It turned out that two teens were playing chicken with firecrackers, holding them in their teeth, lighting them and seeing who would spit his out first.
"Luckily it was just a burned and bruised torn lip; it didn't hurt his eyes," Toscano added.
Yes, there was alcohol involved, the doctor said, adding that the teens were scared when they came in to the hospital.
"We had to call his parents," Toscano recalled. "They were relieved that he was OK, but they were suitably astounded by (the teens') poor judgment."
Toscano said each July 4th brings fireworks injuries, often from firecrackers or Roman candles.
Donna Koon, director of emergency services for ValleyCare Health System, said fireworks injuries have become rarer at its facilities since authorities began cracking down on their usage.
A more common issue seen at ValleyCare, according to Koon, are rattlers.
"Rattlesnake bites are an issue. We start getting those around Memorial Day," she said. "They are out in the heat in the summertime. People have to be aware of where they are stepping in the summertime, and don't reach down and pick up a snake."
If someone gets bitten, it is important to identify the type of snake to know if anti-venom is needed. "If the snake is killed, bring it in," Koon said.
"I've seen rattlesnakes at Sycamore Grove and in the Morgan Territory," she added. "And they are on the Pleasanton Ridge -- people have come in with rattlesnake bites from hiking there."
Rattlesnakes are also found on local golf courses, she warned, especially those close to the hillsides.
Toscano and Koon both said the biggest danger, especially at the beginning of summer, is dehydration and heat exhaustion.
"We see it especially in the elderly and those deciding to do hiking and running and that kind of stuff in the elements," Koon said. "They tend to not keep themselves hydrated. I think they know they should but not to the level they need to."
"We see people get overheated, and the body can't regulate the temperature as well," she explained. "They aren't sweating to be able to cool off, and they can start to get confused, they get really dizzy, then nausea and vomiting from being overheated, which can make you dehydrate even more.
"The skin is very red, with a flushed chest, cheeks and arms, which gives us a quick sign that something is going wrong. We give them fluids, and luckily the hospital is air-conditioned, which helps cool them down," she continued. "A lot of times there is alcohol consumption. It might be that in the wintertime you can drink four or five beers and it doesn't bother you, but in the summer you have heat contributing to it."
She said Dublin Urgent Care will see patients who are members of the military training at Camp Parks.
"They come from out of state and different areas and are not expecting our 104-degree temperatures," Koon said.
Sports drinks with electrolytes help people stay hydrated, she noted, as does wearing a wet bandanna. Letting kids play in the sprinklers helps keep them cool.
Toscano said bodies become acclimatized to the heat during the summer.
"At the very beginning of summer we see a fair number of patients with heat illness, exhaustion, cramps, rapid warming, from people going out and being active," he said. "Any body is more at risk when the temperatures all of a sudden start to get warmer. The body can't do a lot in hot temperatures if it hasn't been acclimatized. You can be aware and not push yourself."
Sunburn is also a bigger problem at the beginning of the summer before the skin gets tanned, he said.
"We see severe sunburns, when people are not using sunblock and are staying out for too long" Koon said. "Depending on the severity, they can actually get blistering, and we have to treat it as a burn."
During the summer, she sees more muscle pulls and injuries from people water skiing and wakeboarding.
"They get back injuries, and get sore and can't move," she said. "They are weekend warriors, they overexert themselves and try a little too hard."
"People are a lot more active outdoors in the summertime and sometimes they try things they wouldn't do during the winter," Toscano said. "With activities like biking, mountain climbing, white water rafting, there is a potential for injury. You should wear protective equipment, and don't try things beyond your capacity."
"I see a fair number of people who go to Tahoe or Yosemite rock climbing then come back to San Ramon (to the emergency room) with a broken leg," he added.
Drowning is another concern in the summertime, he said.
"Luckily not a lot of people die from that, but there are a lot in hospitals from near-drowning in swimming pools, people's backyard pools," he said.
Accidents often happen when the adults are drinking and not minding children who can't swim, he said. Sometimes people pull a child out of the water after about 10 seconds and want to have them checked.
"There is a spectrum of injury that goes along with drowning, not to the lungs but to the brain," Toscano said. "They are deprived of oxygen."
It doesn't happen a lot, he noted, but all the cases are in the summer. People also get injured in swimming pools when they dive into the shallow end.
Another summer hazard can be traveling to other countries without taking proper precautions.
"Occasionally they come back with infectious illnesses," Toscano said. "It's important when people travel to be aware of whether they need immunizations or medications for the prevention of malaria."
He said they see malaria, dengue fever, typhoid fever, salmonella and intestinal infections, usually contracted in the Caribbean, South America or Southeast Asia.
Travelers to India need to take precautions even if they are originally from there, he added.
Poison oak, bug bites and ticks are also more common in the summer, Toscano said.
"A tick will be embedded in the skin, they can't get it out," he said, which poses the danger of Lyme disease, Rocky Mountain spotted fever and other diseases.
He advised hikers and campers to wear long sleeves and pants, and to examine their skin for ticks since they must be embedded for hours to transmit diseases. Outdoor enthusiasts also can use a spray to repel insects.
Koon said ValleyCare facilities see a lot of people with poison oak during the summer.
"They are so swollen up and itching and reacting to it," she said. "We tend to get people who were out camping in other areas a few days before."
The fun summer days are ahead of us, but remember to stay cool and hydrate, and to use common sense.
"Enjoy the outdoors and know what the hazards are," Toscano advised.
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