Firecracker injuries during Diwali festival: The epidemiology and impact of legislation in Delhi

"Diya"-Related Burn Injuries during the Diwali Period: A 5-Year Retrospective Review from a Tertiary Care Hospital in India

Background  Diwali is a festival that is passionately celebrated by Indians all across the globe. Fire hazards associated with this festival are well known. Our hospital is a tertiary care burn center and caters to a patient population from all over North India. Firecracker burns and diya burns constitute two major causes of burn injuries during the festival of Diwali. Since, diya-related burn injuries have been overlooked in the past, this study was primarily designed to study the demographical data of "diya burns" during Diwali. Materials and Methods  The departmental records were analyzed for 3 days around Diwali festival over a period of 5 years from 2018 to 2022. Results  The results indicated that almost a third of all Diwali-related burns were caused by diyas (32.5%). A "burning diya left on floor" was the main reason for these injuries. Females were the most affected (70.4%). Additionally, one-third of these patients required admission. Conclusion  This study emphasizes the need for raising awareness regarding the proper use of "diyas" to bring down the incidence of such preventable burn injuries.

Ocular Firework Injuries among Patients Presented to the Emergency Department During Festival Season in a Tertiary Eye Hospital

Introduction

Fireworks can cause severe ocular injuries which can be prevented if used with proper precautions. It causes not only mechanical injuries but also thermal and chemical injuries. This study aimed to find out the prevalence of ocular firework injuries among patients presented to the emergency department during festival season in a tertiary eye hospital.

Methods

This is a descriptive cross-sectional study done among patients presenting in the emergency department of a tertiary eye hospital after obtaining ethical approval from the Institutional Review Committee. Data of patients from medical records between 26 October 2021 to 28 November 2021 and 15 October 2022 to 17 November 2022 was collected. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 132 patients, the prevalence of ocular firework injuries was seen in 73 (55.30%) (46.82-63.78, 95% Confidence Interval). Closed globe injury was mostly observed in 56 (76.71%) patients with ocular injuries. The most common age group affected was those less than 30 years old 54 (73.97%).

Conclusions

The prevalence of ocular firework injuries was found to be lower than other studies done in similar settings. Protective measures should be used to prevent ocular injuries. A public awareness program needs to be launched before such festivals.

Keywords

festivals; injuries; prevalence.

Firecracker Powder: A Unique Source of Burn Injuries

Firecrackers are a common cause of burns in India; large-scale use of firecrackers is seen during the festival of Diwali, and patients of all age groups present with varying patterns of firecracker burns. With the recent ban of firecrackers in some parts of the country, we have noticed a new emerging cause of burns during Diwali where patients were attempting to prepare firecrackers at home using Gandhak (sulfur) and potash by mixing the materials in a pipe gun. Explosion of this powder leads to varying degree of burns, and this series reports 12 such cases who presented to a tertiary care burn unit in North India during the 2022 festival of Diwali.

Epidemiology and Treatment Outcome of Blast Injuries to the Hand at a Tertiary Hospital of Kashmir Valley, India

Background: Blast injuries to hand can have disastrous consequences on account of loss of critical hand functions. This study was conducted to study the epidemiology and outcome of hand blast injuries reporting to emergency department of a tertiary care hospital.

Materials and Methods: All the blast injuries to hand admitted at our center between 2016 and 2020 were assessed at the time of injury and at 6 weeks after completion of primary management. The severity of injury and functional outcome was assessed using modified hand injury severity score (HISS) and quick disabilities of the arm, shoulder and hand (QuickDASH) scale, respectively. Descriptive statistics was calculated and correlation between HISS and DASH was assessed using Pearson's correlation coefficient.

Results: A total of 26 cases with a mean age of 23.12 ± 9.1 years were included. The subjects included 25 males and 22 subjects had injury to their dominant hand. The grade of injury was severe in 12 (46.15%) cases followed by moderate in 5 (19.2%) cases and major in 5 (19.2%) cases. The mean HISS score at injury was 67.46 ± 37.6. The mean QuickDASH score at follow-up was 37.24 ± 29.7. QuickDASH score at follow-up had a significant correlation with HISS score at baseline with a Pearson's correlation coefficient of (r = 0.67, p = 0.0012)

Conclusions: Blast injuries to hands are primarily seen in young males with low-grade explosives being the primary source of injury. Dominant hand is most commonly involved with many cases needing revascularization procedures. Higher severity of blast injuries to hand is associated with poor outcome at follow-up.

Pediatric Open Globe Injuries Caused by Firecrackers in a Tertiary Eye Care Hospital in Iran

OBJECTIVE

The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population.

METHODS

In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching.

RESULTS

Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes.

CONCLUSIONS

The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.

Retrospective multifactorial analysis of ocular firecracker injuries and review of literature

Purpose

To analyse demographics, risk factors, clinical features, functional, anatomical outcomes, and prevalence of blindness in firecracker injury patients presenting to a tertiary eye care centre.

Methodology

A retrospective analysis of ocular firecracker injuries patients who presented to our hospital from April 2018 to March 2019 was performed. A total of 114 patients with a minimum follow-up of 3 months were included. The parameters recorded were demographics, mode of injury, type of cracker, baseline and last follow up best-corrected visual acuity (BCVA), anterior and posterior segment findings, seidel's test, intraocular pressure, gonioscopy, treatment, functional and anatomical outcomes. Investigations in form of B Scan, X-ray, or CT scan were undertaken whenever indicated.

Results

A total of 132 eyes of 114 patients were analysed. The mean (SD) age was 18.96 +/−15.4 years (range 3–71 years). Seventy-four (64.91%) patients were ≤ 18 years of age. The male-to-female ratio was 4:1. The ratio of right: left eye involvement was 1:1. Eighteen patients (15.79%) had bilateral involvement. A total of 125 eyes had closed globe injury, 7 eyes had open globe injury and 17 patients needed hospital admission for management. The mean (SD) baseline BCVA was 0.54(+/−0.75). The mean (SD) final BCVA improved to 0.23(+/−0.62) till the last follow-up. The final outcome was good in most patients, except 5 eyes (3.78%) which resulted in near/total blindness.

Conclusion

Firecracker injuries are a major cause of irreversible blindness, especially among the younger age group. Prompt diagnosis with meticulous management can prevent devastating sequelae.

Effect of legislation and changing trends of Diwali ocular firecracker injuries in Northern India

OBJECTIVE

The objective of this study is to study the impact of temporary legislation implemented during Diwali on ocular firecracker injuries in Delhi-National Capital Region (NCR) region.

MATERIALS AND METHODS

In this retrospective study, records of the patients presenting with ocular firecracker injury during 10 days of Diwali (prediwali, Diwali and 8 days postdiwali) from 2014 to 2019 were retreived from the medical record section. Clinico-demographic profile, relevant history pertaining to the use of firecracker, and details of eye examination, namely presenting visual acuity (VA), laterality and classification of injury based on Birmingham Eye Trauma Terminology System were noted.

RESULTS

Six hundred and sixty-seven eyes of 646 patients were recruited. The median age of patients was 14 years (R = 3-65 years) and male: Female ratio was 4.9:1. Majority of patients (57.7%; n = 373) were from outside Delhi. Most of them were open globe injuries (66.8%). In 55.4% (n = 356) eyes, presenting VA was perception of light to finger counting close to face and 28% (n = 180) eyes could not perceive any light. A significant reduction was noted in the number of ocular firecrcaker injuries after regulation (preregulation [2014-2016] n = 456; postregulation [2017-2019] n = 211; [P = 0.01, t-test]). During preregulation period, presenting VA was worse than 1/60 in significantly higher number of eyes (85.5%; n = 376) than post regulation (78.8%, n = 160) (P = 0.03, Chi-square test).

CONCLUSION

Although temporary legislation seems to be effective in reducing ocular firecracker injuries (52.7% reduction) in NCR, uniform implementation of stricter laws nationwide is essential to further minimize the problem.

Forensic investigative issues in a fireworks production factory explosion

Since their discovery in ancient China, fireworks rapidly spread throughout the world, where they have always been used to celebrate either popular or private events. Their use is nonetheless related to several risks, especially within production factories, since several injuries or even death can occur following an accidental ignition. In cases of major disasters related to fireworks explosions, stating the accidental or intentional nature of the event might prove challenging, thus raising the need of a multidisciplinary approach. In this regard, we here discuss the case of an accidental explosion that occurred in a fireworks production factory, accountable for five deaths and two hospitalisations.

Prevention of firecracker injuries via the digital platform: A Malaysian experience

INTRODUCTION

Health campaigns include physical campaigns in schools, community halls, or community malls. They can also be broadcast via television, newspaper, and radio. We launched a health campaign on social media platforms that have a powerful impact in this digital era.

METHODS

A three-dimensional short animation was developed for the Burn and Blast Injury Awareness campaign. It was launched during the fasting month and Eid 2020 when firecracker-related injuries are highly incident in Malaysia. The video was launched primarily on Universiti Sains Malaysia (USM) and Wau Animation Sdn Bhd social media platforms. Each party shared the video on the top 3 social media platforms, which are Facebook, Instagram, and YouTube. The numbers of viewers, reaches, and shares, and demographic data were captured at 1 month after the release.

RESULTS

We recorded 29,585 views, 60,920 reach, and 874 shares from the USM and Wau Animation platforms alone. The USM Facebook platform showed predominant female viewership (60%), whereas the Wau Facebook platform showed predominant male viewership (66%). In both platforms, the viewers were aged 18-34 years.

CONCLUSION

Health awareness campaigns on digital platforms are powerful because the message spreads faster, and it is also safe during the pandemic.

Personal exposures to particulate matter <2.5 μm in mass median aerodynamic diameter (PM2.5) pollution during the burning of six most commonly used firecrackers in India

Introduction:

Diwali or the festival of lights is the most popular festival celebrated in India when firecrackers are burnt by almost every household for 3 days. Levels of ambient air pollution are reported to be very high during the Diwali festival in India. In this study, we aimed to measure and compare the personal exposure levels to particulate matter <2.5 μm in mass median aerodynamic diameter (PM_2.5) during burning of six of the most commonly used firecracker types in India.

Methods:

Sparklers, ground spinners, flower pots, pulpuls, a garland of 1000 sounding crackers, and snake tablets were burnt outdoors in an open area during the late evening hours. Minute by minute PM_2.5 levels were measured at a distance and height from where they are normally burnt using Thermo pDR 1200, USA, and a set of five such experiments were conducted to examine the variability between the firecrackers.

Results:

When measured at a distance and height from where they are normally burnt, the burning of snake tablets produced the highest peak level of PM_2.5 (64,500 mcg/m³), followed by a garland of 1000 sounding crackers (38,540 mcg/m³), pulpuls (28,950 mcg/m³), sparklers (10,390 mcg/m³), ground spinners (9490 mcg/m³) and flower pots (4860 mcg/m³).

Conclusion:

Burning of firecrackers produce extremely high levels of personal exposure to PM_2.5 levels that are likely to have significant short-term and long-term adverse health effects. The initiative taken by the Supreme Court of India in 2017 to ban the sale of firecrackers seems to be a step in the right direction to reduce the adverse health impacts in the community.

Comparative evaluation of three methods of skin graft fixation for split thickness skin graft after release of post burn contracture of the neck

OBJECTIVES

Split thickness skin graft is an essential component of release of post burn contracture of neck. There are many methods of fixation of skin grafts; however, there is lack of objective comparison between different techniques. This study has been designed to compare three commonly used techniques of split thickness skin graft fixation methods. Surgical time, advantages, cost factor and post-operative outcome have been compared amongst three techniques.

METHODS

A randomized interventional comparative study was conducted to compare three methods of skin graft fixation in patients of 10-50 years age group, with contracture of more than 3 month duration having more than 100cm² skin defects after contracture release. Resurfacing of the defects after contracture release was carried out in all the groups using autologous split skin grafts. Patients were included in three groups; Group 1: tie over method, Group 2: skin stapler fixation and Group 3: Cyanoacrylate glue fixation.

RESULTS

Mean duration of fixation procedure was 34min in tie over group, in skin stapler group 7min and in cyanoacrylate group 12min. Mean cost of fixation material was 10.23 USD in tie-over group, 11.23 USD in stapler group and 40.06 USD in cyanoacrylate group. Mean score of pain/discomfort (visual analog score) on dressing removal in tie-over group was 3, for skin stapler group was 2.9 and that for cyanoacrylate glue group was 1.8. mean graft take was found to be 90.1% in tie-over group, 94.1% in skin stapler group & 93.8% in cyanoacrylate glue group. On logistic regression analysis, keeping all the variables constant in the groups the complications as the outcome variable, three groups are comparable. The need for regrafting remains inconclusive.

CONCLUSIONS

Skin stapler method for skin graft fixation was least time consuming, affordable and highly reliable when graft take success was considered. Cyanoacrylate glue fixation method was least painful and reliable in terms of graft take success though costlier than other two.

Injuries due to fireworks use: A surveillance data analysis in Colombia, 2008-2013

PURPOSE

To describe the injuries due to fireworks use in Colombia during the period 2008-2013 and to identify factors associated with hospitalization and death due to this cause.

METHODS

A descriptive study from surveillance data was carried out. Incidence rates and relative risks were calculated. The incidence rate trend was modeled with a joint point regression model. Multivariate logistical models were implemented to identify the associated factors with hospitalization and mortality due to firework injuries.

RESULTS

A total of 6585 people were reported to be injured by fireworks during the 2008-2013 period. An upward trend in the incidence rate during this period was observed, with an annual percentage of change of 28% (95% CI 27.7-28.3) during 2008-2011 and 3.5% (95% CI 3.0-3.9) during 2011-2013. The factors associated with hospitalization were injury occurrence at the workplace (odds ratio (OR) 2.62, 95% CI 1.97-3.47), storage (OR 2.40, 95% CI 1.54-3.73), transport (OR 1.63, 95% CI 1.20-2.21), multiple trauma (OR 1.49, 95% CI 1.31-1.70), and injury occurrence at home (OR 1.26, 95% CI 1.07-1.50). The factors associated with mortality were storage (OR 19.52, 95% CI 4.62-82.44), transport (OR 13.37, 95% CI 3.29-54.3), injury occurrence at the workplace (OR 4.88, 95% CI 1.69-14.13), and ethnicity (OR 3.37, 95% CI 1.12-10.12).

CONCLUSION

These results provided information for revising the public policies and intersectorial interventions to reduce the avoidable burden due to firework injuries at all times and not just during the high injury occurrence season.