What is the proper way to clean and manage a fireworks injury?

How to Clean Fireworks Injuries

Immediately irrigate fireworks injuries thoroughly with large volumes of running tap water or sterile saline until all debris and foreign matter is removed from the wound. 1

Initial Wound Management

Irrigation Protocol

• Thoroughly irrigate the wound with running tap water or sterile saline solution until no obvious debris or foreign matter remains in the wound 1
• Tap water is as effective as sterile saline and superior to antiseptic agents like povidone-iodine for wound irrigation 1
• Use large volumes of water—higher volumes (100-1000 mL range) are more effective than lower volumes 1
• Room temperature or warm water is acceptable; warm water is more comfortable than cold water but equally effective for cleaning 1

Special Considerations for Fireworks Injuries

• Fireworks cause complex injuries combining burns, blast effects, lacerations, crush injuries, and tissue avulsion 2, 3, 4
• These wounds often contain embedded debris from explosive materials, paper wrappers, and chemical residues that require meticulous removal 2
• Certain wounds may need only thorough cleansing followed by primary suturing, while others require emergency surgery 2

Burn Component Management

Cooling Protocol

• For burns covering <20% total body surface area in adults or <10% in children without shock, cool the burned area 1
• Cool with tap water for up to 40 minutes to limit burn depth and reduce the need for skin grafting 1
• Do not apply ice directly to burns—this can cause tissue ischemia 1
• Cooling reduces pain, edema, and depth of injury while speeding healing 1, 5

Burn Wound Care

• After cooling and irrigation, clean burn wounds with tap water, isotonic saline, or antiseptic solution 1
• Cover burn blisters with a sterile dressing but leave blisters intact to improve healing and reduce pain 1
• Avoid prolonged use of external cooling devices to prevent hypothermia 1

Wound Dressing and Coverage

Occlusive Dressing Application

• After thorough cleaning, cover the wound with an occlusive dressing to promote wound healing 1
• Occlusive dressings (film, petrolatum, hydrogel, cellulose/collagen) result in better healing than dry dressings 1
• For superficial burns and abrasions, apply antibiotic ointment or cream only if the patient has no known allergies 1
• There is no indication that antibiotic dressings improve healing or decrease infection rates in clean wounds 1

Important Caveat

• Antibiotic ointment should only be applied to abrasions or superficial injuries—not to deep or complex wounds 1
• Silver sulfadiazine should be avoided for prolonged use on superficial burns as it delays healing 1

When to Seek Emergency Medical Care

Immediate Medical Evaluation Required

• All fireworks injuries should be evaluated by medical professionals due to the complex nature of these injuries 2, 4
• Emergency surgery may be indicated for tendon/neurovascular repair, fracture fixation, flap coverage, or amputation 2
• Fireworks can cause blast injuries leading to soft tissue disruption and bony injuries, particularly from high-intensity devices 2

Signs of Infection Requiring Medical Attention

• Remove the dressing and obtain medical care if the patient develops: 1
  • Redness or swelling
  • Foul-smelling wound drainage
  • Increased pain
  • Fever

Critical Safety Points

What NOT to Do

• Do not use antiseptic agents like povidone-iodine for initial irrigation—they provide no benefit over tap water 1
• Do not apply ice directly to burns 1
• Do not use hemostatic agents routinely—they have variable effectiveness and potential for adverse effects including tissue destruction 1
• Do not delay wound cleaning for dressing application 1

Contamination Concerns

• If the wound is contaminated with saliva or involves a bite, evaluate in a medical facility as soon as possible for potential antibiotic prophylaxis 1
• Use gloves and bioseguridad measures during wound care to prevent disease transmission 6