As any ER doctor may tell you, the 4th of July is one of the busiest days of the year. The amount of injuries that can happen on Independence Day is unsurpassed by any other holiday, and that is all thanks to one key difference: fireworks. Yes, fireworks are most definitely essential to celebrating the Fourth; what better way to celebrate our independence than loudly declaring it to the heavens that we are a proud, free nation? But as gorgeous as fireworks are, we tend to forget that, fundamentally, they are explosives.

According to Dr. Buck Parker, a trauma surgeon and one of the stars on NBC’s The Island, there are a wide range of injuries that can happen at your family BBQ this Saturday. “In the summer, you have an increased incidence of burns, and they’re usually in the first week of July. Most of these are from fireworks,” he said in an interview with Medical Daily. Working in trauma, Parker often sees some of the worst cases the 4th of July can bring him. “Every once and a while, we’ll see something bad, like a finger gone, or a third degree burn,” he says. “We’ve also seen some injuries to the eye. I’ve seen people who have had their eyes burned.”

Other than your typical burn, which can get very bad, Parker says a lot of injuries occur to the legs when someone is standing too close, or to the face if someone goes to look at a firework that has seemingly malfunctioned. Dr. Joseph Sliwkowski of CareWell Urgent Care added that many particularly concerning accidents are happening with young children. “About 30 percent of the time, [those lighting fireworks] are below age 14, with 10 percent between the ages of 5 and 10,” he said to Medical Daily. “Even just a sparkler can get up to 2,000 degrees. I have seen some significant second to third degree burns since they get so hot.”

Sliwkowski also mentioned that he’s seen firework-related accidents cause damage to hearing. “Some of the bigger fire crackers can produce a sound at about 110 to 120 decibels. This can damage your hearing nerve, and it can be permanent,” he said. “With any kind of explosion, typically you will get a ringing that goes on for several days, but in some cases the damage can last longer.”

As if the sound of burning your eye isn’t enough, there have been a lot of worse injuries out there that have resulted from fireworks. So, to fully scare you into being safe with your assorted rockets, and fire crackers, I have compiled a list of some of the worst injuries to ever result from our favorite Fourth tradition. A thing to remember before reading the list: a little common sense goes a long way.

Simi Valley Incident

In a 2013 incident in Simi Valley, Southern California, a fireworks display quickly went wrong as 39 people were injured when fireworks began to explode within the crowd. Children as young as 17 months, and adults as old as 78 received an assortment of wounds from flying shrapnel, and subsequent trampling during the mass exodus out of the park. Out of the 39, 12 proved to be children, while three remained hospitalized after the accident.

Police officials reported that the accident was most likely caused by a firework exploding prematurely in its mortar, knocking over a wrack filled with other fireworks and causing them to scatter and explode among the audience. While no one was seriously injured, many were left shaken by the event. Paulina Mulkern, a spectator who experienced some burns, told Huffington Post, “I was really terrified. Every time someone launched a firework it got me into panic mode and they just told me, ignore the sounds around you and concentrate on your breathing.”

Similarly, many others reported experiencing 4th of July shellshock after the event. Whether or not they watched firework displays again after the incident is hard to tell, but I know that if it were me, I certainly would not.

4th of july fireworks Michael Ostendorp, CC BY-ND 2.0

A San Jose Man Loses His Right Hand and Most of the Left

In a 2014 accident in Northern California, 40-year-old Alazar Ortiz lost his right hand and most of his left due to defective, illegal fireworks. The LA Times reported that Ortiz was trying to put on a personal display for his family in his driveway, when a mortar-style firework exploded right in his hands.

“I didn't know what I had left," Ortiz said to San Jose Mercury News. "So I tried to move my fingers, and I went, 'Wow. I don't have any fingers."

Doctors were forced to amputate Ortiz’s right hand, while being able to salvage two fingers on his left. The San Jose resident formerly worked as a construction worker and was subsequently put out of a job, due to the incident.

Parker says that injuries to the hand are common on the 4th. He explained to Medical Daily that hand injuries will either happen when, “someone is holding [a firework] too long, or they’re picking them up after they’ve been lit. Or sometimes if it looks like a dud, someone will then go to pick it up after it’s been lit.” He adds that holding a firework is an almost guaranteed way to hurt yourself, and that no one should touch a firework after it has been ignited.

A Man Is Decapitated In Fargo

Forty-one-year-old North Dakota resident Jesse William Burley literally lost his head on the 4th of July, 2011. The father of two was lighting fireworks at the Riviera Heights mobile home park, while neighbor Chris Hanson watched on in terror. Hanson reported to police that he left his home when heard Burley light off one firework that caused a huge bang, and watched on as he went into the middle of the street to light another.

"Within 10 seconds of us talking to him, he lit it and all we saw was a cloud of smoke, a bang," Hanson said, to NBC News. "When I walked up to his body, it was nothing but his shoulders down."

Authorities are still not sure whether Burley’s handling of the fireworks caused the accident, or whether it was a manufacturing error.

Sparklers on the 4th Jeff Turner, CC BY 2.0

A 19-Year-Old Dies When A Firework Hits Him In The Face

Recent newlywed and new father, Austin McCloud was celebrating the 4th in 2011 with family and friends when a firework display went terribly wrong. According to Daily Mail, the native of Skiatook, Okla., went to light an elaborate, multi-shelled firework that was supposed to send many different projectiles souring into the air. However, once McCloud ignited the fuse, the fireworks exploded on the ground, hitting him in both the face and throat. Authorities believed the fireworks were misfired at the time they hit McCloud, because another nearby person was hit as well.

When family members called 911, and EMTs arrived on the scene, McCloud was already without a pulse. He unfortunately died on the way over to the hospital, says medical professionals involved in the incident, leaving behind an 18-year-old wife, one stepson, and a 2-year-old son of his own.

A Teen Goes Blind In One Eye

During a firework incident unrelated to the 4th of July, a UK teen was severely maimed by a firework. The 14-year-old boy was playing with friends in a Manchester park when an unidentified man launched a firework rocket directly at the boy. When hit, the boy collapsed as his friends quickly called for help. Once the boy arrived at a nearby hospital, doctors struggled to save his eye, but in the end could not, leaving him blind on one side.

What’s more, authorities are saying this was a deliberate attack. After the man had launched the firework at the teen, he was seen fleeing the park. “This is an inexplicably savage attack and I have to say that while it is tragic that this boy has been blinded in one eye, it is also fortunate that nobody was killed,” said Detective Constable Jon Marsh to Mirror. The assailant’s motives are still unknown.

So how do you prevent a trip to the emergency room this 4th of July? Chances are, forward thinking, and some necessary sobriety, you can set off your firework spectacle, injury-free. Sliwkowski suggests, “Definitely keep a bucket of water, or a fire hose handy because you want to have that ready to go.” Similarly, Parker noted, “Keep the kids away, and make sure you have a lot of room.”

Remember, this is the one time of year you are allowed to set off something potentially explosive (depending on your state firework laws of course), but just make sure that when you send those rockets soaring into the sky, you don’t go soaring with them.