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Encouraging Firework Safety Through Public Service Announcements

Published:January 22, 2022DOI:https://doi.org/10.1016/j.jhsa.2021.11.030
      A dramatic increase in firework-related blast injuries to the hand and upper extremity resulted in record-setting numbers at our institution over the July 4, 2018, holiday. This led our hand and upper extremity department to create a public service announcement (PSA) campaign regarding firework safety and injury prevention. This PSA was broadcast in advance of the next July 4 holiday via several media platforms including television, radio, and the internet. The following year only 4 patients required surgery for firework-related blast injuries to the hand and upper extremity over the same 10-day period, including the weekends before and after the July 4, 2019, holiday. This represented a considerable reduction compared with the 14 patients seen within the same time frame in 2018. The purpose of this article was to outline the process and report the impact of creating and disseminating a public service announcement for firework-related blast injury prevention.

      Key words

      In the United States, firework-related injuries are a common reason for admission to the hospital and continue to cause considerable disability to those involved. According to epidemiologic studies, 97,562 firework-related injuries were treated at emergency departments in the United States between the years 2000 and 2010 with the hand being the most common body part injured.
      • Moore J.X.
      • McGwin G.
      • Griffin R.L.
      The epidemiology of firework-related injuries in the United States: 2000-2010.
      These numbers continue to increase in the United States with approximately 10,000–13,000 firework-related injuries in 2019, and approximately 7,600 of those injuries were reported during the month of July.
      • Marier A.
      • Yongling T.
      • Lee S.
      United States Consumer Product Safety Commission. 2019 Firework Annual Report: Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities During 2019. June 2020.
      It is not surprising that the majority of these injuries occur in July, as the Independence Day holiday is often synonymous with firework use.
      • Canner J.K.
      • Haider A.H.
      • Selvarajah S.
      • et al.
      US emergency department visits for fireworks injuries, 2006-2010.
      The liberalization of laws restricting certain classes of fireworks, in combination with the increasing popularity of social media outlets that can glorify dangerous behavior with firework misuse, are likely reasons for the increasing numbers of blast-related injuries seen in emergency departments across the United States.
      Blast injuries occur from both indirect and direct contact following the combustion of fireworks or explosive devices and have the potential to cause harm to an individual with devastating consequences. Historically, the data that have been reported for successful management of blast injuries have come from studying military conflicts and soldiers injured by mortars, grenades, and artillery fire.
      • Bakhach J.
      • Abu-Sitta G.
      • Dibo S.
      Reconstruction of blast injuries of the hand and upper limb.
      ,
      • Kumar A.R.
      • Grewal N.S.
      • Chung T.L.
      • Bradley J.P.
      Lessons from the modern battlefield: successful upper extremity injury reconstruction in the subacute period.
      Although this research, and the recommendations developed from it, has helped lay the foundation for effective damage control treatment strategies, more research is required in the civilian sector with regard to treatment algorithms as well as the prevention of firework-related blast injuries. Furthermore, to the best of our knowledge, the impact of community outreach in the form of public service announcements (PSAs), and the potential for affecting the incidence of these blast injuries, has never been investigated.
      Between 2013 and 2018, our institution observed a steady increase in the frequency and severity of firework-related injuries to the hand and upper extremity during the Independence Day holiday. For example, in the previous 5 years leading up to the July 4, 2018, holiday, the average number of surgically treated upper extremity blast injuries on July 4 and 5 was 5 with steady increases seen as there were 6 total injuries in 2016 and 8 total injuries seen in 2017. During those same 2 days in 2018, our hand surgeons operated on 10 severe firework-related hand injuries with more than half of those involving children under 16 years of age. Considering the 10 days in total, including the weekends before and after the July 4 holiday, there was a total of 14 patients with firework-related injuries to the hand and upper extremity requiring surgery in 2018. Many of these patients required multiple surgeries with some requiring partial or complete amputations due to the severity of these injuries (Fig. 1). Because of the increase in volume, as well as the severity of the injuries, our hand surgery department believed that there was a need for education within our community on the potential hazards of firework use. A PSA campaign was created and broadcast before the July 4 holiday the following year in both English and Spanish over several media platforms, including television, radio, and social media, with the intention of reducing firework-related injuries in our Central Florida area. The purpose of this article was to discuss our experience with developing and implementing a PSA campaign on the hazards of fireworks to reduce blast-related injuries within our community.
      Figure thumbnail gr1
      Figure 1Clinical and radiographic images illustrating firework-related injuries encountered during the 2018 Independence Day holiday.

      Statement of Informed Consent

      The investigator communicated with all patients, and every patient gave verbal consent to include medical information in the writing of this case report.

      The Community Outreach Campaign

      Due to the increase in the number of severe firework-related injuries involving the hand during the July 4, 2018 holiday that were seen at our facility, our hand team became interested in the public safety aspect of the dangers of fireworks and concluded that the general public had a knowledge deficit about the potential injuries that can occur from the handling or misuse of fireworks. We presented an action plan for the PSA to our institution’s administration and media departments with a specific target date of the upcoming July 4, 2019, holiday. In our current era of multiple media outlets, we believed that it would be most efficient to spread this PSA information through multiple resources. We worked in collaboration with local news agencies, including radio and television stations, as well as our hospital’s media department to produce and deliver multiple PSAs before the 2019 Independence Day holiday. Because of the demographics of our population in Central Florida, this information was distributed in both English and Spanish. Looking at recent census data, roughly one-third of the Central Florida population identifies as Hispanic/Latino and approximately one-half of these prefer to speak Spanish.
      United States Census Bureau
      Populations Estimates Program, American Community Survey, 2019.
      We believed that it was imperative to include this considerable portion of the community and worked to provide this information through commonly watched Spanish television channels and their respective social media platforms.
      Our first PSA was a Facebook Live video which aired June 20, 2019, on our institution’s Facebook page.
      • Lewellyn B.
      • Gibson M.E.
      Orlando Health. Facebook Live Video. June 20, 2019.
      The video featured the hand surgeon (B.L.) and resident (M.E.G.) who had been on call during the 2018 Independence Day holiday. The discussion focused on recent firework-related injury statistics in the United States and Central Florida, the spectrum of injuries that are commonly seen, and tips on how to safely enjoy fireworks. The PSA content was intended to remind the Central Florida community that no firework is completely “safe” and how firework misuse can cause life- and limb-threatening injuries. We also encouraged parental supervision and avoidance of alcohol and other substances while handling fireworks. This video was viewed more than10,000 times over the next 2 weeks before the July 4 holiday. With the help of local media, our team was able to produce 4 additional PSAs, which all aired within 2 weeks of the 2019 Independence Day holiday. Three of these PSAs were interviews that were done in both English and Spanish by our surgical residents and hand surgery attendings and were presented on local television and radio stations. The fourth PSA was an interview with the chief of the hand surgery department, which was printed in our local newspaper and published on their website on July 1, 2019. All of these PSAs outlined how common firework-related injuries are and included the Consumer Product Safety Commission’s recommendations for how to safely handle and use fireworks.
      To evaluate the impact of our PSA campaign, we investigated the number of patients with severe blast injuries requiring surgery who presented to our institution the following July 4, 2019, holiday. Four total patients required surgery for firework-related injuries to the hand and upper extremity over the 10- day period, including the weekends before and after the July 4 holiday, which represents a clear reduction compared with the 14 patients seen within the same time frame in 2018. We also re-transmitted the same PSA campaign to the Central Florida community before the 2020 New Year’s holiday. New Year’s Eve and Day are typically the holiday with associated with second most firework-related injuries seen at our institution, and there was only 1 blast-related injury to the hand requiring surgery seen at our institution over that 2-day period. In previous years, it was common to see anywhere from 4 to 7 firework-related blast injuries to the hand requiring surgery during the New Year’s holiday.

      Discussion

      As the images in Figure 1 depict, firework-related blast injuries can be devastating, highly traumatic injuries and can have disastrous consequences for the victims, their families, and the community in general. These injuries require a multidisciplinary approach with regard to their triage and treatment. A wide variety of specialties, including hand surgery, plastic surgery, orthopedic surgery, general surgery, emergency medicine, otolaryngology, and ophthalmology, is necessary to provide appropriate care for these patients, as often several body areas can be injured. Although literature has been published with regard to the triage and treatment of these injuries, there is a dearth of publications related to the potential role that PSAs can have in decreasing the incidence of these injuries.
      There have been previous reported attempts to use public outreach and PSAs as a means of decreasing undesirable effects from consumer products and behaviors. Zimmerman et al
      • Zimmerman R.S.
      • Palmgreen P.M.
      • Noar S.M.
      • Lustria M.L.
      • Lu H.Y.
      • Lee Horosewski M.
      Effects of a televised two-city safer sex mass media campaign targeting high-sensation-seeking and impulsive-decision-making young adults.
      conducted a study that sought to educate impulsive youths, who are at a high risk, on the benefits of safer sex practices in avoidance of contraction of sexually transmitted infections. They found that a carefully targeted, intensive mass media campaign using televised PSAs can lead to a change in the behaviors of the target audience with regard to safer sex practices. Similarly, Cho et al
      • Cho K.W.
      • Lee J.
      • Ryu J.H.
      • Kim S.J.
      Effects of anti-smoking public service announcements on the attitudes of Korean college students toward smoking.
      studied the effects of an antismoking campaign using PSAs on student attitudes toward smoking. They found that positive informational announcements had a greater effect on current smokers than announcements with negative information or connotations. With regard to the efficacy of educating the public, Martiniuk et al
      • Martiniuk A.L.C.
      • Secco M.
      • Yake L.
      • Speechley K.N.
      Evaluating the effect of a television public service announcement about epilepsy.
      focused on evaluating the effect of a PSA viewed by fifth graders on epilepsy education and compared it with an “in school” only education. The study showed that students who viewed the PSA had a higher level of knowledge regarding epilepsy as well as more positive attitudes toward epilepsy compared with students who were educated only by their school institution. Interestingly, these results remained consistent even 1 year after airing the PSA.
      These studies demonstrate the positive effects that a PSA can have on a specific target population. The PSA that our hand and upper extremity department developed and instituted with the Central Florida community was used to target individuals who use and handle fireworks. The role of this PSA was to inform and educate our community with the hopes of decreasing the incidence of severe firework-related blast injuries seen at our institution. Over the course of 1 year, we observed a considerable decrease in the incidence of blast-related injuries to the hand requiring surgery at our institution after instituting a firework use and safety PSA. The PSA that was implemented by our team may have had a direct effect on the incidence of these injuries; however, other factors also could have caused this decrease. For example, the day of the week that the July 4 holiday falls on could affect the number of fireworks being used by a population and, therefore, the number of firework-related injuries. If the holiday was on a Friday or Saturday, there may be an increase in firework use and potential injury compared with a July 4 holiday that was on a weekday, as the majority of the population may have to work the following day and would not be as likely to stay up later or consume alcohol and misuse fireworks. As the July 4, 2018, and July 4, 2019, holidays were on a Wednesday and Thursday respectively, we do not believe that the particular day of the week that the holiday fell on was a contributing factor to the decrease in incidence seen. Similarly, the weather could play a role with regard to firework use and injury. If the night of the holiday was overcast or raining when the fireworks were to be used, then there would be an expected decrease in firework-related injuries as the firework display may be shortened or even canceled. For both the 2018 and 2019 Independence Day holidays, there was no rain in the Central Florida area for the 48-hour period from July 3 to July 5. Another potential confounding factor could be related to the hand surgeon taking the call. There were 2 different hand surgeons taking calls during the Independence Day holidays in 2018 and 2019, and each surgeon may have had different criteria for which particular firework-related injuries required formal surgery in the operating room suite and which injuries could be treated with an informal procedure in the emergency department. It should be noted that both surgeons who took the Independence Day holiday calls are partners within the same group with the same residency and fellowship training with similar years of posttraining experience, thus this selection bias more than likely did not occur.
      It should be noted that we related our PSA campaign to a decrease in surgically treated firework-related injuries by our hand surgery department rather than the simple incidence of firework-related injuries (both surgical and nonsurgical cases) for any body part seen by our hospital’s network. Although the exact number of all firework-related injuries for the years 2018 and 2019 seen by our hospital network is not known, one could assume that major injuries from fireworks that require surgery make up a fraction of the overall total number of firework-related injuries seen in a region and that if severe firework-related injuries requiring surgery decreased, that the overall incidence of blast injuries decreased as well.
      Although there are confounding factors that could have contributed to the decrease in severe firework-related injuries at our institution, it is plausible that the PSA for firework safety and injury prevention that we created and implemented within the Central Florida area did have a positive effect on decreasing the incidence of severe firework-related blast injuries within our community. The rationale for the use of various multimedia platforms and to broadcast the PSAs in multiple languages was to educate as many members of the community as possible. It is our intent to continue to modify and improve the previously created PSAs and to continue to air them annually on as many media outlets as possible before the Independence Day and New Year holidays to educate the public on the potential hazards of firework use.

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