No use looking for lost fingertips after the concussive shock wave
of an illegal "M-80" strips them from a hand. The pulpy tips
disperse like so many specks of violent red confetti.
Nothing left to re-attach.
Debride dead flesh and hope that remaining bits of fingernails
grow back.
That’s just one of the reasons doctors don’t like to be on call
before, during, or after July Fourth.
"You may not hear about it, but it happens every year. We see
everything from minor to serious injuries," said Dr. J. Grant
Thomson, director of the Yale Hand & Comprehensive Microsurgery
Center.
That includes blast wounds, torn away fingers, other avulsions,
burns, eye injuries, ruptured eardrums and broken bones.
Many emergency doctors remember gruesome fireworks injuries: The
man with half a hand and a pinky; the "professional" who broke all
the bones in his wrist when a mortar tube that he was resting his
hand on went off; the man who died from an unexpected rocket blast
to the chest.
Young kids often light the fuse of an M-80 or cherry bomb "to see
what happens," Thomson said.
"The fuse burns faster than they thought. One kid dunked it in a
bucket of water, but the fuse kept burning," he said.
Injuries are most likely when inebriated men set off homemade or
illegal fireworks near children.
According to the National Center for Injury Prevention and
Control, males represent 72 percent of fireworks injuries.
About 45 percent of the victims are 14 years and younger.
Children 5 to 9 have the highest rate of injuries.
"Most of the time the problem is ‘M-80s.’ Patients are vague
about where they got them," he said.
Typical injuries include severed fingertips and thumb, holes
blown through the palm, and burns, Thomson said.
All surgeons can do is clean the wounds, remove charred and
blasted tissue and try to stretch remaining skin over the bony ends
of the damaged digits.
If insufficient tissue remains, the injured hand is sometimes
temporarily sutured to a palm or groin so that new skin can grow.
Thomson remembers the worst cases.
One man had a powerful piece of explosive blow off half of his
dominant hand, leaving only a little finger.
One of the man’s big toes was attached to the hand to function as
a thumb.
"Usually I get four to 10 fireworks injuries the week of July
Fourth. There are probably more injuries but the people don’t come
in," he said.
In 2003, four people died and an estimated 9,300 were treated in
emergency departments for fireworks-related injuries in the United
States.
An estimated 5 percent of fireworks-related injuries required
hospitalization, according to the latest figures from the Nation
Center for Injury Prevention and Control.
Connecticut bans all explosive fireworks, rockets, roman candles,
firecrackers and anything else that detonates or deflagrates.
Connecticut only allows sparklers with no more than 100 grams of
pyrotechnic material.
These legal devices burn at more than 1,000 degrees and spit
pieces of incandescent metal. Sparks are so hot they can leave
permanent black dot tattoos on exposed skin.
Manufacturers have stretched the sparkler definition to include
many devices that emit "showers of sparks."
Last week Attorney General Richard Blumenthal ordered stores to
stop selling "Piccolo Petes," innocuous tubes that spit a flame hot
enough to melt aluminum.
Blumenthal, who last week got the manufacturer of "Piccolo Petes"
to stop shipping the product to Connecticut, said it may be time to
clarify the sparkler law to restrict widely sold "shower of sparks"
products.
Dr. William Horgan, director of pediatric emergency medicine at
the University of Connecticut Health Center, said that even "safe"
sparklers are hazardous.
"They create heat, and lodge in the eye, skin or clothing," he
said.
Still, sparklers generally cause simple burns and corneal
abrasions.
Horgan recalls a case in Waterbury when a man bent over a "dud"
rocket. The device went off, blowing a hole through the man’s chest.
He died immediately.
Fireworks that generate geysers of sparks pose a risk of burns,
said Dr. John Bonadies, director of trauma services at the Hospital
of Saint Raphael.
"Hair and clothing tend to catch on fire. People tend to run
rather than stop, drop and roll," he said.
Both types of burns can cover large areas of the body.
"Usually the people I see with burns were doing stupid things,"
Bonadies said.
Included in that broad category are testing homemade fireworks,
handling fireworks when drunk and using illegal fireworks, he said.
First-degree burns can be treated at home, assuming that there is
no other damage, he said.
However, second-degree burns, which produce blisters, require
medical care to prevent infection.
Wash the burn in cool water and place a clean dressing on it. Do
not apply salves or creams that make examining the wound more
difficult.
Do not burst blisters. This could lead to infection.
A third-degree burn appears whitish and waxy and does not produce
any sensation. Surrounding burns cause the pain.
This is a full-thickness burn and requires immediate medical
attention. Surgery and skin grafts may be necessary, Bonadies said.
Without exception, emergency physicians recommend viewing a
professional display.
If you use sparklers and similar legal devices, do not drink,
keep a source of water nearby and keep your children at a safe
distance.
