Fireworks and pressure on healthcare: are we applying double standards?

When the clock strikes twelve on New Year’s Eve, emergency departments in the Netherlands brace themselves. The next morning, newspapers invariably carry headlines in big red letters: “Code red in A&E: more than 1,200 fireworks casualties treated!” Moral outrage immediately follows. Politicians demand total bans, the anti-fireworks lobby celebrates, and talk shows fall over themselves discussing how dangerous our traditions are. In public opinion, fireworks have become the ultimate destroyer of healthcare.

But anyone who sets emotion aside and looks at the official injury statistics soon discovers a bizarre paradox. Why does the whole country erupt over the casualties of one festive night, while we consider a massive daily stream of serious injuries from everyday activities completely normal?

Fireworks injuries and cycling accidents

Let’s put the figures from knowledge centre VeiligheidNL into perspective. During a traditional New Year celebration, around 1,200 fireworks casualties are recorded that night, most of whom can actually be treated directly by a GP. That is distressing, and every casualty is one too many.

But imagine an activity in which almost 81,000 Dutch people are injured so badly each year that they need urgent hospital treatment. An activity that causes hundreds of deaths and more than 14,000 serious brain injuries annually. We would ban it immediately, wouldn’t we?

Welcome to the world of the Dutch cyclist. With an average of 220 emergency cases per day, every single day of the year, cycling takes an enormous toll on healthcare. Where are the talk shows about the “cycling epidemic”? Why don’t we demand a nationwide cycling ban or a strict alcohol ban on two wheels with the same aggression we use when discussing fireworks? The answer is simple: we have decided this bloodbath is acceptable because cycling is convenient for our lifestyle.

Alcohol at New Year

The hypocrisy surrounding New Year’s Eve itself may be even more outrageous. Overcrowded hospitals are blamed entirely on fireworks, but the Dutch Association of Emergency Physicians (NVSHA) has been sounding the alarm for years about the real culprit: alcohol.

Hundreds of Dutch people end up in A&E that night with acute alcohol poisoning or serious injuries from alcohol-related fights and falls. Doctors even report that a considerable proportion of “fireworks casualties” are injured because they were simply messing around carelessly while drunk.

If a firework rocket causes an injury, the country screams for a total ban. But when dozens of minors are admitted unconscious from binge drinking that same night, there is silence. Nobody proposes restricting beer and champagne sales to relieve healthcare. Why not? Because drinking is socially accepted. We accept alcohol abuse overwhelming services as long as we can keep raising our own glasses.

Dog bites and medical care

If pressure on healthcare really determines what we ban in this country, there is another blind spot: our pets. In the Netherlands, an estimated 150,000 people are bitten by a dog each year. A full 40,000 to 50,000 of them need medical care from a GP or in hospital.

That averages more than 400 biting incidents per day. Every year, thousands of people — very often young children — end up in A&E or with a plastic surgeon with torn faces, deep infections and permanent disfigurement. If we extended the logic of a fireworks ban (“it causes medical suffering, so get rid of it”), there would have to be a nationwide ban on dogs tomorrow. But that does not happen, because dogs are good company and we love them.

A visible peak in healthcare demand

The selective anger surrounding fireworks casualties has very little to do with public health and everything to do with culture and psychology. Fireworks are concentrated: the injuries occur within a few hours. That creates a short, sharp peak that is highly visible on television.

But across an entire year, that fireworks peak is a statistical ripple in the enormous wave of road casualties, alcohol poisonings and dog bites that keep healthcare continuously occupied 365 days a year.

Conclusion

As long as we are willing to accept thousands of casualties annually on cycle paths, in pubs or from pets, the moral panic over that single night of fireworks is pure symbolic politics. We target the rocket while leaving the bottle, the bicycle and the dog safely out of the firing line. It is an easy distraction for the government: take away people’s celebration, and it looks as though you are saving healthcare while the real daily bloodbath is quietly allowed to continue.