Fireworks were special for me and my friends growing up. Now, as I watch kids at fireworks displays, from small community gatherings to those at the Washington Monument, the looks of awe and wonderment remind me of many years in my past.

But as wonderful as the experience can be, especially with the great improvement of professional fireworks, it can be equally tragic when fireworks critically injure someone. In the month around the Fourth of July, more than 5,000 people are injured severely enough by fireworks to be taken to an emergency room. As many as 10 times that number may go to a doctor’s office or use home treatment.

Not surprisingly, bottle rockets cause the most injuries. Because they are often erratic in their course and too often explode in the air, bottle rockets can injure bystanders as well as hurt the person lighting them.

The seemingly harmless sparkler is the second most common cause of injuries. That’s because sparklers can heat up to 1,500 degrees. When pieces of sparkler come in contact with the skin, they can often stick to the skin and continue to burn for a long time.

Also, not surprisingly, twice as many males are injured as females. And although the injury rate is much higher for preteens and younger, all ages, including elderly bystanders are subject to injury. Eye injuries, which can be caused by bottle rockets, sparklers and most other fireworks, are about one-fourth of fireworks-related injuries treated in an emergency room.

In case of injury, know what to do if you need emergency help. Know the location of the nearest emergency room and know how to get there fast – either by calling a rescue squad or driving yourself.

For less severe injuries, it may be better (and less expensive) to see your family doctor or to go to an urgent care center other than an emergency room. So before an injury occurs, please write down – near your telephone – your doctor’s office hours and the location and hours of the nearest urgent care center.

Learn what home treatment to apply (and not to apply) in case of injury. Buy a book and review what emergency medical steps you can take for each type of injury. And attend a local first aid course, if you can.

Because eye injuries are the most severe type of injury caused by fireworks, it’s critically important to know what to do.

John Jeffers, M.D., an ophthalmologist and member of the advisory board of Prevent Blindness America, recommends the following seven actions following an eye injury:

Don’t delay medical attention.
Stay calm, don’t panic, keep the child as calm as possible.
Do not rub the eye.
Do not attempt to rinse out the eye.
Shield the eye from pressure.
Avoid giving aspirin or ibuprofen for pain.
Don’t apply an ointment or any medication.

As with many other public health hazards, the safest way to prevent injury from fireworks is not to play with them at all. Go to community or regional fireworks displays where you can let fireworks professionals handle the job.

But even if you wanted to give up your enjoyment of having family fireworks, it’s difficult to get kids to play it safe at times of such energy and good fun. It’s especially hard when a parent or guardian is also distracted by all that’s going on.

Please take the time before the celebrating begins, and prior to buying any fireworks, to teach children about fireworks safety. Consider letting the ones who are most likely to be using the fireworks to be the teachers.

Use some of the information contained in this column to come up with a small quiz to give to children. Make passing the quiz a prerequisite to buying fireworks. Then have them be the teacher for all the other (probably younger) children.

Also, during fireworks, give your older children the responsibility of helping you look after younger siblings or other relatives. My experience is that it’s often easier to teach a 10-year-old, for example, to protect a younger brother or sister from injury than to look out for his or her own safety.

For more information about preventing and treating eye injuries, you may want to contact Prevent Blindness America. Its toll-free number is (800) 331-2020.

Preventing injuries, and even treating them rapidly, can be fairly simple and straightforward – not unlike the basic principles on which the United States and Canada are founded. But in both cases, unless we take them to heart and practice what we know, a tragedy may be the result.

Terrie Jean Cate died (or as her Mother put it, “was killed”) on August 22, 1992, while undertaking the opening day’s 6-mile training run she had prepared for all summer. It was the inauguration of her freshman soccer season at UC Irvine.

Her Mother has become active in promoting the education of coaches and administrators so that this tragedy is not repeated in the lives of others. One organization that has relayed her message is the National Youth Sports Safety Foundation, based in Needham, Massachusetts.

Heat stroke is an insidious problem and a very real threat that can reach fatal proportions. It is one thing to be active on a hot day, it is quite another to die from it.

Once an athlete is feeling thirsty, the need to hydrate is critical. There is a fine line between maintaining activity while still conscious and struggling along in a state of delirium. By the delirious stage, the athlete will not be capable of reaching the intelligent decision to quit. Someone else must intervene. Apparently, in the case of Terrie Jean Cate, no water was available on the course and no one intervened.

These simple practices should be used by athletes on hot days, especially and implemented by coaches, in charge of young athletes:
Provide fluids (water and electrolyte fluids such as Gatorade)
Provide frequent opportunities to drink
Keep the athletes in view of each other or the coach at all times

Female athletes may be more vulnerable for several reasons, both intrinsic and extrinsic. Many women experience water retention and resort to counter measures such as drinking less, or using diuretics. They must also operate under severe social stresses relating to their body weight. Being slightly dehydrated can lower body weight (although body fat remains the same!) and being lighter can seem like a head start to recording a faster time.

Indeed, the process of storing energy in the muscles requires water, so that a high carbohydrate diet can boost body weight by several pounds (although body fat, again, will be the same). In fact, dehydration of greater than 2% affects the body’s metabolism and will impair performance, especially if you don’t live to reach the finish line.

To quantify this, in round figures, an athletic schoolgirl might weigh around 100 pounds. Some 70% of body weight is water. Therefore, a 2% loss of bodily fluid is tantamount to being a “quart low”, as we tend to say about our car’s motor oil.

Danger levels tend to be slightly greater, perhaps 8-10% i.e., 10 pounds. Any athlete participating in an intensive pre-season regimen can easily lose a few pounds. The important thing to differentiate is how much of this is water and how much is fat. If it is water, the athlete becomes the proverbial “accident waiting for a place to happen.”

That is why well-organized teams, like the Brazilian national men’s soccer team, have a daily weigh-in of their athletes during training camp.

People never guess at what time an urgent situation will happen. Thus, safety officials recommends us to get industrial first aid kits in car, home, office, workplace.

White Out a Burn. After cooling a minor burn with cold running water, apply a thin layer of egg whites to the area and let it dry, says Steven Rosenblatt, M.D., a physician on staff at Saint John’s Health Center in Santa Monica, California. The egg’s proteins speed healing; reapply daily.

Get Cozy with Krazy Glue. Richard Marinson, M.D., a director of South Orlando Dermatology in Florida, recommends the sticky stuff for paper cuts and severely cracked skin. How to use it: Clean the wound, squeeze the edges together and apply a thin layer onto the surface of the skin. Hold the edges closed for a minute.

Bite through a Toothache. If your tooth is throbbing but you can’t get to the dentist right away, place a whole clove over the affected area and gently bite down.

The clove contains a natural anesthetic that will numb the pain and reduce the inflammation, says Doctor.

Soften up with Shortening. “In a pinch, Crisco works wonders on dry skin conditions,” says Doctor Smooth on a thin film after you bathe, then towel off any excess.

PMS Soothers

YOUR BEST BETS

Clean sleeping: This is the sleep equivalent of a good diet. It means making all the simple changes you can before doing anything more drastic. The guidelines: Eliminate caffeine (as much as possible); limit bedroom activities to sleep and sex; avoid naps; go to bed and wake up at the same time every day; don’t exercise or eat heavy meals less than three hours before bed; adjust the temperature and noise level in your room; and control your light exposure (expose yourself to bright light for 15 minutes after waking, but keep the lights low in the evening).

ALSO WORTH A TRY

Valerian: A few German studies suggest that this herb can help insomniacs sleep. However, most American scientists say more research is needed. If you’d like to try valerian, take 260 to 350 mg. an hour before bed. Warning: Avoid valerian if you’ve been drinking alcohol.

Melatonin: This hormone, usually secreted by the brain’s pineal gland, helps regulate your sleep cycles. Though the research has been mixed, one of the most recent studies found that taking exactly 0.2 mg. a few hours before bed does the trick.

Relaxation: No surprises here. Another tip: “Writing a worry list a few hours before bed can help you deal with troublesome issues while you’re awake — not when you’re trying to sleep,” says doctor.

First of all when someone is injured or sick try to stay calm. Remember that by staying calm you will help the injured person to be less afraid. If they can see that you are calm and know what to do they will be less anxious.

Situation:
You and your friend are near a wood stove and your friend, George, touches it without thinking.
Solution:
Run George’s hand under cold water immediately. If the burn looks severe and blisters form, call for help.

Situation:
Your friend Brandon’s coat hangs down in back and he has just backed up to the wood stove. The coat catches on fire and soon Brandon is in flames.
Solution:
Don’t let him run. Remember, stop, drop and roll! Do this until all flames are out and call 911 for help.

Situation:
You’re camping with your family and come upon a young child who has cut his hand, possibly on glass.
Solution:
If the cut is only minor then you can wash it out with soap and water. If the cut is deep, cover it with a clean cloth and apply pressure to the cut to control bleeding. Call 911 for help.

Situation:
You and your friend have been out in the sun too long, and Johnny develops a nosebleed.
Solution:
Remember the old way to solve this problem? The victim had to lay his head back and all the blood would drip down his throat. Today, there’s a better way to treat nosebleed. Have Johnny sit down and lean forward to prevent the blood from dripping down his throat. Take a handkerchief or clean cloth and place it over the nose. Apply gentle pressure on both sides of the nostrils for about 10 minutes or less. This should take care of the problem, but if not, call 911.

Situation:
Your little brother, Bradley, has just swallowed your father’s prescription mediation.
Solution:
Call 911 and the Poison Control Center immediately. Have the medication in your hand and read everything it says on the bottle to the person you are talking to. Do not give Bradley anything to drink until medical help arrives.

Remember by knowing some basic first aid skills you may save a person’s life. As you learn, you can also teach your friends, making the world a safer place for all of us.

If I got an itchy red bump on my skin that felt like a mosquito bite, but it was the middle of winter and I couldn’t remember being bitten, people would invariably tell me, “Oh, it’s just a spider bite. No big deal.” I never believed them, and you shouldn’t either.

First of all, the vast majority of spiders have fangs that are too small or too soft to penetrate human skin to any noticeable degree. For this reason, most people don’t know that a spider has bitten them. Second, spiders often have two biting styles: food-getting bites and defensive bites. The defensive bites usually happen too quickly to inject venom. Venom is the cause of the reaction, and most of what causes pain. So, if you can conclusively say that a spider has bitten you because you’re experiencing a reaction to it, accompanied by pain, it is a “big deal.” There are over 200 species of spiders in North America which are considered potentially dangerous, 60 in the US (4). The three species most commonly implicated in serious bites are black widows, brown recluses, and hobo spiders (1). Though not numerous, deaths have occurred from bites of all three of these spiders.

While the venoms of most individual species of spiders have not been extensively studied, the venoms of the black widow and brown recluse have been analyzed. Black widow venom contains a neurotoxin, which means that enough of it will paralyze the autonomically controlled muscles of the body, such as those involved in breathing, swallowing and heart rate. Without those functions, and without early detection and treatment, death is imminent. (This is why it is imperative to see a doctor immediately if you have been bitten by something and experience any of the symptoms of widow envenoming, which I will get to shortly). In the case of the brown recluse’s venom, the venom contains a necrotic agent, which means it kills tissues that it comes into contact with. However, as stated above, these are only 2 of 200 species of spiders in North America alone which can be dangerous. The hobo spider (also known as the aggressive house spider, species name Tegenaria agrestis) is one brown-colored spider which is often confused with the brown recluse, a dangerous mistake. The bites of both of these spiders create an ulcerous lesion at the site of the bite.

Systemic arachnidism is the poisoning of the entire body by spider venom. Many spider bites, especially those that are treated early, do not become this serious. By contrast, they are localized, meaning the venom only reached the tissues immediately surrounding the bite.

The venom, anatomy and physiology of all those spiders vary, and consequently the signs and symptoms of envenomation will vary depending on the offending critter. At this point, it would be wise to offer an approach to each spider individually, and then deal with general tips for the recognition and treatment serious bites.

The Black Widow

Everybody has heard of the black widow spider, and most people can recognize the signature red hourglass. So, I won’t go into too much detail here. Here are the quick facts on black widows:

Location: Black Widow spiders inhabit warmer regions of the world to latitude of about 45 degrees N. and S. There are several species of black widow, and so a different species will be found in California than in, say, Florida. But one species or another is found in all parts of the US.

Web & Behavior: The black widow web is irregular, showing no pattern, but the strands are stronger than that of all other spiders’ webs. The female black widow hangs upside-down and rarely leaves the web, which is why she is the most often seen and is also easily recognized. They are shy and nocturnal, and not aggressive. However, they may rush and bite if the web is disturbed or when accidentally trapped in clothing. The most often locate themselves outside, on the underside of ledges, rocks, plants and debris, but could be anywhere. Cold weather and drought may drive these spiders into buildings (6). The black widow, unlike the hobo spider, doesn’t have to attack its prey. Once the prey has exhausted itself in entanglement, it makes small punctures in its victim’s body and sucks out the liquid contents.

Appearance: The female is glossy black, with a blood-red hourglass shape on the underside of her abdomen. Her body is about 1.5 inches long. Adult males are harmless, half as big as females, with smaller bodies, and longer legs. The male is marked by four pairs of red marks along the sides of the abdomen.

Symptoms: The black widow’s venom is 15 times more toxic than rattlesnake venom. The bite itself is sometimes painless and may go unnoticed. Here are the symptoms of Black Widow systemic envenomation:

* Dull, numbing pain following the bite
* Cramping & muscular stiffness in the chest, back, shoulders and abdomen
* Alternating salivation and dry-mouth
* Breathing difficulty
* Profuse sweating
* Weakness
* Nausea and vomiting

Treatment: Antivenin is available, and either that or calcium gluconate can be prescribed to relieve pain. Most people recover in two to five days. For immunocompromised people, elderly, and children, clean the site well with soap and water. Apply a cool compress over the bite location and keep the affected limb elevated to about heart level (but not above). Aspirin or Tylenol may be used to relieve minor pain and swelling, and muscle relaxants can be given to reduce cramping. Hospitalization may be required for children less than 5 years old or for adults with severe symptoms.

The Brown Recluse

Location: The brown recluse spider is most common in the western and southern United States. It is often found under stones or in the dark corners of buildings.

Web & Behavior: The brown recluse spider just as shy as the black widow, and only bites humans when trapped in clothing or rolled onto when people sleep in bed.

Appearance: They are pale-colored and about 7mm long, with a leg span of about 2.5cm (1 inch) and a dark violin-shaped design on the back of its thorax.

Symptoms: Pain does not usually occur with the bite, and not for 2-3 hours afterwards. The location of the bite will blister, with intense localized pain and tissue necrosis, as the area becomes ulcerous. A brown recluse bite may go unnoticed for 6-8 hours before any reddening, swelling or blistering of the wound starts to appear. The area around the bite may become red, painful and itchy. The occurrence of additional symptoms depends upon the amount of venom injected by the spider. A severe bite can produce a necrotic lesion that may require surgery.

Diagnosis: The venom destroys the walls of the blood vessels near the site of the bite and causes a skin ulcer several inches in diameter. Differential diagnosis between brown recluse bite and hobo spider bite depends upon geography; symptoms are extremely similar, but there are areas where only recluses are found, and not hobo spiders (and vice versa).

Treatment: Although an antidote for brown recluse venom has been developed, it is not widely available and it appears to be most effective before the lesion develops. Antibiotics may be used successfully to control the ulceration without surgery. Prompt medical attention is critical to successful treatment of the bite.

The Hobo Spider

Location: The hobo spider is actually native to Europe, suspected to have been introduced into the ports of Seattle, Washington, in the 1920′s or ’30′s. It is currently found in all states west of the Rocky Mountains, and as far north as Alaska. High level of hobo activity has occurred in Washington, Oregon, Idaho, Montana, Wyoming, Utah, Colorado, Southern British Columbia. Some hobos have been identified in the Mid-West and North-Eastern US.

Web & Behavior: Hobo spiders build funnel-shaped webs in dark, moist areas. Hobo spiders especially like woodpiles. If you have a wood burning fireplace, be sure to brush off any spider webs before bringing firewood into the house. Keep your woodpiles away from the house. Compared to other species, the hobo spider’s webs are not very sticky. Food which lands in the web does not get stuck; instead, the vibrations alert the hobo spider which is hiding inside the funnel, and it quickly runs out and attacks its victim. Because this is how it eats, it must be very fast (up to 1 m/second) and aggressive, which explains why it appears to be more aggressive towards humans than most spider species (1, 2).

Hobo spiders very rarely climb vertical surfaces and are uncommon above basements or ground level. They are not good climbers, although they’ve been known to do it. They are commonly found in bathtubs because they found a way in but were unable to scale the slick sides of the tub to get out.

Appearance: Hobo spiders are moderately large (7-14 mm body length; 27-45 mm leg span). They brown overall, with no rings or markings of any kind on their legs. However, their bodies are marked with gray or pale brown marking.

The one on the left is male, which is more venomous than the female (on the right). While all kinds of hobo spiders are dangerous, you may like to know how to identify a male. The male has long “palps” that look like boxing gloves coming out of its front end. The abdomen of the male is also smaller than that of the female.

Symptoms: Bear in mind that up to 50% of hobo bites are dry, meaning that no venom was injected. These bites are not included. The hobo bite is often painless but can produce a slight prickling sensation. Migraine headaches often occur in this kind of spider bite. A small area of induration (hardened tissue) may occur around the bite at a diameter up to 15 centimeters (almost 6 inches) in the first 30 minutes after the bite. This hard area can be white or red and may expand gradually. After half a day or a day-and-a-half the point of the bite blisters, and a day later, the blisters may break and weep. It scabs over, but tissues beneath the scab continue to die (spreading necrosis). The ulcer can be as much as an inch across.

A word on necrosis: the hobo’s venom, as well as any kind of necrotic venom, causes immediate and severe coagulation of blood around the bite, causing oxygen deprivation in the tissues at the middle. This is the precise mechanism by which the venom causes tissue death.

Diagnosis: Conclusive diagnosis is virtually impossible without the culprit. Hobo bites are necrotic, just like the bite of the brown recluse. However, there are many places where only one or the other spider lives (i.e., hobos are more common in the West, and brown recluses are not found there at all), so diagnosis is inferred from location and symptoms.

Treatment: Surgical repair is sometimes needed, but permanent scarring is very common. Hobo spider bites generally require only local wound cleaning, topical antibiotics and tetanus prophylaxis to control the open wound.

First Aid for Most Spider Bites

According to the CDC, “optimal treatment for necrotic spider bites is not well defined” (1). In other words, because the spider is rarely recovered, and spiders and their bites are so various, it is difficult to say what will work for all spider bites, especially necrotic ones. Treatment for spider bites is usually symptomatic, meaning that all they can really do is treat the symptoms, not the poisoning itself.

* Find out if the victim saw what bit them, and have someone else track it down and capture it (Be sure to do this with gloves on, and secure the spider in a glass jar from which it can’t escape!)
* Wash the area of the bite with soap and water and apply a cold compress (an artificial cold pack, an ice pack, or even a bag of frozen peas or corn will do). The cold will control both pain and itching.
* Find out if the victim is experiencing the following:

o Severe dizziness
o Fainting
o Trouble Breathing
o Nausea
o Vomiting
o Trouble Swallowing

If the answer to any of these is “yes,” take them (and their little attacker when possible) to the hospital immediately.
If the answers to those questions is “no,” then the bite is not systemic or life-threatening. Oral antihistamines like Benadryl can be taken to control the swelling, itching and burning (all of which are also characteristic of any kind of allergic reaction). NSAIDs can be taken for pain. If the area is not too sensitive to touch and the skin is not ulcerous, calamine lotion or topical steroid cream can be used to relieve itching.

If your bite doesn’t appear serious and you decide not to seek medical attention, watch for the following over the next couple of days:

o No improvement within 3 days
o Any infection developing
o A peculiar rash appearing

See a doctor if any of these things occur.

Case Study

Up for a little medical sleuthing? Remember I said I had been bitten? Here’s what I experienced. You can draw your own conclusions about what bit me.

Location: Indoors in southern British Columbia, Canada.

Spider: Unidentified.

Incident: Experienced an extremely sharp, stinging/pinching pain just underneath the sleeve of my t-shirt in the middle of my bicep. Immediately pulled back the sleeve, but found nothing. Immediately removed my shirt and shook it out, but still couldn’t see anything.

Symptoms: Inspection of the bite revealed a tiny but deep purplish-red pinprick which hurt to touch. A hard, white area around the miniscule bite mark began to spread and swell. The area was hard as a rock, and within 20 minutes had become 3 inches in diameter and raised above the usual surface of my arm by at least a centimeter. The slightest pressure on any part of this hard area caused deep, spasmodic prickling pains throughout the entire area. The entire area was burning hot, even to the touch. I had to keep ice on it constantly, even while driving to get help. The area remained swollen for three days, gradually decreasing in diameter.

Treatment: After consulting with a doctor, “spider envenomation, vector unknown” was the diagnosis. I was instructed to keep ice on it until I was comfortable without it, and to take oral antihistamines. It was 24 hours before I could do without the ice at all times.

This was not a pleasant experience, especially when it didn’t seem to get better very quickly, and they told me they couldn’t do much for me. I was lucky; the poison was localized. If you are bitten, just remember the warning signs of systemic arachnidism, and seek help if you are at all concerned.

One of the best things you can do help yourself be “lucky” is have a first aid kit. If you have a kit take a look at it. Have all the items been used and all that’s left are a couple Band-Aids? Is the kit from your grand father’s experience in World War II? Or may be you’ve never got around to putting a kit together?

Well, here are some helpful ideas that could be potentially lifesaving. First, the supplies should be kept in a convenient place in your home, and all family members old enough to use them should know where they are. Remember to try and keep those items in a separate box so they don’t get used for other purposes. In addition, some items in the first aid kit are potentially dangerous for children, so keeping the box locked or out of reach is also a good idea.

You might buy prepackaged first aid kits or to assemble your own from items that you probably already have on hand. Having a separate carrying case for them is a good thing. First they can be easily transported when needed in an emergency and second, if you only use the kit for emergencies, then you will know you have everything you need to deal with the situation.

Also, in this case, more is probably better, so here is a detailed list of items you might want to consider putting in your first aid kit.

* Thermometer
* Tweezers
* Hand cleanser/soap
* Scissors
* Safety pins
* Bulb syringe
* An accurate measuring device
* Adolph’s Meat Tenderizer
* Insect repellent
* Disposable latex gloves
* Disposable, instant ice bags
* Paper tissues or a roll of toilet paper
* A lightweight blanket
* Aloe vera gel
* Children’s and adult’s decongestant and antihistamine
* Hydrogen peroxide
* Rubbing alcohol
* Eye drops
* Lip balm
* Pepto Bismol (for upset stomachs, diarrhea)
* Antacid tablets
* Dramamine
* Acetaminophen (children’s and adult’s pain reliever)
* Antibiotic cream
* Laxative
* Sun block
* Syrup of Ipecac (to induce vomiting in case of poisoning and give only when directed by the Poison Control Center or the doctor)
* Activated charcoal to absorb poisons in the stomach (give only when directed by the Poison Control Center or the doctor)
* Petroleum jelly
* Prescription medicines, and their prescriptions
* First aid manual
* Change for a telephone call
* Adhesive bandage strips or surgical tape
* Butterfly bandages
* Elastic wraps: for the wrist, ankle, knee, and elbow
* Adhesive tape
* Sterile cotton balls, eye patches and gauze pads
* Adhesive and gauze wrapping in rolls
* Triangular bandage: for wrapping injuries and making a sling.
* Flashlight with extra batteries
* Penlight
* Identification card listing your name, address, phone number and the name and phone number of someone who can be contacted in an emergency
* Medical insurance card
* Telephone numbers for your doctors
* Paper and pencil
* Razor blade
* CPR Shield
* Paper cups

In addition, you should keep a first aid kit in your car and make sure to take one when traveling, especially if you are going to be outside (i.e. hiking, camping, etc.). A few minutes of preparation and a couple bucks invested in a kit is a small price to pay for peace of mind. Remember the life you may be saving could be your own.