CLIMATE CHANGE AND HEALTH
Smoky Yosemite Valley — Taken by Zack Wettstein
A Scourge of Smoke: Wildfires and Emergency Medicine
SAEM PULSE | MAY-JUNE 2021
By Zachary S. Wettstein, MD and Jeremy H. Hess, MD, MPH, on behalf of the SAEM Climate Change and Health Interest Group
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Wildfires in 2020 burned intensely across the United States, casting particulate matter, toxic gasses, and other noxious compounds into the air that spread from coast to coast. Wildfires have always been a threat to health due to their hazardous smoke, intense heat, and potential to displace whole communities, and are a familiar hazard for emergency medical providers. But wildfires are now darkening our horizons much more often than in the past and wildfire exposure is an increasingly prevalent health risk. Although wildland fires are natural events and important to the functioning of many ecosystems, climate change, drought, and fire suppression over the past century have caused wildfires to spiral out of their historical confines, resulting in more frequent, intense, and larger fires than ever, particularly in the American west.
The fire season has also increased in duration across the country, increasingly dramatically to nearly year-round in some states, such as California. While massive fires blaze mostly in the Western states, the particulate matter and smoke are carried by prevailing winds throughout the Continental U.S., so no region goes unaffected. The Pacific Northwest, where we practice in Seattle, is no exception. For weeks in August and September of 2020, we experienced some of the most intense and sustained waves of smoke seen in the region in recent years. Particulate matter hung in the air, muting the quotidian sounds and casting an eerie orange hue to the sky. On many of these days, Seattle’s air quality, normally quite good, ranked at the bottom ten worldwide. On one shift during this period, emergency medical services brought in a 67-year-old man with a history
of coronary artery disease who had collapsed at home. He was found to be in ventricular tachycardia and, by the time we met, he had been defibrillated and revived. Shortly afterwards he was taken for percutaneous coronary intervention where an occlusion in his right coronary artery was stented open. Another patient we saw was a 32-year-old, otherwise healthy man who was brought to the emergency department after being found down at home following a few days of malaise. His noncontrast head CT sadly showed a large intraparenchymal hemorrhage and significant midline shift. A third critically ill patient we cared for during this week was a 54-yearold woman with chronic obstructive pulmonary disease who despite having taken all her medications at home presented in respiratory distress requiring noninvasive positive pressure ventilation and ICU admission.