see a ton of injuries, when people are cleaning up the next day and they think that the firework has already been used and it actually explodes in people's hands and causes a big problem. Because now you're very unaware.

Host: Tell us the danger about relighting. You've mentioned that a couple of times.

Tassia Trink, BSN, RN, PHN, MICN: Yes. So we see many injuries in children and adults after the 4th of July due to those fireworks that are found on the ground. And then someone goes to reach to pick them up or clean up thinking they're just throwing away the trash and debris and it blows up after being handled. There still may be some powder left in it, or it just detonates, or you just didn't know if it was already exploded or not, or you think it's a dud.

They can definitely explode without warning. So the best thing to do with that is if you do see fireworks out and you are unsure about picking them up or they weren't a part of your fun times; contact your local law enforcement for safe removal because celebrations should totally end with laughter and memories and not hanging out with me in the ER.

Host: That's right. So what are some safer alternatives families can use instead of fireworks to celebrate the holiday?

Tassia Trink, BSN, RN, PHN, MICN: Some safer alternatives. My first go-to is allow the professionals to do it. Go to those firework shows. A lot of communities have different firework shows, you know, different stadiums. Angel Stadium has them, Disneyland, so attend a professional firework show. They are more fun and you don't have to do any of the cleanup. If that's not an option, you can always consider the safer alternatives such as they make LED sparklers and streamers, glow sticks, confetti poppers, those types of things.

Host: Oh, I didn't think of that, confetti. How can parents set boundaries now with the older kids or teens who may be tempted, as you know, we were, to experiment with fireworks unsupervised?

Tassia Trink, BSN, RN, PHN, MICN: Great question. I think that answer starts with direct and honest conversation. I think it's very important to be clear. Let them know that fireworks are not toys, not even the small ones. They can cause serious injuries and death. I am an advocate of using real examples. Sharing short age appropriate stories and you know, news reports about the injuries.

Emphasizing that this is totally about protecting them, not just enforcing the rules, not trying to be a downer, but just letting them know that this is actually a big deal and if an injury does happen, it could be life changing if you do survive. So, setting those clear rules and offering different alternatives, and maybe even like letting them be involved in planning that family friendly firework show or more about the party and letting them be involved in that manner as opposed to actually letting them light the fireworks.

Host: Got it. Okay. That's great information. Now, if someone is injured by a firework, what should be done right away and when is it time to go to the ER?

Tassia Trink, BSN, RN, PHN, MICN: So if someone is injured by a firework, immediate action is crucial to reduce harm and possibly save a life. So if it's a burn, you want to stop the burning, remove any of the smoldering clothes or even jewelry because jewelry gets hot near that burn, if possible. You want to use cool water and you want to run it over the burn for 20 minutes.

There's a lot of data that's proven that this is actually really helpful for burns. We even will do the same treatment in the hospital. You want to cover the area with a dry, clean gauze or cloth. If there's an eye injury, we suggest that you don't rub it, rinse it, or apply pressure. We just want you to cover your eyes with a clean cloth or even a paper cup cutting the bottom so it just protects the eye and get emergency help immediately.

Eyes need specialty centers. If there's bleeding or lacerations or cuts, apply that firm direct pressure. If bleeding is severe or spurting, or if an unfortunate amputation happens, you may need to apply a tourniquet and definitely call 9-1-1 right away. I also do want to mention that for like the always go to the ER type situation, the recommendation is if there's any burn larger than a quarter on the areas of hands, feet, face, or genitals. Anytime there's blistering or white charred skin, that's tissue damage. Any eye injury or also something that people don't think about is when fireworks explode, you can have hearing loss or damage. So if you ever have ringing in your ears or things like that, that's also important.

Host: What's your final message to parents and caregivers ahead of the 4th of July when it comes to fireworks and child safety?

Tassia Trink, BSN, RN, PHN, MICN: I just want to remind everyone that every year thousands of kids are injured by fireworks, many from the most seemingly harmless items like sparklers. So this 4th of July and the ones to follow, leave the fireworks to the pros, keep children away from fireworks, including sparklers. Have that water and fire extinguisher ready and first aid kits. And as we celebrate, let's just make that commitment to what matters most, our children's safety.

Host: That's right and the meaning of the holiday. Okay. Thank you so much, Tassia, for your time and your expertise today. I learned so much and we really enjoyed having you on the podcast.

Tassia Trink, BSN, RN, PHN, MICN: You're welcome. Thank you guys. Have a safe holiday.

Deborah Howell (Host): You too, and families can learn more about firework safety and injury prevention resources at millerchildren's.org/injuryprevention.

That's all for this time. I'm Deborah Howell. Have yourself a safe and terrific day.