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A beautiful wedding ceremony this summer was disturbed by the loud and tearful protestations of the 3-year-old flower girl. When her grandfather asked her what was wrong "Don't you like your party dress?" the little girl sobbed and informed him that she really wanted to be a carrot. Apparently she had mistaken the dressing up and pageantry of the wedding for Halloween and had set her heart on being a root vegetable.
Perhaps the little flower girl will get her wish on Oct. 31, when she and thousands of other excited youngsters don costumes, apply makeup and engage in the tricks and treats of Halloween. Over the course of the evening, vampires, ghosts and superheroes of all ages will parade through neighbourhoods, fire stations, school gyms and, not infrequently, hospital emergency departments in their quest for candies and sweets.
Health care workers who have worked in the emergency department on Halloween night know that it can be an exceptional evening for both ordinary and extraordinary presentations. Physicians need to keep their humour in check and proceed with a higher than normal index of suspicion in order not to miss the usual array of chest pains, syncopal episodes and abdominal discomforts disguised in overweight clowns, bedraggled witches, plump pumpkins and spindly carrots. The literature can assist with identifying some of the more unique risks of Halloween: ocular injuries from flying eggs,1 flatus from Gummy Bears2 and intestinal perforations from sewing needles.3
The last category of injury, which occurs when foreign bodies are purposely placed in treats, may be the most publicized Halloween hazard, but a review of available studies indicates that such events are quite rare and the risk may be exaggerated. Observational studies designed to assess the yield of routine radiologic screening of Halloween candy demonstrated the likelihood of finding a radiopaque item to be very low and reported no cases of significant medical problems.4,5
Perhaps we are looking for risks in the wrong places. According to the US Centers for Disease Control and Prevention (CDC), in Atlanta, the main risks on Halloween night are much more pedestrian and obvious. Children are 4 times more likely to be struck by cars on Halloween than on other nights.6 An analysis of childhood pedestrian deaths in the United States from 1975 to 1996 revealed a fourfold increase in the number of deaths on Halloween evening when compared with the same period during all other evenings.6
The reasons for this are many and varied. Children are out in the dark wearing dark costumes, many of which restrict peripheral vision and hearing. They also are excited and distracted and tend to take the shortest rather than the safest route when crossing streets and negotiating traffic.
To reduce the risk of harm, the CDC has compiled a common-sense list6 of safety tips that should be reviewed before Halloween night.
Pedestrian safety
General safety planning
References
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