-- Between the sizzling barbecues, flowing beers, and cacophony of fireworks exploding, it's not hard to understand why the July Fourth holiday can be a wild ride for emergency room doctors and nurses.
With patients rushed in due to boating accidents, fireworks gone awry, and a litany of other injuries that you almost have to see to believe, the holiday has earned a reputation as the most dangerous holiday in the U.S.
Fireworks cause more than 8,500 injuries every year, with more than 40 percent occurring in children under age 15, according to the Consumer Product Safety Commission (CPSC). The injuries skyrocket around this time of year -– CPSC estimates about 230 people per day go to the emergency room with fireworks-related injuries in the month around July Fourth.
Dr. Jennifer Stankus, an emergency medicine physician at Madigan Army Medical Center, used to be an ER doc in Albuquerque, New Mexico. She remembers an episode where a man strolled into the emergency room through the ambulance door, walking in calmly with his bike. The emergency room at that hospital was always packed, and the doctors told the man he had to go back to the front door and sign in with everyone else -– but then the man said he had been shot.
"He said that he was riding his bike on the sidewalk, immediately across from the [emergency department] when he felt something strike him in the back, and he figured he was shot," Stankus said. "Well, we looked, and sure enough, he was."
Apparently in Albuquerque, it is a tradition to shoot off real guns into the air, along with fireworks, as part of the celebratory noisemaking.
"Well, what goes up must come down," Stankus said. "And a stray bullet just happened to come down and hit this guy in the back, right across from the ED ... crazy."
The man on the bike recovered just fine from his injuries, but if it wasn't clear from this story, Stankus firmly advises against firing real bullets into the sky to make festive fireworks noises, as the bullets do ultimately come back to Earth and can endanger innocent bystanders.
Dr. Lorrie Metzler, who has practiced emergency medicine in both Louisiana and Mississippi, says she sees a lot of water sports injuries around July Fourth.
"There are so many bayous here, bordering the Gulf of Mexico," she said. "The population can be very fun-loving and sometimes throw care to the wind and get reckless with jet skis and boats and things like that."
She has really seen it all –- from a man on a jet ski who hit a pier and became a human projectile, to motor blade injuries and boat collisions.
She urges everyone to keep their wits about them this July 4 –- follow boating safety rules, never drink alcohol and drive a boat, and abide by safety lanes marked in different areas.
"Always wear life preservers, keep a safe distance from other boats, don't get caught up in the wake of very large ships," she said. "It's a real problem getting people to wear life vests -– they save lives," especially if someone gets knocked unconscious and falls into the water, she added.
In terms of fireworks hazards, ER doctors have seen it all: Burns, lacerations, and eye injuries are extremely common, they say. Fireworks can also be deadly.
Dr. Brad Uren, an emergency medicine physician at the University of Michigan, says he understands that people putting on fireworks shows feel pressure to "act like they're a star" and impress crowds. But he says he has seen so many injuries from people trying to handle large, commercial-grade fireworks that he advises people to play it safe -- especially if a firework seems to be a dud.
"I understand the temptation is to creep up and take a look down that tube -– the show must go on," he said. "But there's not a backyard fireworks show that's worth your eye, your vision, or your life."
Even with seemingly harmless sparklers, parents should use great caution and think twice before handing them to children –- they can reach 1000 degrees while burning.
The CDC has a list of firework safety tips: never allow young children to play with or light fireworks, avoid buying fireworks packaged in brown paper because they were likely made for professional displays, always watch fireworks from a safe distance, never inspect duds up close, and call 911 immediately for any fireworks-related injury. Keeping water on a hand is also a good idea.
Drinking and driving is as much of a threat on July 4 as any other holiday – these ER docs urge people to never put others and themselves at risk by getting behind the wheel while intoxicated.
"Drinking and fireworks is also an issue," Uren said. "Have a designated lighter. You wouldn't get behind the wheel if you had too much to drink, but a lot of people think they can operate fireworks.”
There are also some Fourth of July injuries that are less visible, but equally intense.
"The loud explosion noises from fireworks may remind you of summer barbecues, warm wind, and good times with the family," said Texas-based emergency room physician Dr. Sudip Bose. "But for an injured soldier –- or anyone with PTSD –- that can remind them of memories from the battlefield."
Bose is an emergency physician, who served in the Iraq War, and devotes a lot of his time to working with injured veterans. He served one of the longest combat tours by a physician since World War II, and founded a nonprofit called The Battle Continues to help veterans, who return to civilian life and deal with feelings of alienation and PTSD.
He said he knows that fireworks bring joy to millions of people, but that if you live an in area with a Veterans Administration hospital or where you know there are a lot of veterans, "maybe just be a little considerate and cognizant of that" this July 4.
Uren will be spending this July Fourth working in the emergency room. He hopes that people will be extra careful this holiday weekend, emergency physicians are the one group who "don't mind putting themselves out of business" if it means people will stay safer, he said.
"Unfortunately, every year I've worked I've seen some kind of fireworks injury, but I would be glad if this was the first year that I don't," he said.
All of the emergency medicine physicians quoted are members of the American College of Emergency Physicians.