|Year : 2018 | Volume
| Issue : 1 | Page : 55-60
Impact of ban on firecracker sale in Delhi-NCR during Diwali of 2017 on the epidemiology of burns patients in a tertiary care center in Delhi
Tejaswini Divakar, Durga Karki, Ravi Prakash Narayan
Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||11-Mar-2019|
Dr. Durga Karki
Y-5, Flat No 210, D-6, Vasant Kunj, New Delhi - 110 070
Source of Support: None, Conflict of Interest: None
Objective: The objective of this study was to validate if the Supreme Court order on banning the sale of firecracker in Delhi-NCR during Diwali of 2017 had any significant effect on the public behavior.
Aim: The aim of this study was to compare the demographics of patients presenting with cracker burn injuries to the burns casualty during Diwali of 2017 (1 day before Diwali, Diwali day, and the day after Diwali) to that of the previous 3 years, i.e., 2014–2016.
Materials and Methods: Hospital-based retrospective study was conducted in the Department of Burns and Plastic Surgery of a tertiary care center in Delhi.
Result: Cracker burn injury cases during Diwali of 2017 reduced by 63% compared to the previous year. The total number of cracker burn patients presenting to the casualty on the 3 days of the festival per 100,000 populations in Delhi during Diwali was 1.56, 1.11, 1.17, and 0.42 in 2014, 2015, 2016, and 2017, respectively. The air pollution level during Diwali of 2017 has come down from “severe to very poor.”
Conclusion: From the significant drop in the cracker burn injuries during Diwali of 2017, we can deduce that the ban on the sale of firecrackers has impacted a change in public behavior. This change should be noted by public authorities and has to be followed up with more measures to sustain the gains derived from banning cracker sales during Diwali of 2017 into future Diwali not only in Delhi but also in other states in the country with alarming air pollution levels.
Keywords: Air pollution, burns, Delhi, Diwali, firecrackers, legislation
|How to cite this article:|
Divakar T, Karki D, Narayan RP. Impact of ban on firecracker sale in Delhi-NCR during Diwali of 2017 on the epidemiology of burns patients in a tertiary care center in Delhi. Indian J Burns 2018;26:55-60
|How to cite this URL:|
Divakar T, Karki D, Narayan RP. Impact of ban on firecracker sale in Delhi-NCR during Diwali of 2017 on the epidemiology of burns patients in a tertiary care center in Delhi. Indian J Burns [serial online] 2018 [cited 2019 Mar 25];26:55-60. Available from: http://www.ijburns.com/text.asp?2018/26/1/55/253858
| Introduction|| |
When the 2014 report of the Ambient air pollution database released by the World Health Organization (WHO) declared Delhi as the most polluted cities in the world, it rang an alarm bell. There were many awareness campaigns on the health hazards of air pollution on the present and future generation. The Delhi Government introduced some well-planned and some knee-jerk schemes to control the problem at hand. The Supreme Court of India also intervened with various legislations.
There are two main problems that need to be tackled while dealing with the air pollution crisis in Delhi. First, multiple sources of pollution such as vehicular emission, large-scale building construction, industrial pollution, stubble burning in neighboring states, and bursting of firecrackers. The second problem is that of implementation of the rules and legislation that are passed. Citizens try to circumvent the laws that cause inconvenience to them.
Some of the legislations introduced to curb air pollution menace are odd-even vehicle rule, transition to CNG, Green-CESS, and restriction on high capacity diesel vehicles, restriction on civil construction and strict compliance of graded response action plan, limitations on industrial activities within Delhi, and ban on waste burning inside Delhi.
The recent being the Supreme Court banning of firecracker sale in Delhi-NCR during Diwali of 2017.
This ban was seen with much skepticism as bursting firecrackers are the main highlight of Diwali celebrations. Furthermore, there were objections from the firecracker manufacturers and retailers as Diwali is the peak profit season.
Of note is that the ban was only on the sale of crackers and not on the bursting of firecrackers. Crackers which were either already bought or bought from a different state could be burst up to 10:00 PM during the festival. Therefore, the outcome of the ban weighed heavily on the citizen's perception of firecrackers as a major air pollutant and being aware of the health hazards caused by it.
Ours is one of the biggest burn facilities in North India and witnesses a major influx of patients during Diwali. Therefore, every year during the festive season, the disaster management protocol is invoked for 3 days: Diwali day, 1 day before Diwali, and 1 day after Diwali. A study comparing the number of patients presenting to the burns casualty during Diwali of the previous years with Diwali of 2017 would provide a surrogate indicator of the awareness and change in the attitude of the general public to acknowledge firecrackers as a cause of air pollution.
To validate if the Supreme Court order on banning the sale of firecracker in Delhi-NCR during Diwali of 2017 had any significant effect on the public behavior.
| Materials and Methodology|| |
The hospital-based retrospective study was conducted in the Department of Burns and Plastic Surgery of a tertiary care center in Delhi. All patients presenting to burns casualty with thermal injuries related to Diwali celebration were included in the study. Patients were further classified into those sustaining burns due to firecrackers and those due to burning of clothing due to Diya (oil lamp). The burns caused by Diya were not analyzed as it was outside the scope of the study. The demography and the distribution of burns surface area during the study period were also compared for insights.
The aim was to compare the demographics of patients presenting with cracker burn injuries to the burns casualty during Diwali of 2017 (1 day before Diwali, Diwali Day, and Day after Diwali) to that of the previous 3 years, that is, 2014–2016.
| Results|| |
Medical records, radiographs, and operative notes were reviewed. Data were analyzed using Microsoft Excel SPSS (Statistical Package for Social Sciences) Version 21.
[Table 1] shows the trend of the cracker burn cases during the Diwali period. In 2017, there were only 80 patients compared to 278,203 and 219 patients during 2014, 2015, and 2016, respectively.
From the [Graph 1], we can see that there is a reduction of 63% in the burns cases during Diwali of 2017 compared to Diwali of 2016.
The burn cases presenting to our casualty per 100,000 population of Delhi  also shows a drastic reduction, i. e., 0.42 in 2017 as compared to 1.56, 1.11, and 1.17 in 2014, 2015, and 2016, respectively [Table 2] and [Graph 2].
[Table 3] shows that the age group between 6 years and 35 years contributes to over 78% of the total cracker burn cases.
The vast majority (>78%) of the cracker burns cases are males [Table 4].
Observation on total body surface area (TBSA) [Table 5] shows that over 90% of the cases are below 10% TBSA.
The data on the body parts involved show that hand and face involvement was 47% and 26%, respectively [Graph 3].
[Table 6] and [Graph 4] depict distribution by hand. The right hand was predominantly involved.
Of the hand injuries, 84.3% were second-degree superficial burns [Figure 1]a and [Figure 1]b which were managed conservatively with 1% silver sulfadiazine dressings, pain control, and limb elevation. Patients were advised physiotherapy of hands. Wounds healed well with no resultant contractures and near normal range of motion of the affected digits.
|Figure 1: (a) Second-degree superficial burns on the palm of the hand. (b) Second-degree superficial burns on the dorsum of the hand|
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Six (15.7%) patients had cracker blast injury of the hands from anar (flower pot) or bomb [Figure 2]a and [Figure 2]b.
|Figure 2: (a) Cracker blast injury with 1st web space split laceration and tip amputation of the index and middle finger. (b) Cracker blast injury with 1st web space laceration and carpometacarpal joint dislocation|
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The most common injury type was to the radial aspect of the hand characterized by the first web space laceration and dislocation of the carpometacarpal (CMC) joint of the thumb which was present in all six patients. These six patients had varied involvement of other web spaces and distal finger amputations.
The primary aim of treatment was to preserve the function of the injured hand as far as possible.
All six patients underwent surgical intervention. Wound was washed thoroughly with copious volumes of saline, and adequate debridement was done to remove the embedded explosive compounds and necrotic debris to prevent postoperative wound infection and tattooing. Dorsal dislocation of the 1st metacarpal was managed with K-wire fixation. Thenar muscle approximation was achieved wherever possible and an attempt was made to close wounds primarily. One patient necessitated wound closure with a reverse pedicled radial forearm flap [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d.
|Figure 3: (a) Cracker blast injury with 1st web space laceration, thumb carpometacarpal joint dislocation, amputation of the ring and little finger with k-wire fixation of 1st carpometacarpal joint and marking of reverse pedicled radial forearm flap. (b) Elevation of reverse pedicled radial forearm flap. (c) Elevated reverse pedicled radial forearm flap. (d) In-setting of reverse pedicled radial forearm flap for 1st web space laceration, pedicle covered with split-thickness skin graft and donor site closed primarily|
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Tip injury of fingers healed by secondary intention.
Postoperative intensive physiotherapy was advised for the operated patients. However, minimal restriction in range of motion was noticed in these patients.
[Graph 5] shows the firecrackers incriminated with burns.
The average air quality index across monitoring stations in Delhi on Diwali as per the central pollution control board  is shown in [Table 7].
| Discussion|| |
The study showed that there was a 63% decrease in cracker burn patients during Diwali of 2017 compared to the previous year which can be taken as an indirect indicator of the reduced bursting of crackers. Reduction in the number of cracker burn patients was not only the phenomena in the hospital where this study was conducted but also across various other hospitals in Delhi as is evident from the press release post-Diwali. Because there was ban only on the sale of firecrackers and not on the purchase or bursting of crackers, this is an appreciable percentage.
Almost 78% of the patients were within the age group of 6–35 years with 1/3rd patients being <15-year-old with a male preponderance M: F: 3.7:1. Majority of cases were young males with careless attitude and disregard for safety norms.
More than 95% of cracker burns involved <10% TBSA  and were managed on an outpatient department basis.
The most common cause of firecracker injury was lighting anar (flower pot)/bomb by hand. The second common cause was trying to reignite a dud firecracker.
The most common organ involved was the hands followed by the face. Right hands were predominantly involved as most patients are right dominant and hold the cracker in that hand.
Almost 84.3% of the hand injuries were second-degree superficial burns managed conservatively. Six (15.7%) patients had cracker blast injury of the hands from anar or bomb and required surgical intervention. The most common injury type was to the radial aspect of the hand characterized by the first web space laceration and dislocation of the CMC joint of the thumb  which was present in all six patients. The firecracker is generally grasped between the thumb and index finger and thenar eminence being closest to the incriminating object bears the brunt of the accident. The 1st CMC joint is a bi-saddle joint and intrinsically unstable. Hence, the 1st metacarpal gets dislocated dorsally.,,,,,
Despite the drastic reduction in bursting of crackers, pollution was still in the “very poor” range as per the Central Pollution Control Board. Environmentalists acknowledge that had there not been a reduction in cracker use; the pollution levels would have been much worse. However, the air quality was better than Diwali of the previous year when it was in the “severe” range.
Although the ban on firecracker sales is a good thought and a good beginning, many people in Delhi got around the ban by purchasing firecrackers outside Delhi. If the intent is to curb pollution, then, the ban should also extend to the burning of firecrackers rather than just on the sale.
| Conclusion|| |
The 63% reduction in the cracker injury patients and reduction in air pollution during Diwali of 2017 suggest that through the major campaigns regarding air pollution in social media, the general public is awakened and has realized that individual participation is important to curb the ill-effects of pollution and not to depend on the Government alone to salvage the situation.
As documented by the WHO in 2017, the most polluted city in the world is Zabol in Iran and Delhi occupies the 11th place. Four Indian cities have made it to the top 10 list with Gwalior, Allahabad, Patna, and Raipur occupying the 2nd, 3rd, 6th, and 7th place, respectively. It is high time that reforms in-line with those implemented in Delhi be implemented in these cities to bring the pollution levels under control.
India could also look at more stringent regulation with heavy penalties for violators as in Singapore. Only allowing firecrackers such as rockets that burn from a considerable distance from the ground as in Sweden can reduce ground-level air pollution.
Furthermore, awareness and co-operation by the public are quintessential in achieving the goals laid down by the government and legislators. Flash mobs in public places such as malls before Diwali can be used to build public awareness regarding ill-effects of burning firecrackers. NGOs can be roped in to perform drama as a medium to build social awareness against firecrackers in schools and residential societies. A reward program can be built around encouraging children in the schools to become spokespersons to eliminate any use of firecrackers within their families and neighborhood.
In future pollution control would necessitate research in developing alternatives to pollution sources such as using drone light shows in place of fireworks.
Hence, the solution to pollution is not only legislation but also education.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]