While fireworks are a part of Fourth of July celebrations, experts warn that the tradition could be triggering for active-duty troops or veterans suffering from post-traumatic stress disorder.

Dr. Jeffrey Fine, director of the PTSD program at VA New York Harbor Healthcare System, warned that veterans with PTSD could have a variety of reactions ranging “from a startle to a full-blown anxiety attack and flashback of combat.”

Fireworks are generally loud with bright flashes of light and create smoke and burning smells, any of which could trigger memories of combat.

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Similarly, Fine’s colleague Dr. Wendy Katz said, “The flash of light, firecrackers, can sound to them like mortar attacks,” and noted that many of the patients she treats are embarrassed after these triggering events.

“I worked with one veteran who took cover with his young son at this kind of celebration,” Katz added. “It’s very complicated for them since it’s supposed to be the birthday of freedom.”

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The doctors at VANYHHS suggest that veterans who are concerned about getting triggered by fireworks plan ahead with their loved ones, including staying near the exits and having a plan if the individual has a strong negative reaction and wants to leave quickly.

“It’s a matter of personal choice about how much a veteran wants to risk having to deal with a bad reaction, balanced with the reluctance to isolate themselves from the center of action,” Fine added.