Fireworks-related Injuries Research Articles

Ultrasound biomicroscopy findings in fireworks-related blunt eye injuries

To present ultrasound biomicroscopic (UBM) findings and their clinical correlations in people with optically hazy media after injury at the Persian Wednesday Eve fireworks festival. Ultrasound biomicroscopy was performed on a series of 32 eyes with severe closed-globe injuries by P40 ultrasound biomicroscope. The median age of the participants was 19 years, and 81.3% were male. All but one had gross hyphema. Seventy-five percent had an extension of the injury (at least) to Birmingham Eye Trauma Terminology zone II. Ultrasound biomicroscopy detected 3 more iridodialyses and 10 more cyclodialyses in addition to the respective 5 and 3 that were diagnosed clinically. Ten cases of angle recession were observed, and 5 were suggestive of subluxation of the crystalline lens. Two cases were suspected for anterior segment intraocular foreign body on clinical examination, but UBM and computed tomography scanning together ruled out such a diagnosis. Our study showed the value of UBM in the assessment of severely contused eyes and hyphema. It made possible evaluation for dialyses and recessions at presentation. Ultrasound biomicroscopy illustrated diverse subclinical disruptions in clinically invisible anterior segment structures.

The burden of childhood injuries and evidence based strategies developed using the injury surveillance system in Pasto, Colombia

ObjectiveThis article characterises the burden of childhood injuries and provides examples of evidence–based injury prevention strategies developed using a citywide injury surveillance system in Pasto, Colombia.MethodsFatal (2003-2007) and non-fatal (2006-2007)...

Legislation as a tool to prevent firework-related eye injuries

Editor, The use of fireworks is banned in Norway except for on New Year’s Eve, the party day when intoxicated young men are allowed to set off these explosives while huge gatherings of people stay close to watch. It is a long tradition associated with many and serious eye injuries. In Denmark (Thygesen 2000) and Sweden (Sundelin & Norrsell 2000), there has been focus on these injuries, but not in Norway until 2002, when preventive measures were initiated because our department of ophthalmology received many young men with injured eyes on New Year’s Eve. This letter examines the effect of these measures, especially legislation. Information on all firework-related injuries was collected by telephone contact to all 17 departments of ophthalmology in Norway on New Year’s Day from 2005/2006 to 2008/2009. Injuries were classified by sex and by degree of seriousness as moderately serious and very serious. Minor injuries, which are rarely referred to departments, were not included. Minor injuries were defined as abrasions of cornea and mild burn injuries of eyelids. Very serious injuries were defined as penetrating or blunt trauma probably causing permanent blindness. Injuries in between minor and very serious were classified as moderately serious. Information was disseminated to the public on the risk of and how to prevent eye injuries by contacting the mass media during the week before New Year’s Eve, informing about the injuries the previous years and disseminating photographs of eyes injured. Local and national newspapers and radio and television stations were contacted. Special focus was given to the use of protective eyewear that from 2006 was distributed free of charge upon purchase of fireworks. The injury data collected from the departments of ophthalmology during New Year’s Day were broadcasted by the main national television station the same day. In 2007, a new focus on a proposal banning the private use of fireworks was introduced, constantly reminding the public authorities of their responsibility for fireworks-related injuries by not implementing effective preventive measures. In 2008, bottle rockets were banned in Norway. The effect of banning bottle rockets before New Year’s Eve 2008 was calculated using the mean annual injuries from 2005/2006 to 2007/2008 compared with the total injuries in 2008/2009. The Pearson chi-square test was performed using injured versus noninjured inhabitants in Norway in the various years. Mainly men were injured (Table 1). The incidence of firework-related eye injuries was relatively stable from 2005/2006 to 2007/2008 despite successful propaganda in the mass media about the risk of and how to prevent eye injuries (Table 2). The incidence decreased in 2006 after protective eyewear began to be offered free of charge upon purchase of fireworks, but this was not statistically significant. A breakthrough in reduction was accomplished in 2008 when bottle rockets were banned. The incidence was reduced by half (p = 0.03) compared with the mean incidence in the previous 3 years (Fig. 1). Incidence of firework-related eye injuries on New Year’s Eve in Norway, 2005–2008. Information about the risk of eye injuries and the use of protective eyewear seems to reach the people who already have low-risk behaviour. Young men, often intoxicated by alcohol while they use fireworks, seem to be out of reach of being influenced to handle fireworks safely and use protective eyewear. The banning of bottle rockets in this study removed the availability of fireworks considered more dangerous and thereby reduced injuries in both the low-risk and high-risk groups, similar to findings from the United Kingdom (Vernon 1988) and from the United States (Wilson 1982). Legislative removal from the market of the type of firework considered the most dangerous was definitely the most effective measure in reducing injury.

A survey of owners' perceptions of fear of fireworks in a sample of dogs and cats in New Zealand

AIMS: To establish reliable information regarding the behavioural responses of dogs and cats to fireworks in New Zealand; record interventions used by owners, and their perceived efficacies; and establish the prevalence of firework-related injury, and quantify owners' attitudes towards fireworks. METHODS: A questionnaire targeting dog and cat owners was distributed via the Auckland Society for the Prevention of Cruelty to Animals (SPCA) Animals Voice magazine and 25 veterinary clinics. The questionnaire covered demographics of animals, fear of fireworks, severity of the fear, and behaviours exhibited. Also included were treatments tried, source and perceived efficacy, prevalence of injury, and owners' attitudes towards the sale of fireworks for private use. RESULTS: From a total of 8,966 questionnaires distributed, 1,007 valid questionnaires were returned, representing 3,527 animals. Of these 1,635 (46%) animals displayed a level of fear of fireworks recognisable to their owners. Owners of dogs identified a significantly higher fear response than owners of cats but the duration of these fear responses did not differ between species. Fear of fireworks frequently resulted in dogs exhibiting active fear behaviours, whereas cats were more likely to exhibit hiding and cowering behaviours. A significantly increased severity and duration of fear response over time in dogs and cats was associated with owners who comforted them when they displayed a fearful response. Only 141/890 (15.8%) of owners sought professional treatment from a veterinarian, animal behaviourist or animal trainer for their animals, with variable efficacy. Six percent (51/923) of animals had received physical injuries from fireworks. The majority (837/1,007; 83%) of respondents, regardless of whether they owned a fearful animal or not, supported a ban on the sale of fireworks for private use. CONCLUSIONS: The results provide valuable information that is, as yet, unsubstantiated in New Zealand, although potential biases exist due to the non-random selection of respondents. Differences between dogs and cats were likely due to differing responses to fear-provoking stimuli between the species. Owner-reported increase in fearful response over time for comforted animals may indicate a negative impact on the longer-term psychological welfare of their animal. CLINICAL RELEVANCE: The greater the awareness of effective treatment plans for animals that suffer from a fear of fireworks, the greater the possibility that this fear can be reduced. Wider dissemination of effective owner behaviour and treatment programmes for firework fears is needed to improve levels of professional treatment for dogs and cats.

Can fireworks-related injuries to children during festivities be prevented?

To determine the epidemiological features and outcome of fireworks-related injuries among children 0 - 13 years old. A retrospective study from the trauma registry of a children's hospital from 2001 - 2009. Fifty-five children were treated for injuries from fireworks. The mean age was 8.8 years, 78% were boys, and the largest age group was 5 - 9 years old. Firecrackers accounted for 95% of the injuries; the most commonly injured body sites were hands (44%), eyes (42%) and face (31%); 47% of the patients had more than one injury. The most common injury type was burns (67%); 25 children were admitted, mostly to the burns and ophthalmology units. The mean length of hospital stay was 3.5 days. Surgical intervention was required in 38% of the patients. Most of the fireworks accidents occurred in or around the patients' homes. There were more fireworks-related injuries around Guy Fawkes Day (85%) than New Year's Eve (9%). Consumer fireworks cause serious but preventable injuries to children, either as users or bystanders. Children and their families should be encouraged to enjoy pyrotechnical displays conducted by professionals at designated areas. All fireworks for individual private use should either be supervised by an adult or banned. Current legislation should be more strictly enforced, especially the sale to under-age children.

Playing with fire and getting burnt—a retrospective analysis of injuries presenting to the emergency department during ‘firework season’

During firework season in the UK (October–January), many patients present to emergency departments across the country with firework-related injuries. These seasonal injuries can vary from minor skin trauma to major burns, inhalation injuries and even death in some cases. Governments have tried to improve public awareness and safety with education using multi-million pound national safety campaigns as well as clamping down on fireworks both from within and outside of the EU which fail to meet safety standards. Despite these measures, firework-related injuries are increasing (2005 census Royal Society of Prevention of Accidents (RoSPA)). Reasons for this have been cited as new variations in firework design, antisocial behaviour and readily available cheap fireworks. The author conducted a retrospective study in the emergency department in Exeter from October 2006 to January 2007 highlighting 18 firework-related injuries. Of those, four patients needed referral to local burns centres and five needed admission for supportive treatment and specialty management. Prevention of firework injuries to the hand is of the utmost importance. It is hoped that an increase in public awareness will concentrate attention on precautionary measures to prevent these avoidable ‘recreational’ accidents. If and when accidents do occur, hand surgeons and therapists attempt to provide patients with the best possible return of hand function with a minimum disability and disfigurement. Further research together with national awareness is suggested to reduce these injuries, all for a tradition which can cost millions in healthcare and loss of earnings, but ultimately, it can cost peoples’ lives.

Firework-Related Injuries in Tehran's Persian Wednesday Eve Festival (Chaharshanbe Soori)

Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori). This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities. This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury. There were 197 patients enrolled in the study with a mean age of 20.94 ± 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period. The fireworks used during a Chaharshanbe Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities.

Can fireworks-related injuries to children during festivities be prevented?

Can fireworks-related injuries to children during festivities be prevented?

The health and economic impact of fireworks-related injuries in Iran: A household survey following the New Year's Festival in Tehran

IntroductionFireworks are used worldwide as a part of national and cultural celebrations. Personal use of fireworks is associated with serious injuries. The “Last Wednesday Eve Festival” is celebrated on the evening before the last wednesday of the Persian calender year. In recent years, fireworks have been widely used during the festival, which has resulted in injuries. The aim of this study was to determine the incidence and risk factors of fireworks-related injuries associated with the Last Wednesday Eve Festival, in Tehran, Iran. MethodsA household survey of residents of greater Tehran, using a random cluster sampling design was performed. Number of fireworks-related injuries, expenditures for fireworks and medical treatment of fireworks-related injuries, length of hospital stay for treatment of these injuries and the personal property damage was gathered. ResultsInterviews were conducted of 2475 households in greater Tehran. At least one member of 19.8% of these households had used fireworks during the 2007 Last Wednesday Eve Festival. Fireworks-related injuries were more common among households whose members had used homemade fireworks than among households whose members had used only commercially made fireworks (OR=16.5, 95% CI: 5.7–47.5). Forty-five households reported that they had sustained personal property damage caused by fireworks during the festival, costing a mean of US$ 36.60. Households with at least one injured member spent a mean of US$ 441.90 for medical care and a mean of US$ 70.80 for other expenses related to seeking medical care. The overall incidence of fireworks-related injury among household members was 0.2% (95% CI: 0.1–0.3%). Fireworks-related injury incidence was highest in the 10–19 age group. The total estimated number of fireworks-related injuries in Tehran during the 2007 Last Wednesday Eve Festival was approximately 17,000. Among the 20 injured individuals, 4 persons (20.0%) were hospitalised for a mean of 2.8 days. ConclusionsThe personal use of fireworks in Iran is associated with serious injuries and non-trivial economic costs. This study is the first to describe the incidence and economic costs of fireworks-related injuries in a major city in Iran using a population-based survey. To prevent these injuries, individuals should attend public firework displays conducted by professionals rather than engage in personal use of fireworks.

Sparkler Burns and the Potential for Serious Injury in Children

A sparkler is a type of novelty hand-held firework that burns slowly while emitting sparks. This product burns at a high temperature -- 1000 to 1600 degrees C and stays hot for a while after they ceased burning. Sparklers, like snap-caps, are marketed as relatively harmless. However, sparklers are responsible for the vast majority of legal fireworks-related injuries. In our pediatric burn center the median age for patients with sparkler-related injuries was 6.5 years (range 1-14). Boys were affected more often than girls (ratio 2:1). Of particular concern are children (usually boys) who use sparklers to make improvised explosive devices. This was done by scraping the powder coating from the sparkler, which was then either lit or used in combination with petrol to make a sparkler bomb. Girls and very young children are typically injured when they touch a recently burned-out sparkler or when a sparkler sets clothing alight. All cases occurred at or around home. All children were supervised by one or both parents (or in one case a friend's parent). The Internet provides easily accessible information on constructing home-made sparkler bombs of astonishing power and intensity. Although the packages of these shop goods fireworks display obvious warnings concerning the need for close adult supervision, the warnings are clearly insufficient to prevent injuries when parents are under the false impression that sparklers are harmless. Language: en

The Persian Wednesday Eve Festival “Charshanbe-Soori” Fireworks Eye Injuries: A Case Series

Purpose: To describe the clinical spectrum and severity of eye injuries sustained during the Persian Wednesday Eve Festival “Charshanbe-Soori” and to identify the fireworks devices involved. Methods: Prospectively, consecutive patients treated for fireworks-related eye injuries in the emergency room at Farabi Eye Hospital, Tehran, over 3 days around the occasion in 2000, 2001, and 2002 were studied. Results: Four hundred thirty-seven cases of eye injuries with an age range of 2–74 (median 17; SD 11.1) years were studied: 84.6% were male; 18.6% of the injuries were bilateral; 79.9% of the injured were bystanders or passersby. Eleven types of devices were involved, of which seven were explosives and eight were homemade. “Narenjaks,” homemade grenades, were involved in 62.2%, firecrackers in 14.8%, and sparklers in 6.2% of the events. Injuries were categorized as severe in 49% of cases, and 45 (10.4%) people were hospitalized. Five eyes with no light perception and/or enucleation, 33 cases of monocular blindness, 54 (12.3%) cases of open globe (including intraocular foreign bodies) were observed. Grenades, bystander and passerby roles, outdoor context, a relatively older age, lower socioeconomic status, and male gender in the subset of passive roles were the determinants of more severe injuries (all p values < 0.05). Lid injuries (67.7%), corneal abrasions (51.6%), hyphema (48.1%), superficial foreign bodies (32.5%), and corneal contusions (13.8%) were the five leading injuries. Conclusions: In Iran, fireworks cause frequent and diverse injuries during the Wednesday Eve Festival and are a leading cause of severe eye injuries and monocular blindness.

Pediatric Fireworks-Related Injuries in the United States: 1990–2003

Our goal was to describe the epidemiology of pediatric fireworks-related injuries among children aged 19 years and younger by using a nationally representative sample. We performed a retrospective analysis of data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System from 1990-2003. An estimated 85800 pediatric fireworks-related injuries were treated in US emergency departments during the 14-year study period. Injured children had a mean age of 10.8 years, and 77.9% were male. Fireworks users accounted for 49.5% of the injuries, whereas 22.2% of the injuries were to bystanders; however, user status could not be determined in 28.3% of cases. The overall fireworks-related injury rate decreased significantly during the study period, but subgroup analysis did not indicate consistent declines among all ages and types of fireworks. Injuries were most commonly caused by firecrackers (29.6%), sparklers/novelty devices (20.5%), and aerial devices (17.6%). The most commonly injured body sites were the eyeball (20.8%), face (20.0%), and hands (19.8%), and the most common injury type was burns (60.3%). Approximately 91.6% of all children with fireworks-related injuries were treated and released from hospital emergency departments, 5.3% were admitted, and 2.3% were transferred to another institution. Bystanders accounted for 13.3% of admitted cases and 20.6% of transferred cases. Consumer fireworks cause serious preventable injuries among pediatric fireworks users and bystanders in the United States. Parents should be advised to take their children to safer public fireworks displays rather than allowing consumer fireworks to be used by or near their children. A national restriction of consumer fireworks, in accordance with the policy recommendations of the American Academy of Pediatrics, should be implemented to reduce the burden of fireworks-related injuries among children.

Invited Critique

This editorial offers a discussion of burns sustained by children caused by the accidental explosion of Snap-Caps (ie, Snappers, Pop-Pop Snappers, Monster Snaps, or Bang Snaps). The sale of explosive devices deemed 'safe' for children 8 years or older poses an oxymoron for adults who legislate safety requirements for any pyrotechnic device to be sold to the public. Although the amount of explosive per snap-cap is relatively harmless, these units are usually sold in bags of 50. When multiple units are detonated simultaneously, the resulting explosive reaction is additive and is capable of causing serious injury. Is it coincidental that all the patients discussed herein were boys carrying multiple snap-caps in the same pocket of their trousers? Is it merely an oversight that neither the U.S. Consumer Product Safety Commission (CPSC) nor the manufacturers did not think of the possibility that multiple units exploding together were no longer 'safe'? Despite the CPSC's report of a significant decline in firework injuries during the past few years (except for the year 2000), the fact is that most of the injuries that do occur are in teen and pre-teen age boys. This paper reports that, in the year 2001, half of the firework-related injuries occurred in children younger than 15 years of age and supports the statistical conclusion that a disproportionate number of injuries occur in the 10- to 14-year-old age group when compared with the population as a whole. We question the claim that snap-caps can be sold as a safe alternative to conventional firecrackers. Although there were no deaths in these children, a 'prudent observer' would conclude that snap-caps pose an unacceptable risk to children and adolescents even when they are used as indicated. We believe that the CPSC should take a closer look at these 'safe' firecracker substitutes. If they cannot be removed from the market completely, then perhaps limiting the packaging to less than 10 units per package, initiating packaging warnings, and limiting the sale of snap-caps to children would decrease the number of injuries. Educational literature distributed through our burn centers also should promote adult education related to these hazards and urge parental or adult supervision when children are given these devices for play toys.

Visual Outcome after Fireworks Injuries

The epidemiology and prognosis of fireworks-related injuries treated at a tertiary eye care center in less developed nations remain unknown. We conducted a prospective observational study that enrolled all consecutive eyes with fireworks-related ocular injury visiting our trauma clinic during a 1-year period. Eyes were graded by ocular trauma classification and followed for 6 months at least. Best corrected visual acuity (BCVA) at 6 months was considered the final visual outcome. Data were analyzed. Twenty-five (96%) of a total of 26 patients enrolled during study period were male patients and 13 (50%) were younger than 15 years. The type of fireworks involved was a bottle rocket in 38.5%. Factors significantly associated with better final visual outcome were better BCVA at presentation (p = 0.041), absence of bottle rocket injury (p = 0.028), closed globe injury (p = 0.028), absence of relative afferent pupillary defect (p = 0.019), absence of intraocular foreign body (p = 0.026), and absence of endophthalmitis (p = 0.006). Besides poor visual outcome, bottle rocket injuries were more frequently associated with facial lacerations, intraocular foreign body, and endophthalmitis development. Fireworks-related ocular injuries commonly affect young male subjects of northern India. Visual outcome is better in eyes having better initial BCVA or closed globe injury and if relative afferent pupillary defect, bottle rocket injury, intraocular foreign body, and endophthalmitis are absent.

Firework-related childhood injuries in Greece: a national problem

During a 5-year period, out of 110 066 children with injuries recorded in the Greek Emergency Department Injury Surveillance System (EDISS), 91 had firework-related injuries. Descriptive analyses and the Barrell matrix were used to determine risk factors and extrapolated national firework childhood injury figures were calculated. The estimated annual incidence of childhood firework injuries treated in the emergency departments of hospitals countrywide, was 7 per 100 000 children years. Seventy percent of injuries concerned older children (10–14 years), mostly boys with self-inflicted injuries, whereas girls suffered injuries as bystanders. A sharp peak in spring was noted, when the Greek Orthodox Easter is celebrated. Illicitly sold fireworks caused most injuries, but in eight instances homemade firecrackers were responsible.

Fireworks-related injuries to children.

An estimated 8500 individuals, approximately 45% of them children younger than 15 years, were treated in US hospital emergency departments during 1999 for fireworks-related injuries. The hands (40%), eyes (20%), and head and face (20%) are the body areas most often involved. Approximately one third of eye injuries from fireworks result in permanent blindness. During 1999, 16 people died as a result of injuries associated with fireworks. Every type of legally available consumer (so-called "safe and sane") firework has been associated with serious injury or death. In 1997, 20 100 fires were caused by fireworks, resulting in $22.7 million in direct property damage. Fireworks typically cause more fires in the United States on the Fourth of July than all other causes of fire combined on that day. Pediatricians should educate parents, children, community leaders, and others about the dangers of fireworks. Fireworks for individual private use should be banned. Children and their families should be encouraged to enjoy fireworks at public fireworks displays conducted by professionals rather than purchase fireworks for home or private use.

Major pediatric hand trauma associated with fireworks.

To characterize the injury pattern and economic impact of major pediatric hand trauma secondary to fireworks. Retrospective. Pediatric Level I trauma center. N/A MAIN OUTCOME MEASUREMENTS: Fractures, amputations, soft tissue defects, length of hospitalization, number and type of procedures performed were obtained from charts, radiographs, and operative reports. Hospital charges were obtained from the billing office. Records of patients with a diagnosis of fireworks-related injuries admitted over a period of ten years were reviewed. Twenty-two patients were identified to have sustained twenty-two hand injuries. The group consisted of nineteen boys and three girls, with an average age of 9.3 years (range, 4 to 17 years). There were thirty-one fractures, nineteen amputations, and one dislocation. The nineteen amputations occurred in nine hands. Local skin graft or flap coverage was required in six hands acutely, and delayed soft tissue procedures were performed on four hands. Four hands had digital neurovascular injuries; two required microsurgical repairs at the time of injury, and two were irreparable. Resource use included: average hospital stay of 4.3 days (range, 0 to 20), average number of trips to the operating room, 1.2 (range, 0 to 3), and average hospital charges of $11,582 (range, $1,035 to $39,489). This study illustrates the severity of pediatric hand injuries associated with fireworks and the significant burden placed on medical resources in treating these injuries. Efforts toward public education and legislative reforms may help to prevent these unnecessary injuries.

Injuries From Fireworks in the United States

Fireworks traditionally are used in the United States to celebrate Independence Day on July 4th. The U.S. Consumer Product Safety Commission (CPSC) estimates that 8500 persons in the United States are treated in emergency departments each year for fireworks-related injuries (1). Of all fireworks-related injuries, 70%-75% occur during a 30-day period that surrounds the July 4th holiday (June 23-July 23) (2). Seven of every 100 persons injured by fireworks are hospitalized, approximately 40% of those injured are children aged < or = 14 years, and males are injured three times more often than females (1). The injury rate is highest among boys aged 10-14 years (3). Most commonly, injuries from fireworks affect the hands (34%), face (12%), and eyes (17%) (4). Injuries are more frequent and more severe among persons who are active participants than among bystanders (3).

Serious fireworks-related eye injuries

Serious fireworks-related eye injuries

Firework related injury and legislation: the epidemiology of firework injuries and the effect of legislation in Northern Ireland

The efficacy of legislation in reducing firework associated injuries is uncertain as is the nature of the problem within the United Kingdom (UK). In September 1996 the legislation governing firework sale in Northern Ireland was relaxed thus equalling that of the rest of the UK. For the 2 years following the change in legislation we prospectively assessed those patients who were admitted with a firework injury over the Halloween period. We then compared these results with retrospective data for the 3 years prior to the change in firework law. In the pre-legislation series the mean number of patients admitted annually was 0.38 per 100,000 while in the post-legislation series the mean was 0.43 per 100,000. Blast injury to the hand was the commonest injury accounting for 53% of cases in both series. Burn injuries were the second commonest form of injury comprising 30% of all admissions. Of those admitted with a hand injury 47% had at least one finger terminalised and nearly half of those patients admitted with burns (44%) required skin grafting. We conclude that early evidence suggests that liberalisation of the law on firework sale has not resulted in a significant increase in firework related injuries requiring hospital admission.