War-like injuries: doctors under constant stress on New Year's Eve

Torn-off fingers or hands, severe burns to the face, destroyed eyes. What doctors see on the operating table on New Year's Eve is something they are only familiar with from war surgery. "These are injuries that happen on the front line in Ukraine. We know what they look like because we provide interdisciplinary care to Ukrainian soldiers here," says Professor Adrian Dragu, Director of the Department of Plastic and Hand Surgery at Dresden University Hospital.

"First comes the pressure wave, then the heat"

Five people died in Germany on New Year's Eve 2024 in accidents involving firecrackers - two of them in Saxony. They were killed by so-called ball bombs. "Every explosion is accompanied by heat and a burn," says senior physician Tim Fülling, describing a specific problem. According to the doctor, the injuries actually occur in stages: "First comes the shock wave, then the heat." This is why complex surgical techniques often have to be used at the turn of the year that are different to those used in normal clinical practice.

Every year, doctors at Dresden University Hospital have to treat up to 30 patients with such injuries in the days around New Year's Eve. They then have to rely on something that also comes from military and disaster medicine: Triage - the selection of patients according to severity of injury and urgency, because too many end up in the emergency room. Fülling: "We then have to decide which injury to treat and in what order."

Injuries mainly to the hands and face

Sometimes patients have injuries to their hands and face - in places that are not protected by clothing. Alcoholized men under the age of 25 are particularly affected. Children also suffer, for example when they play with unexploded bombs in the days after the New Year. Accidents involving homemade pyrotechnics are not uncommon. In recent years, there have been several patients who have blown their entire hand off, says Fülling.

To this day, the senior physician is treating a man who lost several fingers to a firecracker in 2024 - but not on New Year's Eve. He had wanted to blow up voles in his garden with ball bombs. He is now being fitted with prostheses. In most cases, severed limbs can be reattached, although the ability to function usually remains limited afterwards.

The best way to perform replantations - the surgical reattachment of amputated limbs or tissue parts - is when you are dealing with a smooth cut without major damage to the tissue, explains Fülling. "That is the ideal case. But tissue is often lost in explosions or burnt on the wound." Sometimes tissue has to be transplanted from other parts of the body.

"Our biggest concern is infection"

An explosion injury is complex because the doctor has to master the entire spectrum from microsurgery to bone surgery, emphasizes Fülling. The contamination of the wounds is also a major challenge. Patients do not normally come to hospital with a "clean" wound. "Our biggest concern is infection. We are also familiar with this from war surgery."

Ramin Khoramnia, Medical Director of the Clinic and Polyclinic for Ophthalmology, has little to do with replantations. "If the eye is no longer in the eye socket, it cannot simply be "put back in"." The professor admits that New Year's Eve is the worst night for him and his colleagues. The injuries can vary greatly - from minor burns to a completely destroyed organ, for example if a rocket explodes directly in front of the eye. In more than half of the cases, people were affected who had not set off the rocket themselves, often unfortunately children.

"During the first procedure, we have to close the wound so that no pathogens can get in," says Khoramnia. Visual acuity or restoration of vision can only be addressed in a follow-up procedure. "First of all, the eye must be preserved as an organ." Once the wound has healed, another operation is usually performed a few weeks later. The aim is then to preserve as many functions as possible.

"After midnight, the crowds arrive"

The same exceptional situation can be seen in Chemnitz year after year. "We often have relatively few patients on New Year's Eve, but the masses arrive after midnight," says Thomas Baitz, senior consultant at Chemnitz Hospital. While around 80 patients come to the emergency department on a normal day, there are regularly around 120 on New Year's Day - an increase of up to 40 percent.

Injuries that would otherwise hardly play a role are particularly noticeable. "Fractures of the skull and facial bones as well as amputations of the hand and wrist are suddenly among the top diagnoses on New Year's Eve," says Baitz. Alcohol is often added to this: "A very treacherous combination with fireworks."

According to the senior physician, serious eye injuries also play a major role in Chemnitz. On New Year's Eve, several people regularly have to be admitted to hospital due to eye injuries. "This is otherwise extremely rare," says Baitz.

"Never seen before" - a burden for hospital staff too

The most serious cases stay with the team for a long time. "I've never seen that before - two hands almost blown off," recalls Baitz at the turn of the year. Such injuries are practically unheard of in normal hospital routine.

The Leipzig University Hospital has similar experiences. Here, too, the number of patients in the Central Emergency Department on New Year's Day is regularly around 40 percent higher than on New Year's Eve or a normal December weekend. At the turn of the year 2024/25, this corresponded to an increase of 142 patients.

Eight-year-old in Leipzig loses finger

Around the turn of the year 2024/25, numerous people were again treated with firework injuries in Leipzig, including several with serious hand injuries. Among those treated as inpatients was an eight-year-old boy who had several fingers torn off by an unexploded bomb.

An evaluation by Leipzig University Hospital over ten years shows just how serious the consequences can be: almost half of those injured suffered permanent loss of function, and almost a quarter required surgery. The hands were most frequently affected.

Cool severed fingers, but do not transport them on ice

According to Dresden-based hand surgeon Dragu, it is important to act quickly and take a structured approach after an accident involving pyrotechnics. This is not easy, especially with intoxicated patients. Witnesses should administer first aid measures such as the recovery position in the event of a minor injury. In serious cases, however, the victim should be taken to hospital immediately. Dragu advises that severed fingers should be transported in sterile bags and refrigerated - but never on ice. A frozen finger is biologically destroyed.

The three doctors are in favor of a strict ban on firecrackers. "We are talking about exploding costs in the healthcare system, a shortage of resources in care. And then we allow ourselves as a society to push the healthcare system to its limits on a few days a year and drive it into a corner because firecrackers are sold freely. That doesn't make sense to me," says Dragu. "First and foremost, we also need to protect bystanders," adds Khoramnia.

Dragu, Fülling and Khoramnia advocate taking other countries as an example and setting off a central firework display or ushering in the New Year with laser or drone shows. With professional fireworks, the risk is close to zero, says Khoramnia. The fact that anyone can set off fireworks for two days in Germany is simply absurd from an ecological, financial and health policy point of view, almost Dragu summarizes the diagnosis of the medical experts.