# Explosion-Related Polytrauma from Illicit Pyrotechnics: Two Case Reports and a Public Health Perspective

## TL;DR

Two young men suffered severe injuries from illegal fireworks, highlighting the public health risks and high costs of such incidents.

## Contribution

This paper presents two case studies and emphasizes the need for prevention and policy changes to reduce firework-related trauma.

## Key findings

- Two cases of severe trauma from illegal fireworks required ICU care and extensive surgeries.
- Hospital costs for the cases were €58,459.52 and €94,230.23, showing the economic burden.
- Injury rates decreased during the pandemic due to firework bans, supporting preventive measures.

## Abstract

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis® fish skin and Epicite® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts.