Joseph Livingston was sitting cross-legged in his yard with other children during a neighborhood gathering on Labor Day in 2016 as a neighbor set off fireworks on the other side of their cul-de-sac.
Then one of the explosives malfunctioned and rocketed 50 to 60 feet straight at the children and up Joe’s shorts, setting the then-five-year-old’s clothes on fire.
“We thought we were all a safe distance away,” said Marianne Livingston, Joe’s mother. “But instead of up it went sideways. It only took a second.”
Ahead of the July 4 holiday when most fireworks accidents happen, the Columbia family, fire officials and doctors who treat fireworks injuries are warning of the dangers of burns and other injuries. Many types of fireworks, which can burn at temperatures exceeding 2,000 degrees, are illegal in Maryland and all pose safety threats.
Livingston said older children ran when they realized what was happening, including Joe’s brother. His father scooped up his younger sister. Joe’s mother was behind Joe and tried to have him roll to put out the flames. A neighbor quickly arrived with a hose.
His clothes were charred and he received first-, second- and third-degree burns on his left leg and buttocks, serious enough injuries that the community hospital near their home sent Joe to the Johns Hopkins Children’s Center, where he still receives treatment.
More than 11,000 children and adults went to an emergency room with a fireworks-related injury in 2016, according to the latest figures from the U.S. Consumer Products Safety Commission. Most happened in the month around July 4.
Dr. Therese Canares is a pediatric emergency medicine physician at Hopkins Children’s Center who treated Joseph. She said 50 to 60 feet seems like a reasonable distance, but fireworks can malfunction or be mishandled and cause harm in a wide area. Burns are common, but fireworks also can mangle or even blow off fingers and hands, and damage eyes, she said.
Canares sedated Joe, who required the removal of dead and contaminated skin, a procedure called debridement. There were serious burns on 2 percent of his body, about the size of both of his palms.
While Joseph did not approach the fireworks, the colors and glow of fireworks, such as common sparklers, can be irresistible to toddlers and young children, Canares said.
“These kinds of burns can be devastating,” Canares said. “Some need debridement and some need skin grafts. Some kids end up with amputations and eyes are always vulnerable. It’s not just painful, but it can lead to long-term effects. It can be emotionally traumatizing as well.”
Canares said mild burns can be treated a home with aloe or other remedies recommended by the family doctor, but more severe burns with blisters larger than an index finger require emergency attention.
The Consumer Product Safety Commission, the U.S. Centers for Disease Control and Prevention and the National Fire Protection Association, among others, recommend that fireworks be used only by professionals. The CDC reports that even sparklers, for example, burn at more than 1,000 degrees.
For some, fireworks have become a regular part of neighborhood gatherings. The trade group American Pyrotechnics Association said their use is at an all-time high. Sales could exceed $900 million this season, up from $885 million last year and $825 million in 2016.
The association attributed the rise to relaxing consumer fireworks laws in 11 states, including Maryland’s neighbors Delaware and Pennsylvania. In Maryland, most fireworks are illegal, though some handheld and ground-based sparklers are legal in many counties. However, in Howard County, where the Livingstons live, only hand-held sparklers are allowed.
Association officials do call for public education on proper use of fireworks.
“The fireworks industry has made great progress in improving fireworks quality and reducing injuries,” said Julie L. Heckman, the group’s executive director, in a statement ahead of the Fourth of July holiday. “However, there is still work to be done as the vast majority of fireworks-related injuries in the U.S. each year result from the misuse of fireworks.”
Dr. Dylan Stewart, the director of Hopkins’ Pediatric Trauma and Burn Program, continues to treat Joe’s scars. The patches are itchy and can make him uncomfortable. He’s received laser treatments to make his skin softer and less itchy, though it’s not had much of an effect, so he’ll likely try another remedy in addition to daily doses of lotion.
Stewart said it’s a steep price to pay for a few minutes of entertainment with sparklers or fireworks.
“Joseph’s story is typical in that he was an innocent bystander,” Stewart said. “It could have been a lot worse, but it was a tremendously traumatic experience. Burns also are one of the most painful injuries. This is not something he’ll just forget overnight.”
Stewart plans to work around July 4 and dreads possible fireworks-related injuries. There is always at least one case, he said.
While more children burn themselves with hot water and other liquids, the risk from consumer fireworks can be eliminated by not using or being around them, Stewart said.
Dr. Ray Pensy sees the most devastating hand injuries, which once or twice a year involve fireworks.
An orthopedic surgeon at Shock Trauma and the University of Maryland Center for Hand and Upper Extremity Care, Pensy said that if the tissue is severely damaged or missing after an explosion the injuries are usually permanent, even if the medical staff can graft skin and even toes onto hands.
“These injuries are really terrible,” he said. “Prevention is the best method of treating these.”
Pensy works with the University of Maryland’s Center for Injury Prevention and Policy and wants to get messages out about keeping children out of harm’s way — he sees a lot of kids with fingers crushed in doors and dog bites.
“Accidents happen so fast and maybe one thing we need to see change is the decision making,” he said. “Don’t approach dogs you don’t know. Don’t pick up the firecrackers.”
Joe’s mother said she doesn’t blame those who did pick up the fireworks for Joe’s accident, though she now agrees pyrotechnics should be left to professionals.
The accident caused burns but also made Joe fearful of loud noises caused by fireworks, thunder and other sources. Still, she feels fortunate that he didn’t suffer worse injuries and said he largely remains the good-natured and fun-loving boy he has always been.
This July 4, they may just stay home and watch a movie.