EMS Response to India Fireworks Tragedy was Hindered by Lax Standards Enforcement

The time was 3:30 am on Sunday, April 10, 2016. At the Puttingal Hindu temple grounds in Kerala, India, the fireworks show that had been going on since 11:00 pm the night before was just about to wind down. The temple grounds and surrounding areas were filled with throngs of people watching the display, though many of the 15,000-strong crowd had already left. Suddenly, there was a huge flash, multiple loud explosions, and then complete darkness with the acrid smell of smoke and burnt flesh filling the air. Shrieks, moans and cries for help from the many injured and dying victims could be heard above the din of yells and shouts of confused people trying to get away. Eyewitnesses related that charred bodies and human remains were strewn around the temple complex amidst chunks of concrete and metal missiles from the walls and roof of the building in which the fireworks had been stored.

The scene was one of total chaos in the flickering lights and bellowing fire, with people running in all directions in utter confusion. Initial rescue efforts were started by the public, and police officials on scene carried the injured by hand and transported them to nearby hospitals in whatever vehicles they could find. Over the span of a few hours, the extreme chaos gradually gave way to a more orderly relief operation.

Personnel from the Air Force, Navy and National Disaster Response Force (NDRF) joined the Kerala police, disaster management teams and fire brigade on the scene for rescue and relief work.

Four Air Force helicopters joined the rescue operation in addition to the Indian Navy’s six helicopters and medical teams. The Indian Navy deployed three ships with medical teams and supplies and the Indian Coast Guard dispatched one ship loaded with medical team and supplies.

EMS response to India fireworks tragedy

As of April 21, 111 people had lost their lives and more than 400 sustained injuries including severe burns and crush injuries from flying concrete debris and the resulting stampede that followed the explosions.

Initial Cause

One of the aerial shell fireworks, called “amittu,” which was supposed to explode in the air and fizzle out, instead fell to the ground raining sparks that caused a fire, which quickly spread to the remaining fireworks stored in the storage building nearby. The explosion threw large chunks of concrete even as far as a mile away, causing many deaths and destruction to property. To top it all, as bystanders were attempting to rescue the injured, the storage building itself collapsed, causing even more deaths and injuries.

EMS response to India fireworks tragedy

Fireworks and, often, firework competitions are an integral part of a large number of Indian festivals. This is not unique to Hindu festivals alone, but is practiced at Christian and other religious celebrations, and on New Year’s Eve, Independence Day and even at weddings.

At the Puttingal temple, every year, there is a fireworks face-off between two groups trying to outdo each other–each competing to see whose fireworks are grander, explosions are louder and the sights more magnificent. The fireworks display usually involves firecrackers, fountains, rockets, air bursts, air shells, concussion mortars, comets and more to stimulate and thrill the visual and auditory senses of the spectators.

In 2008 the Indian government enacted the Explosives Rules, which has strict guidelines for manufacture, transport, possession, storage and use of explosives and fireworks. These guidelines mandate the amount of sulphur, nitrates and aluminum powder in firecrackers. There are also clear guidelines on permission process, location of fireworks, proximity to public and other buildings, and distance requirements for spectators. However, the implementation and enforcement of these regulations and processes are, in most cases, nonexistent.

EMS response to India fireworks tragedy

In the case of Puttingal temple, the district official had reportedly denied permission for any kind of fireworks this year in light of increasing incidents in the state of fireworks-related accidents and allegations of use of banned chemicals and explosives in the local manufacturing of these fireworks. The temple administrative board–which is very powerful and politically well-connected–is alleged to have used these powers to have police and government officials look the other way and ignore complaints from concerned members of the public and residents.

Lack of Oversight

Fireworks-related accidents are not new to India. The recent increase in the number and severity of such accidents has officials concerned, and renewed efforts are underway to enforce existing regulations and introduce new legislations restricting the current widespread use of heavy fireworks.

EMS response to India fireworks tragedy

In the U.S., federal, state and local authorities govern the use of display fireworks. At the federal level, the National Fire Protection Association (NFPA) sets forth the set of codes that stipulate the minimum standards of display fireworks use, and state and local governments add further restrictions. Although requirements vary from state to state, licensed operators and their crew are typically required to have hours of extensive training in the safe use of display fireworks. These codes can include distance from the audience, maximum size shell, firing location requirements, electrical firing system requirements and the minimum safety gear to be worn by the fireworks crew (as explained in the NFPA 1123 fireworks code).

Accidents do happen in spite of the most elaborate of precautions taken, but in this case, the heavy death toll and damages could have been averted if the guidelines were followed and the regulations enforced by the authorities.

EMS response to India fireworks tragedy


EMS in India is still in its developmental stages, and the level of services available varies from state to state and location to location. Immediate disaster medical response, mass casualty incident response and triage; and incident command systems are not widely practiced. The government and many NGOs dedicate a lot of resources toward optimizing these systems, and a steady evolution into an international level of care is gradually being achieved.

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George P. Abraham, MD, FRCS, FACS, FWACS, MHA, is a member of the JEMS International Editorial Board representing India. George is Medical Director of Western Alliance EMS System; President and Managing Trustee of the Indian Institute of Emergency Medical Sciences; President of the International Institute of Emergency Medical Sciences; and an Official with the Association of Asian EMS.

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