3-year-old boy dies from Honolulu fireworks explosion injuries, raising toll to 4

HONOLULU (AP) — A 3-year-old boy who died Monday was the fourth person to succumb to injuries from a massive explosion of fireworks on New Year's Eve at a Honolulu home, and a doctor said six others faced long recoveries in Arizona, where they were sent to be treated for severe burns.

The blast also killed three women and injured more than 20 people, many of whom have burns over most of their bodies.

The Honolulu medical examiner identified the toddler as Cassius Ramos-Benigno. The cause and manner of death were listed as pending.

After the disaster, Hawaii’s leaders intensified their oft-repeated calls to crack down on the state’s vast illegal fireworks trade with stepped-up enforcement and greater penalties.

The U.S. military flew six of the injured to Phoenix for treatment on Saturday because Hawaii’s lone burn unit doesn’t have enough capacity to care for all the victims.

They are all in their 20s or 30s and have extensive burns, Dr. Kevin Foster, the director of the Arizona Burn Center, said at a news conference streamed online.

The person with the least has burns over 45% of their body while the most has burns over nearly 80% of their body. Each of the six is using a breathing tube and five are in medically induced comas.

Foster said they are all doing “very well” and have good vital signs. But it will be six months to a year before any are able to return to anything resembling a normal life, Foster said. Four patients will likely have to remain intubated and in a coma for weeks, he said.

The patients will likely suffer post-traumatic stress disorder, Foster said, adding the burn center has two full-time psychologists and a psychiatrist hospital on staff to help them.

“There’s something uniquely and particularly horrifying about being burned, especially from this type of injury,” Foster said. “And we anticipate that all of these patients are going to have some adjustment issues.”

Many required emergency surgery before leaving Hawaii and a number had traumatic injuries in addition to burns, because of the explosions and resulting projectiles, he said.

The Arizona Burn Center operated on all six on Sunday, performed three other surgeries Monday and plan three others Tuesday. By then, doctors should be done with removing burns and will progress to closing wounds and grafting skin, Foster said. Infections are the most dangerous and feared complication for burn patients, he said, while also predicting all would likely get them at some point.

“It’s just the way burn injury works, especially when you have large percent-of-total-body-surface-area burns like this,” Foster said.

The scars, and the physical limitations that come with them, will likely be the biggest thing that the patients have to deal with and are what will make these wounds lifelong injuries, he said.

Foundations affiliated with the burn center and the hospital it is a part of, Valleywise Health, are providing housing for patient relatives. Some burn center employees have even volunteered their homes, Foster said.

In Honolulu, Straub Benioff Medical Center admitted 10 patients from the blast — more than from any other single mass casualty event including the 2023 Maui wildfires — and is still caring for nine after one was among those who went to Arizona.

Specially trained nurses in the hospital’s burn unit are changing the wound dressings at least once every 12 hours. It takes them about 30 minutes to an hour to change the dressings of a standard wound patient. But some New Year's explosion victims have such extensive burns that a team of at least four people will spend a couple of hours on the job.

“We’re doing dressing changes around the clock and needing to definitely recruit extra staff just to support that,” said Amy Chong, supervisor of the hospital's burn care unit.

Hawaii’s diverse population has long celebrated New Year’s with fireworks, but in recent years, professional-grade aerial explosives have been growing in popularity even though they are illegal for amateurs. Neighborhoods across Oahu light up for hours as residents launch aerial fireworks into the sky from the narrow streets in front of their homes.

Honolulu authorities say a person attending a party lit a bundle of aerial fireworks, which fell on its side and shot explosives into two crates that contained additional aerials. Video of the resulting explosion shows a rapid series of blasts shooting fireworks in the air and around the front of a house.

Hawaii’s counties have varying rules on other types of fireworks. On Oahu, the state’s most populous island, only certain types of firecrackers are allowed to be used during specific timeframes on New Year’s Eve, Chinese New Year and Fourth of July. However, many residents set off fireworks of all kinds year-round.