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Decrease in injuries from fireworks in Hawaii: associations with a county policy to limit access
  1. Daniel J Galanis1,
  2. Sylvia SJ Koo2,
  3. Devin P Puapong3,
  4. Tetine Sentell4,
  5. Alvin C Bronstein1
  1. 1 Emergency Medical Services and Injury Prevention System Branch, Hawaii State Department of Health, Honolulu, Hawaii, USA
  2. 2 John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
  3. 3 Department of Surgery, Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii, USA
  4. 4 Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
  1. Correspondence to Sylvia SJ Koo, University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA; sylviask{at}


Objective To examine trends in fireworks-related injuries (FRI) before and after enactment of an ordinance to limit access in the City and County of Honolulu (the island of Oahu).

Methods Surveillance of FRI treated in all emergency departments in the state, for 18 new year’s periods (31 December through 1 January) from 2004 to 2021. Prelaw (2004 to 2011) and postlaw (2012 to 2021) number of FRI were compared, by patient age and county.

Results The average annual number of FRI for all ages decreased significantly in Oahu, from 74 during the prelaw period to 27 during the postlaw period (p<0.01), but not in the remaining neighbour islands (p=0.07). Decreases were particularly evident for Oahu paediatric patients (under 18 years), among whom FRI declined from 42 to 10 per year (p<0.01). FRI were approximately halved for older Oahu patients and neighbour island paediatric patients.

Conclusions Legislation requiring permits for a specified number and type of fireworks, and limiting access to persons 18 years and older was associated with significant decreases in FRI in the City and County of Honolulu.

  • policy
  • public health
  • regulation
  • safe community
  • blast/explosion
  • child

Data availability statement

No data are available.

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  • Contributors DJG oversaw data collection, designed the study and conducted the analyses. DJG is the author acting as the guarantor. SSJK undertook the literature review and produced the first draft. All authors participated in reviewing and editing all drafts of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.