Do we need a ban on firecrackers? Explosion injuries to hands caused by pyrotechnic objects during the turn of the year in Berlin/Brandenburg

Do we need a ban on firecrackers? 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Explosion injuries to hands caused by pyrotechnic objects during the turn of the year in Berlin/Brandenburg Frank Eichenauer, Stefan Pandura, Simon Kim, Axel Ekkernkamp, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3749135/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Fireworks carry a high risk for hand injuries. Methods: The study presents data of 146 patients hospitalized with hand injuries caused by fireworks during the turn of the years 2005 to 2023. Statistical data presented include number, age and sex, injury patterns and concomitant injuries. Results: The number of injured increased over the years with a significant increase in 2016 and incision during the COVID pandemic. Those affected were predominantly male. The age group between 19 and 36 years was the most represented, followed by elders between 37 and 65 years. Children and adolescents under 18 were affected in one-third of cases. Injury patterns included combinations of soft tissue lesions, open fractures and finger amputations. Concomitant injuries predominantly involved the head. One quarter of the patients showed post-traumatic stress disorder. Discussion: Hand injuries from fireworks often result in permanent physical integrity disorders. Posttraumatic stress disorder is often. The increasing number of cases may be due to structural changes in the rescue service and the level of awareness of a specialized facility, in addition to a fundamental increase in injuries. Most striking was the decline in numbers during the COVID pandemic. The immediate rebound after the end of the restrictions supports the consideration of a permanent ban. Orthopedic Surgery Plastic & Reconstructive Surgery Hand injuries explosion injuries pyrotechnic objects fireworks New Year's Eve Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction All over the world, firecrackers and fireworks are considered to bring good luck, especially on special occasions such as national holidays and new years. However, pyrotechnic objects can cause serious injuries, sometimes with devastating consequences for those affected. The debate about a ban has intensified in recent years. Fire and rescue service organizations have long warned of the increased risk of injury and fire caused by private fireworks displays. In addition to direct explosion and combustion damage to people, there is also material damage to public facilities, buildings and vehicles, enormous air pollution from fine dust, large quantities of waste, frightened pets and wild animals and much more. According to Directive 2013/29/EU, pyrotechnic articles are divided into categories F1 to F4 according to their intended use and potential hazard ( 1 ) (Supp. 1). Firecrackers and fireworks consist mainly of structural parts and packaging materials such as plastic, clay, wood, cardboard and paper. The pyrotechnic explosion kits, which mainly contain black powder, are responsible for the explosion (Supp. 2). Physically, an explosion results in the release of large amounts of energy in the form of temperature, pressure and kinetic energy in a very short time. Injuries are usually caused by the misuse or improper use of firecrackers and fireworks by re-igniting them or throwing them out of the hands after a delay. Malfunctions can lead to unexpectedly rapid or unintentional explosions. Illegal and non-certified or even home-made explosives often lead to particularly serious injuries. If pyrotechnics are directed at other people or used for demolition, uninvolved people are sometimes harmed. Alcohol and drug consumption contribute to risky use ( 2 – 4 ). Depending on the type of explosive and the exposed tissue, this results in thermo-mechanical combination injuries. High temperatures lead to burns down to deep tissue layers. The explosive change in pressure leads to tearing of the tissue, sometimes complete ruptures and tears, especially in the area of the upper extremities. Hands are particularly frequently affected due to their exposure. If the explosive device explodes in the immediate vicinity of the hands, injury is inevitable. In addition to burns and excoriations, fractures and dislocations, tendon, vascular and nerve injuries can occur, including amputations and mutilating destruction of the entire hand ( 5 – 8 ). Other exposed areas of the body are the face, eyes and ears. As the explosive pressure effect is particularly pronounced in air- and fluid-filled structures, barotrauma leads to ruptures of the eardrum and damage to the middle and inner ear. In addition to foreign body bursts, bulbus ruptures can occasionally be observed in the eyes. In the most severe cases, ruptures of hollow and parenchymal organs result. Inhaled combustion gases can cause inhalation trauma to the respiratory tract. Burns and foreign body injuries mark the entire body ( 4 ). The injuries often lead to permanent physical disability, have an impact on their ability to work or result in long-term incapacity to work. The consequences for individual lives, the healthcare system and society are considerable ( 9 ). The data situation on explosion injuries caused by pyrotechnic objects is weak in Germany. A retrospective analysis from the trauma register of the German Society for Trauma Surgery (DGU) was only able to identify 137 patients with explosion injuries for the period from 1993 to 2011 ( 10 ). The average number of patients with eye injuries caused by fireworks at the turn of the year before the COVID pandemic was 500 ( 11 ). According to an extrapolation by ENT doctors from 2001, more than 8,000 patients suffer inner ear injuries from fireworks at the turn of the year ( 12 ). In the USA, 10,500 patients were treated for injuries caused by firecrackers and fireworks in one year. Men were more frequently affected and the average age was under 20. The hands and face were predominantly injured ( 4 ). Since 2023, an implementing decision of the European Parliament and of the Council lays down practical arrangements for the collection and updating of data on accidents involving pyrotechnic articles in order to maintain and assess the lawful and safe use of pyrotechnic articles ( 13 ). During the COVID pandemic, a temporary ban on the sale of category 2 firecrackers and fireworks was introduced in Germany at the turn of the years 2020/2021 and 2021/2022, in addition to a ban on gatherings, with the aim of protecting hospitals affected by the pandemic from being overloaded ( 14 ). Some countries already have stricter rules for New Year's Eve fireworks. In Sweden, for example, New Year's Eve rockets may only be sold to people with a special permit. In France, the purchase, possession and setting off of fireworks is prohibited in many places. In Australia and Greece, there is a complete ban on private fireworks displays. In Ireland, only sparklers and table fireworks are permitted ( 15 ). Both the extraordinary medical challenge of explosion injuries and the political discourse on a ban on firecrackers and fireworks justify the need for this study. The aim of the work is to evaluate the epidemiological distribution of explosion injuries in the Berlin/Brandenburg region at the time of the turn of the year in the period from 2005 to 2023. The data obtained should contribute to the discussion on potential influencing factors and prevention measures for explosion injuries caused by pyrotechnic objects. 2. Methods This is a retrospective study of all patients with blast injuries who were treated as inpatients in the Department of Hand, Replantation and Microsurgery at the BG Klinikum Unfallkrankenhaus Berlin on days at the turn of the year from December 30 to January 2 in the period from 2005 to 2023. Epidemiological and clinical parameters, including data on the extent of injury and the course of treatment, were recorded from the recruited patient files. The data was analyzed with Microsoft Excel and statistically with SPSS from IBM. The study was approved by the Ethics Committee of the University Medical Center Greifswald (Internal Reg. No.: BB 164/21). 3. Results At the BG Klinikum Unfallkrankenhaus Berlin, a total of 146 patients with injuries to the hands caused by pyrotechnic objects were treated in the Department of Hand, Replantation and Microsurgery between December 30 and January 2 of each year from 2005 to 2023. The number of patients treated for blast injuries to the hands rose on average over the observation period. There was an abrupt drop in the number of patients at the turn of the year 2020/2021 and 2021/2022. While there were 15 patients with blast injuries in 2018/2019, only 3 patients were treated surgically at the turn of 2021/2022. At the turn of 2022/2023, the number of patients rose again to 12. The reason for this development is likely to be the regulations (sales and assembly bans) during the COVID pandemic. ( Diagram 1 ). The age group between 19 and 36 years represented the largest proportion of all inpatients at 46%, followed by the age group over 36 years at 22%. Children between the ages of 0 and 12 accounted for 16%, while adolescents between the ages of 13 and 18 also represented 16%. The youngest patient was 6 years old. The oldest patient was 65 years old. ( Diagram 2 ). Children and young people under the age of 18 were more frequently injured on January 1 and 2. The high injury rate of children and adolescents on the days following New Year's Eve suggests that they set off unexploded firecrackers and fireworks ("duds") from New Year's Eve. Setting off previously unexploded firecrackers and fireworks seems particularly dangerous, as they can explode unexpectedly quickly if the fuse is partially lit, for example. The proportion of men averaged 97% over the observation period. The proportion of women was 3%. The overrepresentation of men suggests that men use firecrackers and fireworks more frequently, are more prone to risky behavior when lighting them than women and that alcohol consumption plays a major role. The proportion of soft skin injuries such as burns, lacerations or avulsions was the indication for surgical treatment in only 19% of cases. Open fractures had to be treated in 80% of all patients treated. In 46% of these cases, fractures occurred on several finger rays. Partial amputations of the fingers were present in 45% of the injuries treated. Complete amputations of the fingers or thumb were observed in 10% of all cases. 7% of patients suffered simultaneous amputations of several finger rays. In one patient, the explosion resulted in the amputation of the entire hand. A regularly observed injury is the separation of the thumb from the metacarpal. The explosion of an explosive device held in the fist results in stereotypical injury patterns, with tearing of the muscles of the thumb, dislocations and fractures along the first ray and occasionally complete avulsion of the thumb. This injury was observed in 12% of the patients treated. Separation of the metacarpal, i.e. between two of the other four rays of the hand, was present in only 3% of cases. ( Diagram 3 ) Regardless of the structural damage, the radial finger rays were primarily affected. The thumb was involved in 79%, the index finger in 77% and the middle finger in 78% of all blast injuries. The ring finger was injured significantly less frequently at 56% and the little finger at 41%. These conspicuous distribution patterns are consistent with the observations of other studies and can be attributed to the holding position of the firecracker or firework in the hand during the explosion ( 6 , 8 , 16 ). Explosion-associated concomitant injuries predominate on the head not covered by clothing. The face was injured in 12% of cases, the eyes in 9% and the ears in 29%. As part of the severe traumatization caused by the event, 23% of patients were diagnosed and treated for post-traumatic stress disorder during their inpatient stay. The high number of post-traumatic stress disorders indicates the psychological component of the acute injury and the foreseeable permanent consequences of the injury. ( Diagram 4 ) The inpatient stay of the patients was between 1 and 52 days, with a median of 9.43 days. In 64% of all cases, the primary operation resulted in definitive treatment of the injury. Revision operations were necessary in 36% of cases. Secondary reconstructive procedures including bone grafting and/or microsurgical soft tissue reconstruction were performed for the most severe injuries. One patient required 12 operations until all injuries were definitively treated. Replantation of detached hand parts was only possible in 8 patients. In most cases, a complete amputation and stump formation of the hand area had to be performed due to the considerable soft tissue damage. During inpatient treatment, the patients benefited from intensive hand therapy in addition to antibiotic shielding and painkillers. The number of patients treated as outpatients in the emergency department of the BG Klinikum Unfallkrankenhaus Berlin with minor explosion injuries to the hands and all other parts of the body during the period under consideration was many times higher than the number treated as inpatients and was not included in the study presented. 4. Discussion The retrospective investigation shows that injuries caused by pyrotechnic objects can sometimes cause extremely serious physical damage. In addition to injuries to the hands, the ears, face and eyes were particularly affected by the explosion. Post-traumatic stress disorders were just as common. These findings are consistent with data from other studies studies ( 9 , 17 ). The number of explosion injuries treated rose continuously during the observation period, fell at the turn of 2020/2021 and 2021/2022 and returned to the pre-COVID pandemic level at the turn of 2022/2023. The deviations are partly due to different weather conditions at the turn of the year, but in the coronavirus years they are certainly due to the regulations introduced. It is not possible to determine from the data collected whether the increase in case numbers can be explained by a general increase in injuries or whether there was a shift due to the supra-regional level of awareness and expertise of the hospital. Young men in particular were affected by the explosion injuries, which appears to be due to risky and reckless behavior when handling firecrackers and fireworks. Children and young people accounted for a third of all injuries and appear to underestimate the danger of firecrackers and fireworks. The injuries often resulted in irreversible and permanent disabilities of the hands due to amputations or functional limitations, such as reduced finger mobility and reduced sensitivity. In addition to these physical consequences of the explosion, post-traumatic psychological disorders are of major importance for children and their parents, as well as all other affected persons ( 17 ). The number of patients injured by pyrotechnic objects must be assumed to be many times higher, as this study focused on hand surgery patients who were admitted as inpatients as part of their injuries and necessary operations. Patients treated as outpatients or those who were assigned to another specialty were not included. Fire departments and rescue service organizations are complaining about a massive increase in call-outs in urban areas. In the years of the sales ban, the number of casualties fell significantly. While the Berlin fire department was called out 1523 times at the turn of the year 2019/2020, there were only 862 emergency and fire operations in 2020/2021. The turn of the year 2022/2023, on the other hand, required a record 1717 deployments ( 18 ). Particulate matter pollution on New Year's Eve was at hourly values of up to 1000 µg/m³ in major cities, while the EU Commission set the limit value for particulate matter at a daily average of 50 µg/m³. At the turn of the year 2021/2022, particulate matter pollution fell by over 90% in some cases compared to previous years ( 19 , 20 ). Firecrackers and fireworks leave behind huge amounts of waste. The remains of fireworks end up on green spaces, in bodies of water or in wooded areas, where they can either not be disposed of at all or only incompletely. In addition to the vast quantities of plastic, cardboard and paper, the heavy metals they contain are particularly problematic. In 2019 alone, over 43,000 tons of fireworks were sold and blown up ( 19 , 21 ). Associations such as Deutsche Umwelthilfe and the police union are calling for a general ban on private firecrackers and fireworks throughout Germany. Sales and firework bans at the turn of the year should not remain an isolated case ( 22 ). In a representative survey commissioned by the Brandenburg consumer advice center, 53% of respondents voted for a ban, while only 39% were against it ( 23 ). The results of the study, along with other studies, confirm the assumption that a sales ban can reduce the number of injuries caused by pyrotechnic articles ( 11 ). What are the arguments against a general ban on the private purchase and use of firecrackers and fireworks? Wouldn't a Europe-wide regulation even be desirable? Instead of the dangerous "firecrackers" of each individual, professional fireworks only pose a low risk of explosion injuries and fire damage. Light and laser shows are becoming increasingly popular as an environmentally friendly alternative to fireworks. Until then, appeals for responsible handling and targeted education remain the only measures to prevent damage and injuries caused by pyrotechnic objects. Taking into account that it is primarily adolescents and young adults who injure themselves, education should take place regularly in schools and educational institutions. Awareness campaigns such as the German Society for Hand Surgery's initiative "Celebrating New Year's Eve without hand injuries - a guide to safe fireworks" or the Federal Institute for Materials Research and Testing's "Safe New Year's Eve fireworks: recognizing dangers and avoiding accidents" provide appropriate material (Supp. 3). However, if an injury is caused by firecrackers or fireworks, patients should be treated at hospitals with multidisciplinary expertise, including hand surgery, ophthalmology, ENT and psychotraumatology. Traditions and celebrating special moments such as the turn of the year are part of our lives and should remain so. Every individual can make a contribution to reducing the risk of fire and injury, particulate pollution and noise, as well as the costs to society as a whole of firecrackers and fireworks. Declarations Competing interests: The authors declare no competing interests. References European Union: Directive 2013/29/EU of the European Parliament and of the Council of 12 June 2013 on the harmonization of the laws of the Member States relating to the making available on the market of pyrotechnic articles (recast): 2013/29/EU 2013. van Yperen DT, van Lieshout EMM, Dijkshoorn JN, van der Vlies CH, Verhofstad MHJ: Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study. Scand J Trauma Resusc Emerg Med 2021; 29(1): 11. Ortiz R, Ozkan S, Chen NC, Eberlin KR: Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization. Hand (New York, N,Y.) 2020; 15(6): 831-6. Jacobson L, Sandvall BK, Quistberg DA, et al: Severe Fireworks-Related Injuries: Demographic Characteristics, Injury Patterns, and Firework Types in 294 Consecutive Patients. Pediatr Emerg Care 2021; 37(1): e32-e36. Giessler GA, Leopold A, Germann G, Heitmann C: Blast injuries of the hands. Injury patterns and plastic surgery therapy. Trauma Surgeon 2006; 109(11): 956-63. Adhikari S, Bandyopadhyay T, Sarkar T, Saha JK: Blast injuries to the hand: Pathomechanics, patterns and treatment. J Emerg Trauma Shock 2013; 6(1): 29-36. Saucedo JM, Vedder NB: Firework-related injuries of the hand. J Hand Surg Am 2015; 40(2): 383-7; quiz 387. Sandvall BK, Keys KA, Friedrich JB: Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types. J Hand Surg Am 2017; 42(5): 385.e1-385.e8. van Yperen DT, van der Vlies CH, Faber JTHN de, et al: Epidemiology, treatment, costs, and long-term outcomes of patients with fireworks-related injuries (ROCKET); a multicenter prospective observational case series. PLoS One 2020; 15(3): e0230382. Kulla M, Maier J, Bieler D, et al.: Civilian blast trauma - an underestimated problem? Results of a retrospective analysis from the TraumaRegister DGU®. Trauma Surgeon 2016; 119(10): 843-53. Gabel-Pfisterer A, Böhringer D, Agostini H: Pandemic-related ban on the sale of fireworks in Germany leads to a significant decrease in eye injuries. Ophthalmology 2022; 119(12): 1257-66. Plontke SK-R, Dietz K, Pfeffer C, Zenner H-P: The incidence of acoustic trauma due to New Year's firecrackers. Eur Arch Otorhinolaryngol 2002; 259(5): 247-52. EU Commission: Commission Implementing Decision (EU) 2023/1096 of June 2, 2023 2023. Federal Ministry of the Interior and for Home Affairs: Press release "2021 no sale of New Year's Eve fireworks" 2021. RND/hyd: Debate on firecracker ban: Private fireworks are already banned in these countries. https://www.rnd.de/panorama/boellerverbot-in-diesen-laendern-ist-das-private-feuerwerk-untersagt-DEXVJ7U6URE55J3MOUCI4NVS7A.html (last accessed on September 18, 2023). Hazani R, Buntic RF, Brooks D: Patterns in blast injuries to the hand. Hand (New York, N,Y.) 2009; 4(1): 44-9. Smith GA, Knapp JF, Barnett TM, Shields BJ: The rockets' red glare, the bombs bursting in air: fireworks-related injuries to children. Pediatrics 1996; 98(1): 1-9. Berliner Feuerwehr: Silvesterbilanz der Berliner Feuerwehr. http://www.feuerwehr.de/einsatz/berichte/einsatz.php?n=67889 (last accessed on September 18, 2023). Ute Dauert, Wolfgang Straff, Holger Gerwig, Thomas Myck, David Kuntze: Zum Jahreswechsel: Wenn die Luft "zum Schneiden" ist. https://www.umweltbundesamt.de/sites/default/files/medien/479/publikationen/hgp_wenn_die_luft_zum_schneiden_ist_2019.pdf (last accessed on September 18, 2023). Federal Environment Agency: Particulate matter from New Year's Eve fireworks 2022. Deutsche Umwelthilfe e.V.: On new paths into the new year: #BÖLLERCIAO. https://www.duh.de/projekte/mitmach-aktion-silvester/ (last accessed on September 18, 2023). Deutsche Umwelthilfe e.V.: Deutsche Umwelthilfe draws a bitter balance: Even worse New Year's Eve than feared, up to 9 times higher air pollution, millions of people and animals to suffer in 2023. Verbraucherzentrale Brandenburg e.V.: Majority across Germany in favor of ban on private fireworks on New Year's Eve 2022. Federal Ministry of the Interior and for Home Affairs: Fireworks at the turn of the year: Celebrate New Year's Eve safely 2022. Bundesanstalt für Materialforschung und -prüfung BAM: FAQs für ein sicheres Silvester: Sicherheitshinweise für Silvesterfeuerwerk. https://www.bam.de/Navigation/DE/Aktuelles/Silvester/silvester.html (last accessed on September 18, 2023) . Supplement Supplement 1 Categories F1 - F4 of fireworks Fireworks in category F1 (firecrackers, firecrackers, table fireworks, sparklers, party firecrackers) may only be issued to persons aged 12 and over throughout the year. Firing is permitted all year round. Firecrackers and fireworks in category F2 (rockets, batteries, Roman lights, firecrackers, composite fireworks) may only be released from December 29 to 31 to persons aged 18 and over. Fireworks in categories F3 and F4 are (semi-)professional fireworks and may only be used by trained pyrotechnicians. The setting off of fireworks is restricted to December 31st and January 1st. An exemption permit is required on other days. The handling of non-certified and non-CE-marked pyrotechnic articles constitutes a criminal offense ( 24 ) Supplement 2 Black powder Black powder is essentially made up of three components: potassium nitrate (saltpetre), sulphur and coal. During the combustion process, the coal burns off to form carbon dioxide. The resulting heat causes sulphur to react with potassium nitrate, producing potassium sulphate, potassium sulphide and potassium carbonate as well as nitrogen. The chemical reaction and the energy released results in an enormous increase in temperature. In addition, the rapid release of carbon dioxide and nitrogen leads to a massive expansion in volume and acceleration of the surrounding matter - ultimately to an explosion ( 19 ). Supplement 3 Safety instructions for New Year's Eve fireworks ( 25 ): Only buy firecrackers and fireworks from specialist retailers with the CE mark and BAM test number Never use homemade explosives or manipulated fireworks, as these are life-threatening for yourself and others Read the instructions for use and safety information calmly and with a clear mind before setting off firecrackers and fireworks Observe safety distances (category F1: 1 m, category F2: 8 m) Never carry firecrackers or fireworks on your person! It is best to store them closed and at a safe distance from matches or lighters and not in jackets or trouser pockets Only launch fireworks vertically upwards from a suitable outdoor area or the street, not at an angle or from a balcony Firecrackers are taboo for children and young people: Young people are particularly frequently affected by serious injuries caused by fireworks. Firecrackers and fireworks that have not exploded should never be set off again - it is better to clear them away and dispose of them to protect them from children If alcohol is involved: keep your hands off fireworks. Alcohol makes you careless. Never direct firecrackers and fireworks at people or animals Supplementary Files Supplement.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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observed period\u003c/p\u003e","description":"","filename":"Diagram3.png","url":"https://assets-eu.researchsquare.com/files/rs-3749135/v1/edd39e27349e89a30e5f6202.png"},{"id":48461879,"identity":"f6bf2ba2-bd52-4914-9f83-fb8b0b95a319","added_by":"auto","created_at":"2023-12-19 13:42:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":33897,"visible":true,"origin":"","legend":"\u003cp\u003eThe number of sequelae of injuries over the observed period\u003c/p\u003e","description":"","filename":"Diagram4.png","url":"https://assets-eu.researchsquare.com/files/rs-3749135/v1/b7fedbd2b3fac12f6a5a148c.png"},{"id":48462931,"identity":"46dcad99-0e72-4257-ad71-8d11d026fa82","added_by":"auto","created_at":"2023-12-19 13:50:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":473150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3749135/v1/ba5845ae-d657-4aa2-9351-38e4d51771fc.pdf"},{"id":48461157,"identity":"06572a62-3074-4d20-a342-2a81c066f5b5","added_by":"auto","created_at":"2023-12-19 13:34:13","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29664,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-3749135/v1/21c8ac66b39eab16a32c0775.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eDo we need a ban on firecrackers? Explosion injuries to hands caused by pyrotechnic objects during the turn of the year in Berlin/Brandenburg\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAll over the world, firecrackers and fireworks are considered to bring good luck, especially on special occasions such as national holidays and new years. However, pyrotechnic objects can cause serious injuries, sometimes with devastating consequences for those affected.\u003c/p\u003e \u003cp\u003eThe debate about a ban has intensified in recent years. Fire and rescue service organizations have long warned of the increased risk of injury and fire caused by private fireworks displays. In addition to direct explosion and combustion damage to people, there is also material damage to public facilities, buildings and vehicles, enormous air pollution from fine dust, large quantities of waste, frightened pets and wild animals and much more.\u003c/p\u003e \u003cp\u003eAccording to Directive 2013/29/EU, pyrotechnic articles are divided into categories F1 to F4 according to their intended use and potential hazard (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) (Supp.\u0026nbsp;1). Firecrackers and fireworks consist mainly of structural parts and packaging materials such as plastic, clay, wood, cardboard and paper. The pyrotechnic explosion kits, which mainly contain black powder, are responsible for the explosion (Supp.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003ePhysically, an explosion results in the release of large amounts of energy in the form of temperature, pressure and kinetic energy in a very short time.\u003c/p\u003e \u003cp\u003eInjuries are usually caused by the misuse or improper use of firecrackers and fireworks by re-igniting them or throwing them out of the hands after a delay. Malfunctions can lead to unexpectedly rapid or unintentional explosions. Illegal and non-certified or even home-made explosives often lead to particularly serious injuries. If pyrotechnics are directed at other people or used for demolition, uninvolved people are sometimes harmed. Alcohol and drug consumption contribute to risky use (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDepending on the type of explosive and the exposed tissue, this results in thermo-mechanical combination injuries. High temperatures lead to burns down to deep tissue layers. The explosive change in pressure leads to tearing of the tissue, sometimes complete ruptures and tears, especially in the area of the upper extremities.\u003c/p\u003e \u003cp\u003eHands are particularly frequently affected due to their exposure. If the explosive device explodes in the immediate vicinity of the hands, injury is inevitable. In addition to burns and excoriations, fractures and dislocations, tendon, vascular and nerve injuries can occur, including amputations and mutilating destruction of the entire hand (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOther exposed areas of the body are the face, eyes and ears. As the explosive pressure effect is particularly pronounced in air- and fluid-filled structures, barotrauma leads to ruptures of the eardrum and damage to the middle and inner ear. In addition to foreign body bursts, bulbus ruptures can occasionally be observed in the eyes. In the most severe cases, ruptures of hollow and parenchymal organs result. Inhaled combustion gases can cause inhalation trauma to the respiratory tract. Burns and foreign body injuries mark the entire body (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe injuries often lead to permanent physical disability, have an impact on their ability to work or result in long-term incapacity to work. The consequences for individual lives, the healthcare system and society are considerable (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe data situation on explosion injuries caused by pyrotechnic objects is weak in Germany. A retrospective analysis from the trauma register of the German Society for Trauma Surgery (DGU) was only able to identify 137 patients with explosion injuries for the period from 1993 to 2011 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The average number of patients with eye injuries caused by fireworks at the turn of the year before the COVID pandemic was 500 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). According to an extrapolation by ENT doctors from 2001, more than 8,000 patients suffer inner ear injuries from fireworks at the turn of the year (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the USA, 10,500 patients were treated for injuries caused by firecrackers and fireworks in one year. Men were more frequently affected and the average age was under 20. The hands and face were predominantly injured (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince 2023, an implementing decision of the European Parliament and of the Council lays down practical arrangements for the collection and updating of data on accidents involving pyrotechnic articles in order to maintain and assess the lawful and safe use of pyrotechnic articles (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring the COVID pandemic, a temporary ban on the sale of category 2 firecrackers and fireworks was introduced in Germany at the turn of the years 2020/2021 and 2021/2022, in addition to a ban on gatherings, with the aim of protecting hospitals affected by the pandemic from being overloaded (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome countries already have stricter rules for New Year's Eve fireworks. In Sweden, for example, New Year's Eve rockets may only be sold to people with a special permit. In France, the purchase, possession and setting off of fireworks is prohibited in many places. In Australia and Greece, there is a complete ban on private fireworks displays. In Ireland, only sparklers and table fireworks are permitted (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBoth the extraordinary medical challenge of explosion injuries and the political discourse on a ban on firecrackers and fireworks justify the need for this study.\u003c/p\u003e \u003cp\u003eThe aim of the work is to evaluate the epidemiological distribution of explosion injuries in the Berlin/Brandenburg region at the time of the turn of the year in the period from 2005 to 2023. The data obtained should contribute to the discussion on potential influencing factors and prevention measures for explosion injuries caused by pyrotechnic objects.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis is a retrospective study of all patients with blast injuries who were treated as inpatients in the Department of Hand, Replantation and Microsurgery at the BG Klinikum Unfallkrankenhaus Berlin on days at the turn of the year from December 30 to January 2 in the period from 2005 to 2023.\u003c/p\u003e \u003cp\u003eEpidemiological and clinical parameters, including data on the extent of injury and the course of treatment, were recorded from the recruited patient files.\u003c/p\u003e \u003cp\u003eThe data was analyzed with Microsoft Excel and statistically with SPSS from IBM.\u003c/p\u003e \u003cp\u003e The study was approved by the Ethics Committee of the University Medical Center Greifswald (Internal Reg. No.: BB 164/21).\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eAt the BG Klinikum Unfallkrankenhaus Berlin, a total of 146 patients with injuries to the hands caused by pyrotechnic objects were treated in the Department of Hand, Replantation and Microsurgery between December 30 and January 2 of each year from 2005 to 2023.\u003c/p\u003e \u003cp\u003eThe number of patients treated for blast injuries to the hands rose on average over the observation period. There was an abrupt drop in the number of patients at the turn of the year 2020/2021 and 2021/2022.\u003c/p\u003e \u003cp\u003eWhile there were 15 patients with blast injuries in 2018/2019, only 3 patients were treated surgically at the turn of 2021/2022. At the turn of 2022/2023, the number of patients rose again to 12. The reason for this development is likely to be the regulations (sales and assembly bans) during the COVID pandemic. (\u003cem\u003eDiagram 1\u003c/em\u003e).\u003c/p\u003e \u003cp\u003eThe age group between 19 and 36 years represented the largest proportion of all inpatients at 46%, followed by the age group over 36 years at 22%. Children between the ages of 0 and 12 accounted for 16%, while adolescents between the ages of 13 and 18 also represented 16%. The youngest patient was 6 years old. The oldest patient was 65 years old.\u003c/p\u003e \u003cp\u003e(\u003cem\u003eDiagram 2\u003c/em\u003e).\u003c/p\u003e \u003cp\u003eChildren and young people under the age of 18 were more frequently injured on January 1 and 2. The high injury rate of children and adolescents on the days following New Year's Eve suggests that they set off unexploded firecrackers and fireworks (\"duds\") from New Year's Eve. Setting off previously unexploded firecrackers and fireworks seems particularly dangerous, as they can explode unexpectedly quickly if the fuse is partially lit, for example.\u003c/p\u003e \u003cp\u003eThe proportion of men averaged 97% over the observation period. The proportion of women was 3%. The overrepresentation of men suggests that men use firecrackers and fireworks more frequently, are more prone to risky behavior when lighting them than women and that alcohol consumption plays a major role.\u003c/p\u003e \u003cp\u003eThe proportion of soft skin injuries such as burns, lacerations or avulsions was the indication for surgical treatment in only 19% of cases.\u003c/p\u003e \u003cp\u003eOpen fractures had to be treated in 80% of all patients treated. In 46% of these cases, fractures occurred on several finger rays.\u003c/p\u003e \u003cp\u003ePartial amputations of the fingers were present in 45% of the injuries treated. Complete amputations of the fingers or thumb were observed in 10% of all cases. 7% of patients suffered simultaneous amputations of several finger rays. In one patient, the explosion resulted in the amputation of the entire hand.\u003c/p\u003e \u003cp\u003eA regularly observed injury is the separation of the thumb from the metacarpal. The explosion of an explosive device held in the fist results in stereotypical injury patterns, with tearing of the muscles of the thumb, dislocations and fractures along the first ray and occasionally complete avulsion of the thumb. This injury was observed in 12% of the patients treated. Separation of the metacarpal, i.e. between two of the other four rays of the hand, was present in only 3% of cases.\u003c/p\u003e \u003cp\u003e(\u003cem\u003eDiagram 3\u003c/em\u003e)\u003c/p\u003e \u003cp\u003eRegardless of the structural damage, the radial finger rays were primarily affected. The thumb was involved in 79%, the index finger in 77% and the middle finger in 78% of all blast injuries. The ring finger was injured significantly less frequently at 56% and the little finger at 41%.\u003c/p\u003e \u003cp\u003eThese conspicuous distribution patterns are consistent with the observations of other studies and can be attributed to the holding position of the firecracker or firework in the hand during the explosion (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eExplosion-associated concomitant injuries predominate on the head not covered by clothing. The face was injured in 12% of cases, the eyes in 9% and the ears in 29%.\u003c/p\u003e \u003cp\u003eAs part of the severe traumatization caused by the event, 23% of patients were diagnosed and treated for post-traumatic stress disorder during their inpatient stay.\u003c/p\u003e \u003cp\u003eThe high number of post-traumatic stress disorders indicates the psychological component of the acute injury and the foreseeable permanent consequences of the injury.\u003c/p\u003e \u003cp\u003e(\u003cem\u003eDiagram 4\u003c/em\u003e)\u003c/p\u003e \u003cp\u003eThe inpatient stay of the patients was between 1 and 52 days, with a median of 9.43 days. In 64% of all cases, the primary operation resulted in definitive treatment of the injury. Revision operations were necessary in 36% of cases.\u003c/p\u003e \u003cp\u003eSecondary reconstructive procedures including bone grafting and/or microsurgical soft tissue reconstruction were performed for the most severe injuries. One patient required 12 operations until all injuries were definitively treated. Replantation of detached hand parts was only possible in 8 patients. In most cases, a complete amputation and stump formation of the hand area had to be performed due to the considerable soft tissue damage.\u003c/p\u003e \u003cp\u003eDuring inpatient treatment, the patients benefited from intensive hand therapy in addition to antibiotic shielding and painkillers.\u003c/p\u003e \u003cp\u003eThe number of patients treated as outpatients in the emergency department of the BG Klinikum Unfallkrankenhaus Berlin with minor explosion injuries to the hands and all other parts of the body during the period under consideration was many times higher than the number treated as inpatients and was not included in the study presented.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe retrospective investigation shows that injuries caused by pyrotechnic objects can sometimes cause extremely serious physical damage. In addition to injuries to the hands, the ears, face and eyes were particularly affected by the explosion. Post-traumatic stress disorders were just as common. These findings are consistent with data from other studies studies (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe number of explosion injuries treated rose continuously during the observation period, fell at the turn of 2020/2021 and 2021/2022 and returned to the pre-COVID pandemic level at the turn of 2022/2023. The deviations are partly due to different weather conditions at the turn of the year, but in the coronavirus years they are certainly due to the regulations introduced. It is not possible to determine from the data collected whether the increase in case numbers can be explained by a general increase in injuries or whether there was a shift due to the supra-regional level of awareness and expertise of the hospital.\u003c/p\u003e\n\u003cp\u003eYoung men in particular were affected by the explosion injuries, which appears to be due to risky and reckless behavior when handling firecrackers and fireworks.\u003c/p\u003e\n\u003cp\u003eChildren and young people accounted for a third of all injuries and appear to underestimate the danger of firecrackers and fireworks.\u003c/p\u003e\n\u003cp\u003eThe injuries often resulted in irreversible and permanent disabilities of the hands due to amputations or functional limitations, such as reduced finger mobility and reduced sensitivity.\u003c/p\u003e\n\u003cp\u003eIn addition to these physical consequences of the explosion, post-traumatic psychological disorders are of major importance for children and their parents, as well as all other affected persons (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe number of patients injured by pyrotechnic objects must be assumed to be many times higher, as this study focused on hand surgery patients who were admitted as inpatients as part of their injuries and necessary operations. Patients treated as outpatients or those who were assigned to another specialty were not included.\u003c/p\u003e\n\u003cp\u003eFire departments and rescue service organizations are complaining about a massive increase in call-outs in urban areas. In the years of the sales ban, the number of casualties fell significantly. While the Berlin fire department was called out 1523 times at the turn of the year 2019/2020, there were only 862 emergency and fire operations in 2020/2021. The turn of the year 2022/2023, on the other hand, required a record 1717 deployments (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eParticulate matter pollution on New Year's Eve was at hourly values of up to 1000 \u0026micro;g/m\u0026sup3; in major cities, while the EU Commission set the limit value for particulate matter at a daily average of 50 \u0026micro;g/m\u0026sup3;. At the turn of the year 2021/2022, particulate matter pollution fell by over 90% in some cases compared to previous years (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFirecrackers and fireworks leave behind huge amounts of waste. The remains of fireworks end up on green spaces, in bodies of water or in wooded areas, where they can either not be disposed of at all or only incompletely. In addition to the vast quantities of plastic, cardboard and paper, the heavy metals they contain are particularly problematic. In 2019 alone, over 43,000 tons of fireworks were sold and blown up (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAssociations such as Deutsche Umwelthilfe and the police union are calling for a general ban on private firecrackers and fireworks throughout Germany. Sales and firework bans at the turn of the year should not remain an isolated case (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn a representative survey commissioned by the Brandenburg consumer advice center, 53% of respondents voted for a ban, while only 39% were against it (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe results of the study, along with other studies, confirm the assumption that a sales ban can reduce the number of injuries caused by pyrotechnic articles (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eWhat are the arguments against a general ban on the private purchase and use of firecrackers and fireworks?\u003c/p\u003e\n\u003cp\u003eWouldn't a Europe-wide regulation even be desirable?\u003c/p\u003e\n\u003cp\u003eInstead of the dangerous \"firecrackers\" of each individual, professional fireworks only pose a low risk of explosion injuries and fire damage. Light and laser shows are becoming increasingly popular as an environmentally friendly alternative to fireworks.\u003c/p\u003e\n\u003cp\u003eUntil then, appeals for responsible handling and targeted education remain the only measures to prevent damage and injuries caused by pyrotechnic objects.\u003c/p\u003e\n\u003cp\u003eTaking into account that it is primarily adolescents and young adults who injure themselves, education should take place regularly in schools and educational institutions. Awareness campaigns such as the German Society for Hand Surgery's initiative \"Celebrating New Year's Eve without hand injuries - a guide to safe fireworks\" or the Federal Institute for Materials Research and Testing's \"Safe New Year's Eve fireworks: recognizing dangers and avoiding accidents\" provide appropriate material (Supp.\u0026nbsp;3).\u003c/p\u003e\n\u003cp\u003eHowever, if an injury is caused by firecrackers or fireworks, patients should be treated at hospitals with multidisciplinary expertise, including hand surgery, ophthalmology, ENT and psychotraumatology.\u003c/p\u003e\n\u003cp\u003eTraditions and celebrating special moments such as the turn of the year are part of our lives and should remain so. Every individual can make a contribution to reducing the risk of fire and injury, particulate pollution and noise, as well as the costs to society as a whole of firecrackers and fireworks.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompeting interests: The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEuropean Union: Directive 2013/29/EU of the European Parliament and of the Council of 12 June 2013 on the harmonization of the laws of the Member States relating to the making available on the market of pyrotechnic articles (recast): 2013/29/EU 2013.\u003c/li\u003e\n\u003cli\u003evan Yperen DT, van Lieshout EMM, Dijkshoorn JN, van der Vlies CH, Verhofstad MHJ: Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study. Scand J Trauma Resusc Emerg Med 2021; 29(1): 11.\u003c/li\u003e\n\u003cli\u003eOrtiz R, Ozkan S, Chen NC, Eberlin KR: Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization. Hand (New York, N,Y.) 2020; 15(6): 831-6.\u003c/li\u003e\n\u003cli\u003eJacobson L, Sandvall BK, Quistberg DA, et al: Severe Fireworks-Related Injuries: Demographic Characteristics, Injury Patterns, and Firework Types in 294 Consecutive Patients. Pediatr Emerg Care 2021; 37(1): e32-e36.\u003c/li\u003e\n\u003cli\u003eGiessler GA, Leopold A, Germann G, Heitmann C: Blast injuries of the hands. Injury patterns and plastic surgery therapy. Trauma Surgeon 2006; 109(11): 956-63.\u003c/li\u003e\n\u003cli\u003eAdhikari S, Bandyopadhyay T, Sarkar T, Saha JK: Blast injuries to the hand: Pathomechanics, patterns and treatment. J Emerg Trauma Shock 2013; 6(1): 29-36.\u003c/li\u003e\n\u003cli\u003eSaucedo JM, Vedder NB: Firework-related injuries of the hand. J Hand Surg Am 2015; 40(2): 383-7; quiz 387.\u003c/li\u003e\n\u003cli\u003eSandvall BK, Keys KA, Friedrich JB: Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types. J Hand Surg Am 2017; 42(5): 385.e1-385.e8.\u003c/li\u003e\n\u003cli\u003evan Yperen DT, van der Vlies CH, Faber JTHN de, et al: Epidemiology, treatment, costs, and long-term outcomes of patients with fireworks-related injuries (ROCKET); a multicenter prospective observational case series. PLoS One 2020; 15(3): e0230382.\u003c/li\u003e\n\u003cli\u003eKulla M, Maier J, Bieler D, et al.: Civilian blast trauma - an underestimated problem? Results of a retrospective analysis from the TraumaRegister DGU\u0026reg;. Trauma Surgeon 2016; 119(10): 843-53.\u003c/li\u003e\n\u003cli\u003eGabel-Pfisterer A, B\u0026ouml;hringer D, Agostini H: Pandemic-related ban on the sale of fireworks in Germany leads to a significant decrease in eye injuries. Ophthalmology 2022; 119(12): 1257-66.\u003c/li\u003e\n\u003cli\u003ePlontke SK-R, Dietz K, Pfeffer C, Zenner H-P: The incidence of acoustic trauma due to New Year\u0026apos;s firecrackers. Eur Arch Otorhinolaryngol 2002; 259(5): 247-52.\u003c/li\u003e\n\u003cli\u003eEU Commission: Commission Implementing Decision (EU) 2023/1096 of June 2, 2023 2023.\u003c/li\u003e\n\u003cli\u003eFederal Ministry of the Interior and for Home Affairs: Press release \u0026quot;2021 no sale of New Year\u0026apos;s Eve fireworks\u0026quot; 2021.\u003c/li\u003e\n\u003cli\u003eRND/hyd: Debate on firecracker ban: Private fireworks are already banned in these countries. https://www.rnd.de/panorama/boellerverbot-in-diesen-laendern-ist-das-private-feuerwerk-untersagt-DEXVJ7U6URE55J3MOUCI4NVS7A.html (last accessed on September 18, 2023).\u003c/li\u003e\n\u003cli\u003eHazani R, Buntic RF, Brooks D: Patterns in blast injuries to the hand. Hand (New York, N,Y.) 2009; 4(1): 44-9.\u003c/li\u003e\n\u003cli\u003eSmith GA, Knapp JF, Barnett TM, Shields BJ: The rockets\u0026apos; red glare, the bombs bursting in air: fireworks-related injuries to children. Pediatrics 1996; 98(1): 1-9.\u003c/li\u003e\n\u003cli\u003eBerliner Feuerwehr: Silvesterbilanz der Berliner Feuerwehr. http://www.feuerwehr.de/einsatz/berichte/einsatz.php?n=67889 (last accessed on September 18, 2023).\u003c/li\u003e\n\u003cli\u003eUte Dauert, Wolfgang Straff, Holger Gerwig, Thomas Myck, David Kuntze: Zum Jahreswechsel: Wenn die Luft \u0026quot;zum Schneiden\u0026quot; ist. https://www.umweltbundesamt.de/sites/default/files/medien/479/publikationen/hgp_wenn_die_luft_zum_schneiden_ist_2019.pdf (last accessed on September 18, 2023).\u003c/li\u003e\n\u003cli\u003eFederal Environment Agency: Particulate matter from New Year\u0026apos;s Eve fireworks 2022.\u003c/li\u003e\n\u003cli\u003eDeutsche Umwelthilfe e.V.: On new paths into the new year: #B\u0026Ouml;LLERCIAO. https://www.duh.de/projekte/mitmach-aktion-silvester/ (last accessed on September 18, 2023).\u003c/li\u003e\n\u003cli\u003eDeutsche Umwelthilfe e.V.: Deutsche Umwelthilfe draws a bitter balance: Even worse New Year\u0026apos;s Eve than feared, up to 9 times higher air pollution, millions of people and animals to suffer in 2023.\u003c/li\u003e\n\u003cli\u003eVerbraucherzentrale Brandenburg e.V.: Majority across Germany in favor of ban on private fireworks on New Year\u0026apos;s Eve 2022.\u003c/li\u003e\n\u003cli\u003eFederal Ministry of the Interior and for Home Affairs: Fireworks at the turn of the year: Celebrate New Year\u0026apos;s Eve safely 2022.\u003c/li\u003e\n\u003cli\u003eBundesanstalt f\u0026uuml;r Materialforschung und -pr\u0026uuml;fung BAM: FAQs f\u0026uuml;r ein sicheres Silvester: Sicherheitshinweise f\u0026uuml;r Silvesterfeuerwerk. https://www.bam.de/Navigation/DE/Aktuelles/Silvester/silvester.html (last accessed on September 18, 2023) .\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Supplement ","content":"\u003cp\u003eSupplement 1\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eCategories F1 - F4 of fireworks\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eFireworks in category F1 (firecrackers, firecrackers, table fireworks, sparklers, party firecrackers) may only be issued to persons aged 12 and over throughout the year. Firing is permitted all year round. Firecrackers and fireworks in category F2 (rockets, batteries, Roman lights, firecrackers, composite fireworks) may only be released from December 29 to 31 to persons aged 18 and over. Fireworks in categories F3 and F4 are (semi-)professional fireworks and may only be used by trained pyrotechnicians. The setting off of fireworks is restricted to December 31st and January 1st. An exemption permit is required on other days. The handling of non-certified and non-CE-marked pyrotechnic articles constitutes a criminal offense (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eSupplement 2\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eBlack powder\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eBlack powder is essentially made up of three components: potassium nitrate (saltpetre), sulphur and coal. During the combustion process, the coal burns off to form carbon dioxide. The resulting heat causes sulphur to react with potassium nitrate, producing potassium sulphate, potassium sulphide and potassium carbonate as well as nitrogen. The chemical reaction and the energy released results in an enormous increase in temperature. In addition, the rapid release of carbon dioxide and nitrogen leads to a massive expansion in volume and acceleration of the surrounding matter - ultimately to an explosion (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eSupplement 3\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSafety instructions for New Year's Eve fireworks\u003c/span\u003e (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e):\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eOnly buy firecrackers and fireworks from specialist retailers with the CE mark and BAM test number\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNever use homemade explosives or manipulated fireworks, as these are life-threatening for yourself and others\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRead the instructions for use and safety information calmly and with a clear mind before setting off firecrackers and fireworks\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eObserve safety distances (category F1: 1 m, category F2: 8 m)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNever carry firecrackers or fireworks on your person! It is best to store them closed and at a safe distance from matches or lighters and not in jackets or trouser pockets\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOnly launch fireworks vertically upwards from a suitable outdoor area or the street, not at an angle or from a balcony\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eFirecrackers are taboo for children and young people: Young people are particularly frequently affected by serious injuries caused by fireworks.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eFirecrackers and fireworks that have not exploded should never be set off again - it is better to clear them away and dispose of them to protect them from children\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIf alcohol is involved: keep your hands off fireworks. Alcohol makes you careless.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNever direct firecrackers and fireworks at people or animals\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Greifswald","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hand injuries, explosion injuries, pyrotechnic objects, fireworks, New Year's Eve","lastPublishedDoi":"10.21203/rs.3.rs-3749135/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3749135/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eIntroduction:\u003c/em\u003e Fireworks carry a high risk for hand injuries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods:\u003c/em\u003e The study presents data of 146 patients hospitalized with hand injuries caused by fireworks during the turn of the years 2005 to 2023. Statistical data presented include number, age and sex, injury patterns and concomitant injuries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults:\u0026nbsp;\u003c/em\u003eThe number of injured increased over the years with a significant increase in 2016 and incision during the COVID pandemic. Those affected were predominantly male. The age group between 19 and 36 years was the most represented, followed by elders between 37 and 65 years. Children and adolescents under 18 were affected in one-third of cases. Injury patterns included combinations of soft tissue lesions, open fractures and finger amputations. Concomitant injuries predominantly involved the head. One quarter of the patients showed post-traumatic stress disorder.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDiscussion:\u003c/em\u003e Hand injuries from fireworks often result in permanent physical integrity disorders. Posttraumatic stress disorder is often. The increasing number of cases may be due to structural changes in the rescue service and the level of awareness of a specialized facility, in addition to a fundamental increase in injuries. Most striking was the decline in numbers during the COVID pandemic. The immediate rebound after the end of the restrictions supports the consideration of a permanent ban.\u003c/p\u003e","manuscriptTitle":"Do we need a ban on firecrackers? Explosion injuries to hands caused by pyrotechnic objects during the turn of the year in Berlin/Brandenburg","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-12-19 13:26:09","doi":"10.21203/rs.3.rs-3749135/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce087854-e8f7-4b05-a3b9-0da77000b4ac","owner":[],"postedDate":"December 19th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27382299,"name":"Orthopedic Surgery"},{"id":27382300,"name":"Plastic \u0026 Reconstructive Surgery"}],"tags":[],"updatedAt":"2023-12-19T13:26:09+00:00","versionOfRecord":[],"versionCreatedAt":"2023-12-19 13:26:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3749135","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3749135","identity":"rs-3749135","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}