Mumbai: While homes light up and families gather to celebrate Diwali, emergency departments across hospitals are preparing for a very different kind of festive rush. Burns from firecrackers, blast-related eye and hand injuries, road accidents and a spike in respiratory complaints are among the emergencies doctors anticipate as celebrations gather pace.
For hospitals, the challenge is not just managing a higher patient load. It is being ready when several emergencies arrive simultaneously, ensuring trauma teams, operating theatres and critical care units can respond without delay. The pressure extends beyond the emergency room, with firecracker smoke adding to deteriorating air quality and raising the risk of respiratory complications, particularly among people with asthma, COPD and other pre-existing conditions.
The scale of the festive emergency burden is reflected in data from hospitals and emergency ambulance services. In Gujarat, 5,406 medical emergencies were reported on Diwali in 2025, marking a 12.06 per cent increase over the normal daily average, according to GVK-EMRI.
Road accident emergencies rose 73.18 per cent, with 919 cases reported against the usual daily average of 529.
In Mumbai, four major BMC-run hospitals, including KEM, Sion, Nair and Cooper, collectively reported nearly 40 firecracker-related burn injuries during Diwali 2024, prompting hospitals to keep additional emergency and burn-care staff on alert.
As we gear up the Diwali weekend, ETHealthworld spoke to emergency physicians, trauma specialists and pulmonologists across hospitals to understand what the festive period means for emergency preparedness, which patients are most vulnerable, the injuries that can have lasting consequences and the precautions people should take before celebrations turn into hospital visits.
Emergency Care During the Festive Season
Emergency departments sit at the front line of the festive surge and remain on duty throughout. Dr Nitin Jagasia, Regional Director, Emergency, Western Region, Apollo Hospitals, says this makes advance planning non-negotiable.
“Diwali is a period for which hospitals need to be prepared in advance. There has to be proper coordination between the emergency department, trauma team, operating theatres and critical care services.”
He explains that when multiple patients arrive together, the first step is triage.
“Every patient is assessed according to the severity of the injury and how urgently intervention is required. Someone with significant blood loss, airway compromise or extensive burns will need immediate attention. This is where multidisciplinary coordination becomes very important. A complex case may require a trauma surgeon, plastic surgeon, anaesthetist, ophthalmologist and critical care specialist. If several patients require surgery simultaneously, procedures are prioritised according to clinical urgency.”
On the ground, hospital experience shows that the festive season brings a measurable change in emergency presentations. Dr Mohammad Nadeem, Head of Emergency, Fortis Memorial Research Institute (FMRI), Gurugram, said breathing complaints lead the rise, with other categories expected to follow as the festival draws closer.
He said, “We have noticed a measurable rise during Diwali, mainly in patients with shortness of breath, particularly those prone to allergies and those with chronic lung conditions, with children and the elderly most affected. The numbers are not large compared with last year so far, but we expect more as we reach Diwali week. Across the board we see an increase in most categories, especially road traffic accidents, which rise because of alcohol. Burns patients tend to start arriving as the festival draws closer, but we have not seen any so far.”
The Pollution Aftermath: A Respiratory Health Warning
Diwali arrives at a time when air quality is already a concern in several Indian cities. Firecracker emissions can add to the particulate pollution burden, raising concerns for people with asthma, chronic obstructive pulmonary disease (COPD) and other respiratory conditions.
In the week before Diwali, Delhi reported “very poor” air, with its 24-hour Air Quality Index (AQI) rising from 324 on 2 November to 350 on 3 November, and 377 on 4 November, according to data from Central Pollution Control Board (CPCB).
Across Faridabad, Gurugram, Noida and Ghaziabad in Delhi-NCR, the CPCB’s 24-hour Air Quality Index (AQI) on 4 November ranged from 160 to 330, from “moderate” to “very poor”.
Fine particulate matter (PM2.5) and coarser particles (PM10) were the prominent pollutants.
Similarly, Mumbai’s 24-hour AQI was 77 on 2 November, 85 on 3 November and 91 on 4 November before reaching 105, in the “moderate” category, on 5 November.
But the worst may still be ahead. In 2025, CPCB data revealed that Delhi’s average PM 2.5 matter pollution rose from 156.6 micrograms per cubic metre before Diwali to 488 in the 24 hours after, the highest in five years of data.
Dr Vivek Nangia, Vice Chairman and Head, Pulmonology, Max Super Speciality Hospital, Saket, agrees with this adding that while they haven’t witnessed an increase in emergency visits yet, the full impact will only be visible after the festival.
“We haven’t really seen an increase in emergency visits yet. However, I think the effects of Diwali fumes are yet to become apparent. Every year, around Diwali, we notice that OPD and emergency visits increase by 20–30 per cent compared with a normal week. Fortunately, this hasn’t happened so far, but I think it is just around the corner, and it is only a matter of time before the numbers start going up.”
Dr Jalil Parkar, Consultant Pulmonologist, Lilavati Hospital and Research Centre, said hospitals see more intensive care unit (ICU) admissions after Diwali as a result of increased air pollution.
He said, “Studies tracking hospital numbers pre- vs. post-Diwali show a quantifiable jump in critical care utilization in terms of increased ICU admissions and need for both non-invasive and invasive mechanical ventilation. The exacerbations occurring during the festival smog peak are found to be more severe and often refractory to standard front-line therapies than routine winter exacerbations.”
This is evident in cases across the country. A prospective observational study at SDS TB Hospital and Sanjay Gandhi Institute of Chest Disease, a tertiary-care respiratory state referral centre in Bengaluru, recorded a 126.7% increase in respiratory admissions in the 15 days following Diwali compared with the preceding 15 days.
The study, published in the Journal of Evidence Based Medicine and Healthcare, analysed 98 patients above the age of 14 admitted with breathlessness. Admissions rose from 30 in the pre-Diwali period to 68 post-Diwali.
The average hospital stay also increased from 7.59 days to 9.46 days, while the proportion requiring ventilator support rose from 13.3 per cent to 55.9 per cent.
Five deaths were recorded in the post-Diwali group.
The impact is not limited to the lungs, Dr Parkar said. Patients who are admitted often need stronger drug treatment than usual, and some also experience a worsening of existing heart conditions.
“Patients commonly present with moderate to severely low oxygen levels necessitating hospitalisation and escalation of systemic pharmacotherapies (systemic corticosteroids, intravenous antibiotics, frequent nebulisations). Due to systemic vascular inflammation triggered by ultrafine particles, a higher rate of decompensation of cardiac comorbidities (acute coronary syndromes, hypertensive crises, acute right-heart failure) has also been seen.”
The concern is particularly acute in the Delhi-National Capital Region (NCR), where air quality tends to deteriorate around this time of year.
Dr Avi Kumar, Additional Director, Pulmonology, Fortis Hospital, said patients with asthma and COPD are among the most vulnerable, because fine particulate matter (PM2.5), particles smaller than 2.5 micrometres, can travel deep into the lungs.
“Diwali coincides with deteriorating air quality in Delhi-NCR, which can aggravate asthma, COPD, persistent coughing and worsening breathlessness. PM2.5 particles can penetrate deep into the lungs and trigger inflammation. Patients with pre-existing respiratory conditions are particularly vulnerable.
“The effects of pollution may continue beyond Diwali. Exposure to elevated particulate matter can aggravate airway inflammation, causing cough, wheezing, chest tightness and breathlessness that persist for days. Patients with asthma or COPD may experience prolonged exacerbations. Comparing respiratory visits before and after the festival can help establish the duration and extent of this burden.”
Research supports that the pollution burden can extend several days beyond Diwali. A study led by IIT Delhi, IIT Kanpur and PRL Ahmedabad published in Atmospheric Pollution Research in 2022, found that the direct impact of fireworks on pollution levels declined within approximately 12 hours, however biomass-burning emissions increased in the days following the festival.
The respiratory impact of this exposure can also extend beyond the immediate festival period. A 2025 study titled Respiratory deposition of particulate matter in Delhi: a five-year assessment of exposure patterns and health risks, published in Scientific Reports, found elevated PM2.5 and PM10 matter deposition in the respiratory tract throughout a five-day post-Diwali observation window in Delhi.
These findings highlight that the health burden of deteriorating air quality may not be confined to Diwali night, with particulate exposure and associated respiratory emergencies extending into the days that follow.
Firecracker Injuries: When Burns Can Leave Lasting Damage
Firecracker use during Diwali brings a risk of burn, eye and hand injuries. While doctors say public awareness has improved over the years, emergency departments continue to encounter injuries ranging from minor burns to cases involving permanent functional damage.
The Ministry of Health and Family Welfare’s 2026 firecracker safety guidelines cite an estimated annual incidence of seven firecracker-related injuries per 100,000 people, based on a 2021 study published in the Indian Journal of Burns.
Hospital-based studies further illustrate the burden.
AIIMS Delhi reported 190 cases of firecracker and carbide gun related eye injuries during the 10 day Diwali period in 2025, marking a 19 per cent increase compared to 2024.
Another multicentric study published in the Indian Journal of Ophthalmology analysed 67 cases of firecracker-related eye injuries reported across three tertiary eye care centres in Central and Western India during the 2023 and 2024 Diwali periods.
The study found that children accounted for 62.7 per cent of the cases, while nearly 90 per cent of those injured were male. More than 40 per cent of patients presented with severe visual impairment, and nearly one in four (23.9 per cent) required surgical intervention.
Dr Sanjay Jaiswal, Director and HOD, Emergency and Trauma, Max Super Speciality Hospital, Noida, said, “During the Diwali week last year, firecracker-related injuries accounted for around 3 per cent of the hospital’s emergency footfall, with most patients presenting with minor first-degree burns. The numbers vary each year depending on the scale of celebrations.”
While most burns are minor, a smaller group of injuries can cause lasting damage. Dr Renaldo Pavrey, Senior Consultant and Clinical Lead, Department of Emergency Medicine, Lilavati Hospital and Research Centre, Mumbai, identified three categories that worry emergency doctors the most, beginning with hand injuries, where the force of the explosion and the heat of the burn combine.
“Three categories are particularly concerning: complex hand injuries, severe ocular trauma and deep burns involving functionally important regions. Hand injuries can be devastating because firecrackers combine explosive force with thermal damage.
“Ocular injuries carry an equally significant burden such as blast-related globe rupture, intraocular foreign bodies, retinal damage and severe corneal injury can result in irreversible visual impairment or blindness.
“Deep thermal burns, particularly involving the hands, face, neck and major joints, may require debridement, skin grafting and prolonged rehabilitation. Hypertrophic scarring and contractures can substantially affect mobility, appearance and quality of life.”
Doctors stressed the importance of first aid measures while handling fireworks, adding that the right steps in the first few minutes can prevent further damage before a patient reaches the hospital.
Dr Raghuveer Rao, Lead Consultant, Emergency Medicine, Manipal Hospital Yeshwanthpur, advised that in the case of an eye injury, the affected eye should be washed immediately and thoroughly with clean running water, and that the washing should continue while arranging to reach the nearest hospital.
He said, “Firecrackers can release chemical particles that may come into contact with the eyes, and washing helps flush these out and reduces the possibility of further injury.”
For burns involving the limbs, chest, abdomen or other parts of the body, the affected area should be placed under cool running tap water for at least 15 to 20 minutes, which helps limit the depth of the burn and can reduce the extent of tissue damage, he added.
As India celebrates Diwali, the pressure on emergency and critical care services will depend not just on the number of people seeking treatment, but also on the severity of injuries and respiratory complications. Doctors say careful handling of fireworks, timely first aid and limiting exposure to polluted air can help reduce avoidable emergencies during the festive period.
