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Evaluation of Firework-Related Harm in Scotland, October 2020 2 Authors

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Evaluation of Firework-Related Harm in Scotland, October 2020 2 Authors Mrs Eleanor R Robertson MB ChB BMSc (hons) MRCS MD - Plastic Surgery Registrar, Canniesburn Department of Plastic Surgery, Glasgow Mrs Janet Bouttell BA, MA, MSc - Research Associate Health Economics & Health Technology Assessment (HEHTA), University of Glasgow Mr Stephen Leonard BEng (Hons), PgD, MPhil - Data analyst, NHS Greater Glasgow and Clyde Miss Kerry Davies BSc MSc MBBC MRCS - Plastic Surgery Registrar, Canniesburn Department of Plastic Surgery, Glasgow Professor Andrew M Hart MBChB BSc(Hons) MRCS AFRCS MD(Hons) PhD FRCS(Plast), - Consultant Plastic Surgeon, Canniesburn Department of Plastic Surgery, Glasgow - Chair of Plastic Surgery Research, University of Glasgow - Editor-in-Chief of Europe's leading peer reviewed Journal for Plastic Surgery (JPRAS) Mr Stuart Watson FRCS(Plast) - Consultant Plastic Surgeon, Canniesburn Department of Plastic Surgery, Glasgow - Clinical Lead for Care of Burns in Scotland (COBIS) Managed Clinical Network, NHS National Services Scotland Funding for the health economic evaluation was kindly funded from the Jean Brown Bequest Fund, NHS Greater Glasgow and Clyde Health board endowments. The authors would wish to thank: - Prof Phil James FRGS CGEOG, Director National Urban Observatory Facility Newcastle - Dr Tom Clemens BA MRes PhD, School of Geosciences University of Edinburgh - Dr Mark Cherrie MA(Hons.) PhD who provided invaluable assistance in Study 4. Evaluation of firework-related harm in Scotland, October 2020 2 Authors .................................................................................................................................................... 2 Executive summary ................................................................................................................................. 6 Introduction ............................................................................................................................................ 7 Objectives ............................................................................................................................................... 9 Study 1: A firework injury survey of all Scottish Emergency Department and Minor Injury Units during bonfire night 2019 ................................................................................................................................ 10 Study 1: Methods .............................................................................................................................. 10 Study 1: Results ................................................................................................................................. 10 Study 1: Discussion ........................................................................................................................... 14 Study 2: Health economic and epidemiological review of firework-related presentations and admissions to NHS Greater Glasgow and Clyde 2008 – 2019 ............................................................... 16 Study 2: Methods .............................................................................................................................. 16 Study 2: Results ................................................................................................................................. 17 Patient demographics ................................................................................................................... 17 Clinical management ..................................................................................................................... 18 Firework injury rate....................................................................................................................... 20 Health economic evaluation ......................................................................................................... 21 Study 2: Discussion ........................................................................................................................... 23 Study 3: Health economic evaluation of a paediatric firework injury .................................................. 26 Summary ........................................................................................................................................... 26 Outcome and discussion ................................................................................................................... 26 Study 4: Review of literature relating to firework particulates and their health impact ..................... 28 Study 4: introduction ........................................................................................................................ 28 Study 4: Firework-specific products of combustion ......................................................................... 29 Study 4: Particulate concentration over bonfire night in the UK ..................................................... 31 Study 4: Firework-specific products of combustion and health ....................................................... 33 Study 4: Discussion ........................................................................................................................... 35 Report Discussion.................................................................................................................................. 36 Report Conclusion ................................................................................................................................. 37 Abbreviations ........................................................................................................................................ 38 References ............................................................................................................................................ 39 Evaluation of firework-related harm in Scotland, October 2020 3 Figure 1 Frequency of firework-related injury, by month of admission[12] .......................................... 7 Figure 2 Study 1: map demonstrating location of patient with firework-related injury ........................ 9 Figure 3 Study 1: firework injuries presenting to ED/MIU 2019 categorised by age and sex .............. 10 Figure 4 Study 1: type of firework and event where firework-related injury occurred ....................... 11 Figure 5 Study 1: date of presentation to ED/MIU 2019 categorised by date presenting ................... 11 Figure 6 Study 1: firework injuries presenting to ED/MIU 2019 categorised by SIMD decile .............. 12 Figure 7 Total number of patients presenting with firework-related injuries to Scottish ED/MIU & Plastic Surgery from 1976 - 2000[20] ................................................................................................... 13 Figure 8 Study 2: % Patients in each SIMD decile; attending ED and admitted for firework-related injuries in NHS GGC 2008 - 2019 ........................................................................................................... 17 Figure 9 Study 2: date of first admission to NHS GGC with a firework-related injury .......................... 18 Figure 10 Emergency hospital admissions result of unintentional injury year ending 31 March 2017 by deprivation [32] ................................................................................................................................ 22 Figure 11 Maps of the risk of PM10 on respiratory hospital admissions; left: whole Scotland; right: central belt[59] ..................................................................................................................................... 27 Figure 12 Hourly trends PM2.5-elements Guy Fawkes Night Central London (Barium, Ba; Copper, Cu; Strontium, Sr; Antimony, Sb) [66] ......................................................................................................... 29 Figure 13 5th November 2018 Very High pollution levels: North East, Yorkshire & Humberside; High levels: North West & Merseyside, East Midlands [71] ......................................................................... 30 Figure 14 Particulate matter concentrations measured in York City Centre between November 2018 and March 2019[17]. ............................................................................................................................ 30 Figure 15 Median hourly PM2.5 and PM10 concentrations (µg/m3), 2017-19[72] ............................. 31 Figure 16 PM2.5 concentration µg/m3 Newcastle Urban Observatory Network 5th Nov 2018[72] ... 31 Evaluation of firework-related harm in Scotland, October 2020 4 Figure 17 Screenshot of http://www.scottishairquality.scot/, 6th November 2019 [74] .................... 32 Figure 18 Summary of findings: PM2.5 concentration and health outcomes [77] ............................... 33 Figure 19 Firework-related morbidity and mortality ............................................................................ 35 Table 1 Sale of fireworks[13] .................................................................................................................. 8 Table 2 Study 1: anatomical injury, child and adult .............................................................................. 11 Table 3 Anatomical region of injury, 1999/2000; 2005 and 2019 in Scotland [6, 20] .......................... 15 Table 4 Study 2: age and bodily location of injury for patients attending A&E and admitted to hospital (injuries exceeds number of patients, n=198, as some patients have more than one injury) 17 Table 5 Study 2: Age and bodily location of injury
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