Statement of Purpose In May 2017, the Iowa legislature approved SB489, allowing the sale and use of fireworks in Iowa from June 1 through July 8 and December 10 through January 3. Herein, we evaluated the impact of this law on hospital admissions for firework injuries in the State.

Methods/Approach The Iowa Hospital Admission database (IHA) and the registries and medical records of Iowa’s two Level 1 Trauma Centers were queried to identify inpatient and outpatient admissions for firework injuries from June 1, 2014 to July 31, 2019. Trends in hospital admissions for firework injuries across Iowa were determined using IHA data. Data from the Trauma Centers were reviewed to obtain demographics, injury information, and hospital course. Pre- and post-firework legalization data were compared. P < 0.05 was considered significant.

Results Admissions for firework injuries increased in Iowa post-legalization (IHA: 595 vs. 330; Level I Trauma Centers: 107 vs. 42). Most admissions occurred in July. Compared to pre-legalization, IHA data showed that firework-related admissions significantly increased post-legalization in July (73.1% vs. 63%; p < 0.001), which reflected an increase in pediatric admissions post-legalization (81.9% vs. 61.5%; p = 0.003). No significant increase in adult admissions was observed post-legalization (70.2% vs. 63.6%; p = 0.120). Trauma Centers’ data showed similar trends. Pediatric admissions increased post-legalization (30.8% vs. 19.5% pre-legalization). Noteworthy, pre-legalization, all pediatric cases were outpatients while post-legalization, 27.3% were inpatients. The proportion of injured patients who were handlers increased post-legalization (64% vs. 52%). The most common injury site across both study periods was the hands (50%), followed by the eyes (32%) and face (27%). Post-legalization, 18% of injuries required amputation, while no amputation was required pre-legalization.

Conclusion Firework legalization led to an increase in the number of admissions and more severe injuries.

Significance/contribution Our data highlight the need for firework safety campaigns.