By Ana Rappold, Mary Clare Hano, Steven Prince and Ann Brown, U.S. Environmental Protection Agency (EPA)
Hospitals, clinics, and public health organizations in wildfire-prone areas of the West and Southwest are seeing firsthand the impacts of wildfire season on public health. As these fires become larger, more frequent, and more intense—leaving smoke-filled skies for days, weeks, and even months—patient visits are on the rise. Health providers in some areas are overwhelmed by requests for medical assistance and guidance.
One population-based study published April 2018 in the Journal of the American Heart Association and co-authored by EPA scientists found that dense smoke days during the 2015 California wildfire season increased emergency room visits for heart attacks by 42% among older adults. Not surprisingly, respiratory conditions also increased for older adults.
State, local, and tribal public health providers are critical to any efforts aimed at protecting public health from smoke exposure during wildfires and annual prescribed fires for agriculture and land management. They can assist with increasing awareness of the health threats from smoke exposure and provide information that empowers individuals to take action to protect their health and reduce respiratory, cardiovascular, and cerebrovascular effects.
EPA is conducting a crowd-sourcing project called Smoke Sense to better understand the health effects of wildland fire smoke and identify effective risk communications strategies. EPA is using a Smoke Sense mobile application to encourage the public to participate.
This effort requires considerable public health outreach. EPA is engaging health providers and agencies to share the app with their patients and communities and learn more about their needs in communicating the risks of smoke from fires.
The app provides users with current and forecasted air quality information; a map showing current fire locations and smoke plumes; a learning module about air pollution, wildland fires, and health impacts; and a tool to allow reporting of personal health symptoms and smoke observations. The data collected from the Smoke Sense app include individual-level anonymous demographics and health reports like age and pre-existing cardiovascular or pulmonary conditions, weekly reports of smoke exposure and concurrent health symptoms, as well as perspectives on health communication vignettes.
EPA hopes that as an educational tool and information resource, Smoke Sense will change behaviors that will lead people to become more prepared to protect their health from smoke. Many people don’t know what to do when smoke is in the air, and EPA wants to help them learn about specific actions they can take to reduce their exposure. Steps to protect health during wildland fire smoke are available in the app tutorial and on Airnow.gov and EPA’s Smoke Ready Toolbox.
While researchers are starting to collect clinical data, EPA hopes to learn the following:
- Do people not seeking help through the traditional health care system use their inhalers? Are symptoms mild or severe, and what is the length of symptoms?
- What kind of actions do individuals take—and when—in response to smoke exposure?
- What motivates individuals to reduce their exposure when needed, and what health messages about smoke are received and interpreted by susceptible people?
- How can research studies that use a citizen science and crowd-sourcing design (as opposed to the typical cross-sectional research survey design) be developed to support rigorous analysis of complex research questions?
The kinds of questions that Smoke Sense aims to address are difficult to answer using more conventional approaches to data collection because of the immediacy of the event and the timeline of launching a research study in response to that event. This study approaches the issue in a very different way from epidemiologica research, which is largely focused on determining the risk, and who is at risk. Smoke sense engages users to make a personal connection between environmental factors and our health.
EPA thanks those who have participated in the project in 2017 and encourages others to use the revised 2018 Smoke Sense App and provide feedback.
For comments to the scientists about the project, email SmokeSense@epa.gov.