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    ABSTRACT: In 2007 wildfires ravaged Southern California resulting in the largest evacuation due to a wildfire in American history. We report how these wildfires affected emergency department (ED) visits for respiratory illness. We extracted data from a Kaiser Permanente database for a single metropolitan community ED. We compared the number of visits due to respiratory illness at time intervals of 2 weeks before and during the time when the fires were burning. We counted the total number of patients with chief complaint of dyspnea, cough, and asthma and final international classification of disease 9 coding diagnosis of asthma, bronchitis, chronic obstructive pulmonary disease and respiratory syndrome, and analyzed data for both total number and proportion of ED visits. We evaluated the data using Early Aberration Reporting System software to determine significant single-visit increases compared to expected counts. We also analyzed the average length of ED stay. Data on air quality were extracted from the http://www.airnow.gov site. There were significant differences between pre-fire and fire period average visit counts for the chief complaints of dyspnea and asthma. Dypnea complaints increased by 3.2 visits per day. During the fire the diagnoses of asthma increased significantly by 2.6 patients per day. Air quality reached air quality index values of 300, indicating very unhealthy conditions. Average ED length of stay times remained unchanged during the fire period compared to the pre-fire period. The 2007 Southern California wildfires caused significant surges in the volume of ED patients seeking treatment for respiratory illness. Disaster plans should prepare for these surges when future wildfires occur.
    The western journal of emergency medicine 03/2013; 14(2):79-84.
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    ABSTRACT: This study investigated occupational exposure to wood and vegetative smoke in a group of 28 forest firefighters at prescribed forest burns in a southeastern U.S. forest during the winters of 2003-2005. During burn activities, 203 individual person-day PM(2.5) and 149 individual person-day CO samples were collected; during non-burn activities, 37 person-day PM(2.5) samples were collected as controls. Time-activity diaries and post-work shift questionnaires were administered to identify factors influencing smoke exposure and to determine how accurately the firefighters' qualitative assessment estimated their personal level of smoke exposure with discrete responses: "none" or "very little," "low," "moderate," "high," and "very high." An average of 6.7 firefighters were monitored per burn, with samples collected on 30 burn days and 7 non-burn days. Size of burn plots ranged from 1-2745 acres (avg = 687.8). Duration of work shift ranged from 6.8-19.4 hr (avg = 10.3 hr) on burn days. Concentration of PM(2.5) ranged from 5.9-2673 μg/m(3) on burn days. Geometric mean PM(2.5) exposure was 280 μg/m(3) (95% CL = 140, 557 μg/m(3), n = 177) for burn day samples, and 16 μg/m(3) (95% CL = 10, 26 μg/m(3), n = 35) on non-burn days. Average measured PM(2.5) differed across levels of the firefighters' categorical self-assessments of exposure (p < 0.0001): none to very little = 120 μg/m(3) (95% CL = 71, 203 μg/m(3)) and high to very high = 664 μg/m(3) (95% CL = 373, 1185 μg/m(3)); p < 0.0001 on burn days). Time-weighted average PM(2.5) and personal CO averaged over the run times of PM(2.5) pumps were correlated (correlation coefficient estimate, r = 0.79; CLs: 0.72, 0.85). Overall occupational exposures to particulate matter were low, but results indicate that exposure could exceed the ACGIH®-recommended threshold limit value of 3 mg/m(3) for respirable particulate matter in a few extreme situations. Self-assessed exposure levels agreed with measured concentrations of PM(2.5). Correlation analysis shows that either PM(2.5) or CO could be used as a surrogate measure of exposure to woodsmoke at prescribed burns.
    Journal of Occupational and Environmental Hygiene 08/2011; 8(8):503-11. · 1.28 Impact Factor
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    ABSTRACT: Introduction Wildfires are common globally. Although there has been considerable work done on the health effects of wildfires in countries such as the USA where they occur frequently there has been relatively little work to investigate health effects in the United Kingdom. Climate change may increase the risk of increasing wildfire frequency, therefore there is an urgent need to further understand the health effects and public awareness of wildfires. This study was designed to review current evidence about the health effects of wildfires from the UK standpoint. Methods A comprehensive literature review of international evidence regarding wildfire related health effects was conducted in January 2012. Further information was gathered from authors' focus groups. Results A review of the published evidence shows that human health can be severely affected by wildfires. Certain populations are particularly vulnerable. Wood smoke has high levels of particulate matter and toxins. Respiratory morbidity predominates, but cardiovascular, ophthalmic and psychiatric problems can also result. In addition severe burns resulting from direct contact with the fire require care in special units and carry a risk of multi - organ complications. The wider health implications from spreading air, water and land pollution are of concern. Access to affected areas and communication with populations living within them is crucial in mitigating risk. Conclusion This study has identified factors that may reduce public health risk from wildfires. However more research is needed to evaluate longer term health effects from wildfires. An understanding of such factors is vital to ensure preparedness within health care services for such events.
    PLoS currents. 01/2012; 4:e4f959951cce2c.