Fireworks and Injury in the United States: A Review of Epidemiology, Clinical Burden, and Policy Implications.

Fireworks are a hallmark of American celebrations, yet they generate a growing and under-recognized burden of injury. The aim of this narrative review is to integrate current United States evidence on firework-related harm, reveal clinical and economic patterns, and evaluate how policy shapes risk. Recent studies and national surveillance reports show a steady rise in emergency visits linked to consumer fireworks, with males comprising most patients. The hands and upper extremities sustain the largest share of harm, followed by the eyes and the head, face, and neck region. Although less frequent, amputations, open globe injuries and full-thickness burns produce the gravest morbidity and often require multiple operations and lengthy rehabilitation. Complex cases routinely incur hospital charges in the tens of thousands of dollars, while indirect costs such as lost productivity, long-term disability, and psychological distress are seldom captured. States that allow broad retail access to consumer fireworks report markedly higher injury rates than those enforcing permits, age limits, or brief sales periods, and time series observations show clear surges when access is relaxed and declines when it is tightened. Public education alone has shown little measurable effect. The evidence indicates that firework injuries are increasing in both frequency and severity, cluster where regulation is weakest, and impose substantial human and financial costs. National surveillance, device-specific controls, and rigorously evaluated legislation, rather than education alone, are essential if preventable harm is to be reduced while holiday traditions are preserved.