There is a reason Halloween is called "fright night" — it is, after all, the spookiest night of the year. But there is another interpretation of that term that concerns the emergency department: Visits to the Emergency Department spike on Halloween.

Data gathered from the National Electronic Injury Surveillance System, between 2007 and 2015, found that Halloween was one of the top five holidays for ED admissions, behind Labor Day, Memorial Day, Independence Day, and Easter, respectively.

What encounters are ED physicians likely to have on All Hallows’ Eve? Let's divide it into two categories: Tricks (traumas) and Treats (things that are, well, just odd).

Tricks

Emergency departments in the U.S. reported more than 700,000 Halloween-related injuries involving children and teens between 2007 and 2016, with nearly one in five involving the head, reported the American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America in a study.

Lacerations to the hand and fingers are also common: One-quarter of all hand and finger cuts resulted from kids running to get candy and tripping on their costume, not being able to see clearly through a mask, or carving pumpkins. (Believe it or not, cuts from carving pumpkins — figuratively referred to as "Halloween hand" — is one of the most common injuries during the holiday.)

Aside from relatively minor injuries — although it's arguable as to whether a cut that could damage muscles, tendons, and blood vessels should be considered "minor" — there are the decidedly more serious.

Sadly, Halloween is the night with the highest occurrence of pedestrian traffic deaths, according to State Farm Insurance. Children, the most vulnerable, are two times as likely to be hit by a car. The reason? Kids can get easily distracted or can’t see clearly out of their masks and may cross the street not realizing there is oncoming traffic.

Worse, however, is the danger of injury and death from people driving while intoxicated. Statistics from the National Highway Traffic Safety Administration show that 43 percent of all motor vehicle deaths on Halloween night were caused by drunk driving-related accidents.

Fire is another hazard not often considered, with kids' costumes catching fire due to contact with candles or jack-o-lanterns.

An estimated 860 fires caused by Halloween decorations were reported each year, on average, between 2009 and 2013, according to the National Fire Protection Association.

These blazes were to blame for an average of one death and 41 injuries annually.

Food allergens in candy are yet another hazard: An estimated 4 to 6 percent of U.S. children have food allergies of some kind, and more than 160 foods can cause allergic reactions.

Other kinds of cases that may come through the emergency department on Halloween include:

  • Dog bites from canines protecting their homes from trick-or-treaters;
  • Dental injuries caused by hard candy or falls;
  • Eye injuries from sharp costume props, such as swords, canes, and sticks;
  • Dehydration resulting from over-exertion while trick-or-treating. 

Treats

Unfortunately, ED physicians are all too familiar with the aforementioned scenarios. They have seen their fair share of Halloween-related traumas. But, not every year is filled with “tricks.” There are also a few “treats,” -- those wild and crazy occurrences that take place during this spirited holiday.

Here are a few examples gathered from around the web.

It's a given that most patients will arrive in some kind of costume. One doctor noted that Spiderman could be in one room and Wonder Woman in the next. Another cited the case of the "persistent nurse," a woman who came in wearing a nurse costume.

According to the doctor, the "nurse" was being treated for injuries resulting from falling while intoxicated. Even though her injuries were minor, the staff had to constantly attend to her because she kept running out of the room approaching patients with a fake stethoscope pretending to be an actual nurse!

Another provider mentioned what is a not too uncommon problem: candy stuck in places where it doesn't belong — the nose, for instance.

This next example, from EverydayHealth.com, is one for the books:

“One Halloween several years ago, my colleague was working the overnight shift in the ER when a 20-something man checked into triage. He was dressed head-to-toe in military fatigues, a helmet, and combat boots, with bloody wounds across his chest and abdomen.

“The triage team quickly realized that the blood wasn’t an intentional accessory to his costume: The patient had been shot. The wound was a result of a fight at a party where people were drinking excessively.”

Another doctor, referring to an experience his father, an ED physician, had with a patient, said, "A few years ago, he evaluated a 31-year-old male with an ankle injury who had been injured on the job while working as a mime at a local tourist destination. My father and his team were forced to gather all the information they needed via pantomime, as the patient adamantly refused to break character."

We can even add a couple of our very own physicians to this list.

Dr. Stephen Nichols, chief clinical operations officer, said, "I once took my daughters trick-or-treating right after my shift ended, so I just stayed in my scrubs and long white coat. Many people — children in the streets and adults who opened their doors — were very frightened!"

Dr. David Schillinger, chief medical officer, confessed, "I dressed up many years ago as a nurse (stockings, skirt, hat and all). However, it was not viewed as funny by the parents of a young woman I had intubated for an overdose and went to talk with them! Needless to say, I stopped dressing up at work after that."

Suffice it to say, Halloween night holds plenty of opportunities for both "tricks" and "treats," and we expect emergency rooms will see patients suffering from a variety of injuries and ailments. Our hope, however, is that everyone — children as well as adults — will stay safe so that no nightmares result.