Study found hazardous air quality conditions at fire camps in Oregon and California

Smoke exposure levels at the Creek Fire ranged from hazardous to unhealthy for 30 days

(From Bill: Wildland firefighters and people who live in areas where long-term fires are common, such as Northern California and the Northwest, know that smoke can persist for days or weeks and can cause or aggravate respiratory and other medical issues. But knowing it exists and having peer reviewed quantifiable data proving it is hazardous to health, are two different things. Science like this could lead to changes that may benefit firefighters and the general public.)


In September and October the Centers for Disease Control and Prevention (CDC) deployed two staff members to serve as air resource advisors at wildfires in Oregon and California.

Air resource advisors were fully integrated into the wildfire incident management teams to provide insights into understanding and predicting smoke exposure levels. The individuals interacted with stakeholders, including air quality regulators, fire personnel, public health practitioners, and community residents. A primary aspect of this engagement was to forecast smoke levels for areas immediately affected by fires and generate a daily smoke outlook to keep stakeholders informed about prevailing smoke levels. 2020 is the first year during which the CDC worked with the Interagency Wildland Fire Air Quality Response Program and deployed staff members as air resource advisors for wildfire incidents.

From August 31 to September 14, 2020, one CDC staff member supported wildfires in central Oregon’s Cascade Range east of Sisters, which included the Beachie Creek, Holiday Farm, Lionshead, and Riverside fires. Strong east winds across the Cascade Mountains resulted in more than 560,000 acres of fire growth from September 7 through 10.

satellite photo fires smoke Washington, Oregon, and California
GOES-17 photo of smoke from wildfires in Washington, Oregon, and California at 5:56 p.m. PDT Sept. 8, 2020. The photo was taken during a very strong wind event.

Another CDC staff member was deployed to the Creek Fire from September 20 to October 5, 2020. This fire near North Fork, California started September 4 and grew to 193,000 acres during its first week; as of December 3, 2020, the fire had burned 379,895 acres.

Air quality study, fire camps, 2020
Abbreviation: PM2.5 = particles with aerodynamic diameters ≤2.5 μm.
       * Sensitive groups include persons aged ≤18 years; adults aged ≥65 years; pregnant women; persons with chronic health conditions such as heart or lung disease, including asthma and diabetes; outdoor workers; persons experiencing homelessness, and those with limited access to medical care. (https://www.cdc.gov/air/wildfire-smoke/default.htm).
       † Fire camps typically offer logistical support to the wildfire suppression operation by providing firefighters and incident personnel sleeping locations (camping), morning and evening meals, workspaces, and administrative services.
       § The monitoring instrument in North Fork, California, recorded errors and did not report data during September 12–15, 2020.
       ¶ Start date of Creek Fire in California was September 4. Start dates of fires in Oregon were as follows. Lionshead was August 16; Beachie Creek was August 16; Holiday Farm was September 7; Riverside was September 8.

During these two deployments, several public health concerns came to light. Of note, although smoke from wildfires drifted long distances and affected downwind communities, the brunt of poor air quality was observed in communities adjacent to wildfire incidents. For example, communities near the fires in California and Oregon experienced high concentrations of PM2.5, as measured by air quality monitors, resulting in “Unhealthy” to “Hazardous” conditions, as defined by the U.S. Environmental Protection Agency Air Quality Index.

Fire personnel who camped and rested between work shifts at nearby fire camps (North Fork, California and Sisters, Oregon) were also exposed to poor air quality levels. These fire camp exposures contribute to higher overall cumulative smoke exposure and, along with other occupational risk factors such as fatigue and stress, could limit recovery that is much needed for fire personnel while away from the active fire perimeter. In addition, environmental hazards such as extreme heat and higher concentrations of ambient carbon monoxide were prevalent during days with heavy smoke and after extreme fire growth days. These hazards added a layer of complexity to fire response efforts and might have limited fire personnel recovery between work shifts.


From: Navarro K, Vaidyanathan A.  — Notes from the Field: Understanding Smoke Exposure in Communities and Fire Camps Affected by Wildfires— California and Oregon, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1873–1875. DOI: http://dx.doi.org/10.15585/mmwr.mm6949a4

Thanks and a tip of the hat go out to Bob.

Smoke — and the health of firefighters

smoke pyrocumulus bushfires Australia
Photo of smoke from bushfires by Merrin Macleod on a flight from Canberra to Melbourne, Australia, posted January 4, 2020.

Originally published by the Centers for Disease Control and Prevention

While research has not yet been conducted on all the hazards and risks associated with the wildland firefighting job, the National Institute for Occupational Safety and Health (NIOSH) is asked numerous questions about the hazards of fighting wildland fires. This blog is designed to answer some of those questions.

What Is in Wildland Fire Smoke?

Wildland fire smoke is a mixture of gases and particles such as carbon monoxide (CO) and respirable particulate matter (PM) that may cause short- and long-term health effects. Wildland firefighters can be exposed to smoke at wildfires and “prescribed” fires (planned and intentionally ignited low-intensity fires). The contents of and exposure to wildfire smoke can vary greatly throughout the day depending on the vegetation type, fire behavior, and meteorological conditions. Research has shown that wildland firefighters have been exposed to gases and particles such as CO and PM above the occupational exposure limits during both wildland and prescribed fires. While burning vegetation is the primary exposure of concern for wildland and prescribed fires, when fires burn in the wildland urban interface (WUI, where wildland vegetation and urban areas meet) the smoke may contain compounds that are more similar to what structural firefighters encounter. Wildland firefighters will often suppress these fires and may be exposed to some of the hazardous compounds of WUI smoke such as volatile organic compounds (VOCs), flame retardants, and polycyclic aromatic hydrocarbons (PAHs). However, wildland firefighters do not have the benefit of wearing some of the personal protective equipment (PPE) typically used in a structural response (e.g., self-contained breathing apparatus [SCBA], turnout gear) that could provide protection from these compounds. Additionally, wildland firefighters may be exposed to smoke at firefighting base camps (incident command posts) where they eat and rest while off-duty.

What Do We Know About the Health of Wildland Firefighters?

Cardiovascular and Lung Health

In the past decade, several studies have linked exposure to wildfire smoke to short-term health effects, such as increases in inflammation and respiratory effects, for example, lung function decline.[i] However, these studies have only examined the health effects across a few shifts or a single fire season. It is not clear if these adverse health effects continue after fire season and whether they worsen after several seasons of fighting fires. Researchers suspect that exposure to particulate matter and other contaminants from wildfire smoke, heavy physical exertion, existing health and behavior risk factors, and cardiovascular strain could contribute to sudden cardiac events for wildland firefighters. Recent research indicated that wildland firefighters may be at an increased risk of mortality from cardiovascular disease and lung cancer than the general public from career exposure to wildfire smoke.[ii]

COVID-19

The strenuous work, long work shifts, close living and working conditions, limited access to hygiene supplies, and a workforce that responds to incidents all over the country on short notice to wildland fire incidents may be conducive for the transmission of infectious diseases, including SARS-CoV-2. Exposure to air pollutants in wildfire smoke can irritate the lungs, cause inflammation, alter immune function, and increase susceptibility to respiratory infections, possibly including COVID-19.[iii] In addition to potentially making firefighters more vulnerable to getting COVID-19, inflammation in the respiratory tract due to wildfire smoke might also increase the risk of developing more severe outcomes for those with COVID-19.[iv] Wildland firefighters should implement the recommendations described in the CDC’s FAQ for Wildland Firefighters to prevent infection and spread of COVID-19.

Heat-Related Illness and Rhabdomyolysis

Due to the nature of their work, firefighters are at risk of developing severe heat-related illness (such as heat stroke) and rhabdomyolysis (muscle breakdown).[v],[vi] Delays in diagnosis and initiating treatment of these illnesses increase the risk of permanent muscle damage. Since 2010, 62 cases of severe rhabdomyolysis among wildland firefighters have been reported to a passive surveillance system designed to capture fatalities and certain types of injuries and illnesses including rhabdomyolysis. The actual number of cases is likely higher due to underreporting and inconsistencies in reporting requirements and systems. Prior to 2010, no cases were reported.

Hearing

Wildland firefighters work around power tools and heavy equipment that produce noise levels that are hazardous to hearing. In addition to hearing loss, noise exposure may also cause tinnitus (ringing/buzzing in ears), increased heart rate, fatigue, and interfere with verbal communication. Researchers from NIOSH and the United States Forest Service (USFS) evaluated personal noise measurements on 156 wildland firefighters conducting various training and fire suppression tasks, and reported that 85 of the 174 measurements were above the NIOSH maximum allowable daily dose[vii]. A follow-up study showed use of hearing protection was mixed; while almost all the wildland firefighters were aware of the noise in their environment and potential risk, very few were enrolled in hearing conservation programs.

What Are NIOSH Researchers Doing to Better Understand Exposures and Health Effects?

NIOSH is currently conducting research to understand the exposures and health effects of firefighters suppressing wildland and WUI fires. NIOSH researchers and collaborators at the US Forest Service and Department of the Interior have finished the second year of a multi-year study investigating exposures and health effects among six federal 20-person firefighting crews. The primary goal of this study is to measure exposures in the wildland fire environment and examine associations between those exposures and changes in lung, cardiac, kidney, and hearing function during each fire season and the off season over multiple fire seasons. This study has been paused in 2020 due to COVID-19 but is expected to resume.

To understand exposures and health effects faced by WUI firefighters, NIOSH is working with researchers from the University of Arizona and University of Miami to expand an existing collaborative research study (the Fire Fighter Cancer Cohort Study) to collect data regarding exposures from WUI fire incidents during the 2019 and 2020 fire seasons. Characterizing the types of chemicals, as well as the routes and levels of exposures, will help us understand health risks for wildland firefighters.

NIOSH is also in the process of developing a study assessing self-reported exposures to wildfire smoke and COVID-19 health outcomes among wildland firefighters. Additional information about this research will be available soon on the NIOSH Fighting Wildfires Page.

 

Authors of this article:

LCDR Corey Butler,MS REHS, is a Lieutenant Commander with the United States Public Health Service and an Occupational Safety and Health Specialist in the NIOSH Western States Division.

CAPT Christa Hale,DVM, MPH, DACVPM (Epi), is a Captain with the United States Public Health Service and Senior Epidemiologist and Veterinarian in the NIOSH Western States Division.

Kathleen Navarro, PhD, MPH is an Associate Service Fellow with the Division of Field Studies and Engineering.

Elizabeth Dalsey, M.A., is a Health Communication Specialist in the Western States Division.

CAPT Chucri (Chuck) A. Kardous, MS, PE, is a Captain with the United States Public Health Service and a research engineer with the NIOSH Division of Field Studies and Engineering.

Pamela S. Graydon, MS, COHC, is an Electronics Engineer working in hearing loss prevention in the NIOSH Division of Field Studies and Engineering. 

CAPT David C. Byrne, Ph.D., CCC-A, is a Captain with the United States Public Health Service and a research audiologist with the NIOSH Division of Field Studies and Engineering.

References

[i] Adetona O, Reinhard T, Domitrovich J, Boryles G, Adetona A, Kleinman M, Ottma R, Naher L [2016]. Review of the health effects of wildland fire smoke on wildland firefighters and the public. lnhal Toxicol 28(3): 95-139. Available from: https://pubmed.ncbi.nlm.nih.gov/26915822/

[ii] Navarro K, Kleinman M, Mackay C, Reinhardt T, Balmes J, Broyles G, Ottmar R, Naher L, Domitrovich J [2019]. Wildland firefighter smoke exposure and risk of lung cancer and cardiovascular disease mortality. Environ Res 173:462-468. Available from:https://www.sciencedirect.com/science/article/pii/S001393511930194X

[iii] Reid CE, Maestas MM. Wildfire smoke exposure under climate change: impact on respiratory health of affected communities. Curr Opin Pulm Med 2019;25:179–187.

[iv] Moore JB, June CH. Cytokine release syndrome in severe COVID-19Science 2020;368:473.

[v] West MR, Costello S, Sol JA, Domitrovich JW [2020]. Risk for heat-related illness among wildland firefighters: job tasks and core body temperature change. Occup Environ Med77(7):433-438. Available from: https://pubmed.ncbi.nlm.nih.gov/31996475/

[vi] NIOSH [2012]. Report of a NIOSH health hazard evaluation, HHE 2011–0035. By Eisenberg J and McFadden J. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Unpublished.

[vii] Broyles G, Butler C, Kardous C [2017]. Noise exposure among federal wildland fire fighters. J Acoust Soc Am 141(2) EL177. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5975217/

Breathing smoke

October 4, 2020   |   6:09 a.m. PDT

 

Photographers at a wildland fire may be able to use and tolerate a mask that traps 95 percent of the 0.3 micron particulates in smoke, but the devices are not practical for firefighters. (see photo above)

In case you are wondering, masks and respirators are divided into rating classes: N is not oil resistant, R is oil resistant, and P is oil proof. The number, such as 95, refers to the percent of particles removed that are at least 0.3 microns in diameter.

Be careful out there.

Wildfire smoke and COVID-19

Preliminary evidence suggests exposure to wildfire smoke may increase susceptibility to COVID-19

Wildfire Smoke And COVID 19

The U.S. Forest Service has published a three-page fact sheet with information about the impacts of wildfire smoke during the COVID-19 pandemic. It covers the effects of smoke during the pandemic, who is most at risk, symptoms, masks and face coverings, and how to minimize potential health effects from wildfire smoke. The document has useful information and many links to additional materials.

Here are some excerpts:

  • The COVID-19 pandemic is overlapping with the occurrence of wildfires in the United States.
  • Wildfire smoke is a complex mixture of air pollutants that are harmful to human health.
  • Exposure to air pollutants in wildfire smoke can irritate the lungs, cause inflammation, alter immune function, and increase susceptibility to respiratory infections, likely including COVID-19.
  • Recent scientific publications (Conticini et al., 2020 & Travaglio et al., 2020) suggest that air pollutant exposure worsens COVID-19 symptoms and outcomes.
  • Those with or recovering from COVID-19 may be at increased risk of health effects from exposure to wildfire smoke due to compromised heart and lung function caused by the disease.
  • Although N95 respirators provide protection from wildfire smoke, they might be in short supply as frontline healthcare workers use them during the pandemic.
  • Cloth face coverings that are used to slow the spread of COVID-19 offer little protection against harmful air pollutants in wildfire smoke because these coverings do not capture most small particles in smoke.
Satellite photo smoke Australia fires
Satellite photo of smoke from fires in New South Wales and Victoria January 4, 2020. The red areas represent heat.

Wildfire smoke worsens coronavirus risk, putting firefighters in extra danger

Researchers found that wildfire smoke exposure can lead to an increase of other pathogens in lungs.

Norbeck prescribed fire Wind Cave National Park
A firefighter at the end of the day, igniting the Norbeck prescribed fire in Wind Cave National Park in the Black Hills of South Dakota, Oct. 20, 2014. Photo by Bill Gabbert.

By Luke Montrose, Assistant Professor of Community and Environmental Health, Boise State University

(This article first appeared at The Conversation)

As summer approaches, two forces of nature are on a collision course, and wildland firefighters will be caught in the middle.

New research suggests that the smoke firefighters breathe on the front lines of wildfires is putting them at greater risk from the new coronavirus, with potentially lethal effects.

At the same time, firefighting conditions make precautions such as social distancing and hand-washing difficult, increasing the chance that, once the virus enters a fire camp, it could quickly spread.

As an environmental toxicologist, I have spent the last decade expanding our understanding of how wood smoke exposure impacts human health. Much of my current research is focused on protecting the long-term health of wildland firefighters and the communities they serve.

‘Camp crud’ and the dangers of air pollution

People have long understood that the air they breathe can impact their health, dating back more than 2,000 years to Hippocrates in his treatise on Air, Water, and Places. Today, there is a growing consensus among researchers that air pollution, specifically the very fine particles called PM2.5, influences risk of respiratory illness. These particles are a tiny fraction of the width of a hair and can travel deep into the lungs.

Italian scientists reported in 2014 that air pollutants can increase the viral load in the lungs and reduce the ability of specialized cells called macrophages to clear out viral invaders.

Researchers in Montana later connected that effect to wood smoke. They found that animals exposed to wood smoke 24 hours before being exposed to a pathogen ended up with more pathogen in their lungs. The researchers showed that wood smoke exposure decreased the macrophages’ ability to combat respiratory infection.

Now, new evidence suggests that long-term exposure to PM2.5 air pollution, which is produced by sources such as wildfirespower plants and vehicles, may make coronavirus particularly deadly.

Researchers from the Harvard T.H. Chan School of Public Health conducted a nationwide study of county-level data and found that even a small increase in the amount of PM2.5 from one U.S. county to the next was associated with a large increase in the death rate from COVID-19. While small increases in PM2.5 also raise the risk of death from other causes for older adults, the magnitude of the increase for COVID-19 was about 20 times greater. The results were released last week, before the usual peer review process was conducted, to help warn people of the risks.

Taken together, these findings suggest that air pollution, including wood smoke, could increase the risk that wildland firefighters will develop severe COVID-19 symptoms.

That probably doesn’t surprise seasoned firefighters.

They’re already familiar with “camp crud,” a combined upper and lower respiratory illness accompanied by cough and fatigue that has become common in firefighting camps.

The National Wildfire Coordinating Group, in its guidance on infectious disease, has pointed out that “the close, overlapping living conditions of an incident command post lends itself to rapid spreading of contagious microorganisms, as witnessed by the common outbreaks of ‘camp crud.’ Outbreaks also have a history of spreading from incident to incident as people are reassigned.”

How to protect wildland firefighters

So, what can be done to avoid the spread of COVID-19 among wildland firefighters and prevent them from being vectors in the communities they serve?

In some areas, officials have been delaying firefighter training sessions and brush-clearing operations that would normally be underway now. But while that might protect firefighters from exposure right now, it can be put off for only so long. Wildfires have already broken out in several states, and delaying controlled burns leaves more fuel when fires get out of control.

The National Wildfire Coordinating Group’s guidance on infectious disease encourages planning ahead so personal protective equipment is available and maintaining records of symptoms so illnesses can be tracked and stopped from spreading.

The guidance also calls for better camp hygiene, providing access to medical care, making isolation possible and coordinating cross-agency communication about the public health risks.

Firefighter camps are not typically well outfitted to promote good personal hygiene. Improving those conditions could help prevent a virus’s spread, such as by adding hand-washing stations and possibly mobile shower units. Single-person tents would allow for more effective social distancing.

Camp personnel should also have access to thermometers and coronavirus test kits. Protocols for quarantining and removing infected firefighters from the field should not only be implemented but practiced.

Also missing from the National Wildfire Coordinating Group’s guidance are policies on traveling to and from training sites, working within communities and traveling from camp. Social distancing may not always be possible, so protective gear, such as face masks, should be made available and their use encouraged.

firefighters crew Whitetail Fire 3-8-2017 Photo by Bill Gabbert
Firefighters on the Whitetail Fire in the Black Hills of South Dakota, March 8, 2017. Photo by Bill Gabbert.

A recent paper from Belgium suggests that even some of the ways firefighters operate in the field should be reconsidered to protect against the virus’s spread. It shows how droplets released when a person exhales can travel farther than six feet during heavy activity. For firefighters, that could mean walking farther apart and in a V-shaped delta formation, rather than a traditional line, to reach the fire.

It is also important to consider that frontline firefighters are often younger and could be asymptomatic but still able to spread the virus, so their contact with with rural community members, such as volunteer firefighters and ranchers, should be considered.

Finally, a system for cross-state communication should be engaged to facilitate sharing of best practices and lessons learned. It also could help track the movement of firefighters across the region.

The safety of rural western communities depends on the wildland firefighters and their ability to respond to emergencies. Protecting their health helps protect public health, too.

National Firefighter Registry releases time line toward implementation

UPDATED at 10:45 a.m. MDT Nov. 21, 2019

On November 21 the National Firefighter Registry that is being created by the National Institute for Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control and Prevention, released information about their accomplishments. We are updating this article originally published November 17, 2019 to include the new data.


Milestones from this Quarter
Much of the work this quarter focused on creating the NFR protocol, filling staffing needs, and meeting with firefighters and stakeholders about the NFR. Some of our key milestones for this quarter include:

  • Reviewed Federal Register comments made on the NFR’s Request for Information (RFI). Thank you to those that were able to provide feedback. These comments are very helpful in guiding the development of the NFR.
  • Began development of the protocol, informed consent document, and enrollment questionnaire.
  • Started gathering details on record keeping systems at fire departments to better understand what data are available and potential mechanisms for importing the data.
  • Made progress on developing requirements for the registration web portal.
  • Held discussions with representatives from select state cancer registries and related organizations to better understand cancer surveillance on a national level.
  • Hired a new health scientist, Andrea Wilkinson, formerly of the First Responder Health & Safety Laboratory at Skidmore College.
    Created the NFR webpage https://www.cdc.gov/niosh/firefighters/registry.html
  • Began formation of the NFR Advisory Committee. This committee will include at least 10 members with various backgrounds, expertise, and experience related to firefighter health and research.

Next Steps

  • Finalize protocol and consent form
  • Begin Office of Management and Budget (OMB) clearance process for enrollment questionnaire
  • Hire Health Communications Specialist
  • Continue conversations with stakeholders and obtain their support
  • Continue conversations with select fire departments throughout the country.

(Originally published at 9:54 a.m. MDT Nov. 17, 2019)

The National Firefighter Registry, originally called the Firefighter Cancer Registry in the authorizing legislation, has released very broad time-based goals for implementing a system which hopefully can identify any relationships between cancer and occupational exposure to toxicants.

Earlier this year the National Institute for Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control and Prevention, asked firefighters for input on how to maximize participation in the Registry (perhaps working on the first goal in the timeline chart). That comment period ended May 28, 2019.

From the time line, it appears that NIOSH hopes to begin enrolling firefighters sometime between 2019 and 2022.

firefighters smoke
Firefighters in a smoky environment on the White Tail Fire, March 8, 2019, Black Hills National Forest.

Previous studies, including one completed by NIOSH in 2014, have highlighted firefighters’ increased risk for certain cancers compared to the general population. However few previous studies have collected data about wildland firefighters, volunteer firefighters, or sufficient numbers of female and minority firefighters in order to draw conclusions regarding their risk of cancer.

In one study that collected data from wildland firefighters in the field, a group of researchers concluded that firefighters’ exposure to smoke can increase the risk of mortality from lung cancer, ischemic heart disease, and cardiovascular disease by 22 to 39 percent. The project only looked at the wildland fire environment, and was not a long term study of firefighters’ health.

The ultimate goal of the Registry is to better understand the link between workplace exposures and cancer among firefighters. The Registry will include all U.S. firefighters, not just those with a cancer diagnosis. The Registry also has the potential to provide a better understanding of cancer risk among subgroups such as women, minorities, and volunteers, and among sub-specialties of the fire service like instructors, wildland firefighters, and arson investigators.

From the Registry information, CDC/NIOSH will estimate an overall rate of cancer for firefighters. They might find certain groups of firefighters are at a higher risk of cancer than others based on level of exposure, geography, gender, or other factors. They may also find that certain protective measures are associated with a reduced risk for cancer, which could provide additional evidence and support for specific control interventions.

The Registry will be completely voluntary, and no one can force a person to join.

All active and retired as well as volunteer, paid-on-call, and career firefighters will be encouraged to join the Registry, regardless of their current health status.

CDC/NIOSH promises that they will always maintain participants’ privacy and will never share personal information with an outside organization including fire departments, unions, or other researchers without permission of the individual.