Wildfires and Public Health:Lessons Learned in Los Angeles County
Jonathan Fielding, MD, MPHCyrus Rangan, MDDeborah Davenport, RN, PHN, MS
Los Angeles County Department of Public HealthJanuary 29, 2008
Learning ObjectivesDiscuss the growing public health importance of wildfires.List three roles for local public health departments in responding to wildfires.Describe how the use of a public health emergency management system can support wildfire response efforts.By the end of this presentation, you will be able to:Malibu Fire, Pepperdine University Used with permission of LA County Fire Department
OverviewBackground PH Emergency Management SystemSurveillance of air quality impacts Surveillance of adverse health effects External communicationsAddressing sheltering needsRole of environmental health Conclusions
The risk of wildfires in my jurisdiction is: A. Unchanged recentlyB. IncreasingC. DecreasingD. Minimal
Public Health ImplicationsProfound public health implicationsSmoke and ash exposures lead to acute respiratory symptoms, exacerbations of cardiac conditions, and mental health effects.Affects vulnerable populations: children, seniors, people with chronic diseases such as asthma, emphysema, and heart disease.Creates major disruptions in services secondary to evacuations: school closures and increased traffic congestion.
Environmental Factors Increase RiskEnvironmental factors that elevate the risk of wildfiresDrought conditionsIncreased residential and commercial development in high-risk areasGlobal warming
HistoryOctober 2003 Wildfires across Southern California consumed more than 750,000 acres and destroyed 3,640 homes.October 2007Wildfires again spread across Southern California, burning 500,000 acres from Santa Barbara to the U.S. - Mexico border.
History (cont.)Totals for LA County, 2007105,000 acres burned.60 homes and structures destroyed; another 67 damaged.Largest LA County blazesRanch Fire (Castaic/Piru): ~58,000 acres burned; 1 home and 9 structures destroyed.Buckweed Fire: ~40,000 acres burned; 63 homes destroyed. Fire started by child playing with matches.
Fire NameAcresProperties Damaged and DestroyedProperties ThreatenedEvacuatedFire FightersCanyon Fire4,5002290021,0002,750October Fire35084Magic Fire2,82400Ranch Fire58,40112600Buckweed Fire38,3569359,000
Wildfires: Arial ViewNASA Satellite ImageOctober 24, 2007View from Santa Clarita Valley Near Magic MountainOctober 21, 2007 Used with permission of LA County Fire Department
Wildfires: Arial View (cont.)NASA Satellite ImagesOctober 21, 2007(3 hours, 15 minutes between images)
Public Health Emergency Management System Activation
LAC DPH Emergency Management:Activation24 hour contact & coordination for PH emergenciesCounty EOCDPH Emergency Desk Exec. Duty OfficerHealth Officer DirectorCommunity Health Services/FieldPHN & PHI StaffPublic Health NursingCD ControlEnvironmental Health ServicesToxics EPIInitial notificationPrimary DPH units that provide initial response to public health emergencies
Los Angeles County Emergency Operations Center (EOC)The EOC is hub for coordinating all emergency incidents in L.A. County.All county departments, as well as other agencies, have liaisons at the EOC to ensure resources are matched to needs, and departments can collaborate to ensure needs are met.DPH desk notifies Dept of Mental Health (DMH) that public health nurses are staffing shelters and collaborate with DMH staff for stress debriefing of shelter residents.LA Co. Fire notifies DPH that new base camps are opening for EHS inspections of food facilities.
LAC DPH Emergency ManagementAfter information is provided to immediate response program group, decision is made by director, through the Emergency Desk, to stand up Department Operations Center (DOC).DOC is the Incident Command System (ICS)-formatted emergency management operations unit, dedicated to managing the incident for Public Health.
The DOCECCs called into action based on scope of the emergency.EHS routinely sets up an ECC to manage environmental health emergencies.Public Health liaison has desk at the EOC to facilitate DPH resources and information needs.County EOCPublic Health DOC
SPA ECC (Emergency Control Center)Environmental Health ECCSPA ECC
Advantages of Using EMS/ICS for PH Emergency ManagementUse of the Emergency Management System with ICS provides field staff with organized system for:Incident trackingCosts of staff and resources for incident responseClear chain of command and communication among field staff, PH management, and LA County EOC
Surveillance of Air Quality ImpactsSanta Clarita and Castaic Fires, 2007
Air Quality SurveillanceSimi ValleyRapid Changes in Air QualityOctober 21 to October 22, 2007
Air Quality IndexSCAQMD estimates air quality impacts of criteria pollutants using the Air Quality Index (AQI) systemAQI 050: Good51100: Moderate101150: Unhealthy for Sensitive Groups151 200: Unhealthy201 or above: Very Unhealthy
Public Health AlertTEP initiates a Public Health Alert if any one region will have an AQI > 150, or three or more regions will have an AQI >100.Health alerts may be initiated at discretion of health officer.Each morning, Alert is revised, based on new information from AQMD.
Air Quality SurveillanceTwo-way communication established between LADPH and South Coast Air Quality Management District (SCAQMD).SCAQMD formulates regional A.M. air quality report, based on results from air monitoring stations, field testing, and mathematical models.LADPH Toxics Epidemiology Program (TEP) reviews air quality reports and smoke advisories issued by SCAQMD.
Air Quality Surveillance ConcernsSCAQMD regions based on topography, not population centers.Lack of published standards to predict health impacts based on these measurements.Potential to validate our internal judgments based on Syndromic Surveillance data.
Air Quality Surveillance UpdatesUpdated air quality data reviewed throughout day, and preparations made for potential alerts for next day.Daily communication occurs with Los Angeles Unified School District (LAUSD) and Los Angeles County Office of Education (LACOE) to coordinate outside physical activity messaging.Local school districts outside of LAUSD and private schools added to distribution list depending on location. TEP available throughout day for media inquiries about health effects of adverse changes to air quality.
Surveillance of Adverse Health EffectsSmoke Off Pepperdine Dorms, Malibu Used with permission of LA County Fire
Pre-existing Syndromic Surveillance System Collects daily chief complaint data from 35 hospital emergency departments (ED).Reviews and categorizes presenting complaints into syndromes (GI, neuro, rash, respiratory).Transmits data electronically each day, including weekends.Tracks syndrome counts over time.Statistical increase in syndrome counts triggers a signal.
Strengths of the Syndromic SystemPotential for early detection of major outbreaks or public health events.Useful in defining location and scope of an outbreak or public health event in near-real time.Can customize syndromes such as heat-related and asthma syndrome during wildfires.Detects major trends from baseline patterns, not individual cases.
Limitations of Syndromic SystemData includes chief complaints, not diagnosis.Potential concerns related to sensitivity and specificity.
Respiratory Syndrome-Related ED VisitsOverall respiratory-related visits significantly increased during the wildfire. Generated three consecutive signals from October 22 to October 25.
Respiratory Syndrome-Related ED Visits (cont.)
Asthma Syndrome-Related ED VisitsThree signals generated during October 21 to 24.Average asthma syndrome-related daily ED visits changed from 69 in week before fires began to 87 during week after fires began (p=0.0115).
Asthma Syndrome-Related ED Visits (cont.)
Public Information Officers (PIO)One PIO stationed at Public Health Department Operations Center at all times.One PIO stationed at County Emergency Operations Center for 36 hours.Coordinated with TEP to develop air quality alerts; distributed to internal and external audiences. Participated in daily conference calls with state Emergency Operations Management communication team and other affected county PIOs.
Health AlertsHealth alert listserv established.Health alerts posted on County and Department of Public Health Web sites.Health alerts sent to:School districts and private schools211: LA the Countys information and referral line311: LA Citys information lineBoard of Supervisor offices and other county departments (Dept of Health Services; Parks and Recreation)California National Guard
Other External Communication ActivitiesPress releases/fact sheets on wildfire smoke and safe ash clean-up created in English and Spanish.Public service announcement, created by CDC on safe ash clean-up, disseminated to local radio stations. Ran on 13 AM and FM stations (news radio and music format).Participated in hot wash call sharing lessons learned from state OES and other impacted counties. Emergency management personnel from CDC and other CA county PIOs listened in as observers.
Addressing Sheltering NeedsStructural Fire, Santa Clarita, Used with permission of LA County Fire
Public Health Nurse (PHN) Disaster Response RolesDisease surveillance and controlHealth educationMass prophyla