JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas -- Fireworks won't be the only thing skyrocketing on Fourth of July. Injuries will also be on the rise if people light up the sky without keeping safety in mind.


According to witness accounts, the man was at a party in 2016 shooting off mortar-type fireworks, which involves loading shells into a tube. The man believed his shell had misfired and attempted to reload the tube. Instead, the charge detonated, impaling what was possibly a live round into the man's thigh. He was rushed to Brooke Army Medical Center's Level I Trauma Center.

Air Force Capt. (Dr.) Andrew Murtha, a second-year orthopedic surgery resident at that time, recalled the trauma team's concerns when they learned what had happened.

"We had X-rays but didn't know whether the foreign body in his thigh was an undetonated round, shrapnel from the tube, or some other debris," said Murtha, who is now BAMC's chief resident for orthopedics.

Concerned they were dealing with an unexploded round, the trauma team isolated the patient and called an explosive ordnance disposal unit and the local fire department.

"We were told that it was most likely a paper-type fuse," Murtha said. "The fire department recommended we irrigate it with water to prevent it from igniting. We still weren't sure if it was a live round, but approached the situation with an abundance of caution to protect the other patients and our medical personnel."

The surgeons were able to safely remove the debris and foreign material. The patient underwent several surgeries on his leg, but was fortunate to walk away in the end.

Based on the experience, Murtha helped to author an article about the incident in the May 2018 Journal of Emergency Medicine titled "An impaled potential unexploded device in the civilian trauma setting: A case report and review of the literature." The authors aimed to ensure emergency providers, both stateside and downrange, are familiar with the protocols needed to manage and coordinate care for patients impaled with unexploded devices. The authors noted there have been 39 documented cases of impaled unexploded ordnance since the Korean War.

"Improper management can have catastrophic consequences for the patient, the hospital and the medical team," the authors wrote.

"Knowing how to triage and protect patients and the care team is an integral part of the trauma mission and training," Murtha noted. "These protocols apply whether dealing with fireworks, an act of terrorism, or an explosive device injury downrange."

In the case of fireworks, the best injury prevention measure is to leave the light shows to the professionals, Murtha said.

In 2017, eight people died and more than 12,000 needed medical treatment due to fireworks-related incidents, with most occurring from June 16 to July 16, according to the National Safety Council. The majority of these incidents were due to amateurs attempting to use professional-grade, homemade, or other illegal fireworks or explosives.

While sparklers seem like a safe alternative, especially for children, these handheld fireworks are more dangerous than they seem. With a heat that can reach 1,200 degrees, sparklers account for about a quarter of fireworks-related injuries, according to the National Fire Protection Association.

If fireworks are legal to buy where you live, the National Safety Council recommends the following tips for a safe and festive Fourth of July:

-- Never allow young children to handle fireworks;
-- Never use fireworks while impaired by drugs or alcohol;
-- Anyone using fireworks or standing nearby should wear protective eyewear;
-- Never hold lighted fireworks in your hands;
-- Never light them indoors;
-- Only use them away from people, houses and flammable material;
-- Never point or throw fireworks at another person;
-- Only light one device at a time and maintain a safe distance after lighting;
-- Never ignite devices in a container;
-- Do not try to re-light or handle malfunctioning fireworks;
-- Soak both spent and unused fireworks in water for a few hours before discarding; and
-- Keep a bucket of water nearby to extinguish fireworks that don't go off or in case of fire.