Every breath you take: Climate change, wildfires, and the hidden health toll

By Kate Weber, MD
EMS1 Contributor

“I can’t breathe” was a common presentation if you were working as a first responder or in the emergency department this past summer. It was once again a season of red alerts for the air quality, but instead of the usual West Coast news headlines, there was a shift in demographics, with those on the East Coast unaccustomed to taking risk mitigation measures now breathing air humans were never meant to breathe.

Firefighters and those living in traditionally risk prone regions out West are intimately aware of what breathing smoke-filled air does to your lungs. But those living in the Eastern half of the country, were not familiar with bad air due to wildfire smoke.

There remains a possibility that the wildfires will continue to burn throughout the winter (5). These previous “once in a lifetime” and “unprecedented events” are now making headlines every day and those who dedicate careers to scientific inquiry have concluded that it is no longer debatable but fact that these changes are fueled by human-caused climate change.

We as medical professionals have chosen careers dedicated to the alleviation of human suffering by delivering treatments that have been refined through hundreds of years of scientific inquiry. Many of us also participate in the scientific process with various research activities and clinical investigations.

This begs the question of how are events intensified by climate change (e.g., the Canadian wildfires) affecting patient’s health and what are we as first responders and medical professionals doing to protect ourselves and our patients?

Burning questions: How is our health being affected?

The Fourth National Climate Assessment concluded with high confidence that rising temperatures and earlier snowmelt due to climate change will very likely increase the wildfire season and there is a very high confidence that increased exposure to wildfire smoke will increase adverse health effects [15].

The most obvious way climate change and the subsequent increase in wildfire season affects human health is through a direct effect on our lungs. The fine particulate matter or PM2.5 that is produced by wildfires – some smaller than a third the diameter of a human hair – can enter deep into the lungs and cause significant damage [3].

Wildfire smoke has been linked to mortality and respiratory morbidity from conditions such as asthma, COPD, bronchitis and pneumonia [6]. From April 30-August 4 2023, there was a 17% higher than expected rate of visits to the emergency department for asthma alone during the 19 days of wildfire smoke that was observed in one study [12].

Our cardiovascular health is also at risk due to increased frequency and severity of wildfires. The toxic fine particulate matter we breathe during a wildfire causes oxidative stress, inflammation, microvascular dysfunction and hypercoagulability, ultimately leading to increased incidences of cardiac arrest, acute coronary syndrome, stroke, heart failure and arrhythmias [9]. Studies published in the Journal of the American Heart Association found that ER visits increased 42% for heart attacks and 22% for ischemic heart disease within a day of exposure to dense wildfire smoke and that exposure to heavy smoke during wildfires raised the risk of out of hospital cardiac arrest up to 70% [16].

In addition to direct effects on our physical health, there is also the unseen mental toll that comes with the physical displacement, loss of home and community, and not being able to do activities you normally do because of poor air quality. One review found that after a wildfire disaster, the prevalence of PTSD was as high as 30-50% among direct victims, 10-20% among rescue workers and 5-10% among the general population [14]. Another systematic review found that not only is air pollution associated with increased depressive and anxiety symptoms, but also it is also associated with physical alterations in brain regions implicated in psychiatric disease [17].

Other health effects include higher risk for preterm birth and birth weight reduction for babies of mother’s exposed to wildfire smoke during pregnancy, and increased risk of gestational diabetes and hypertension for pregnant women. [1].

Read more: Respond to ‘I can’t breathe’ like it’s a mayday – because it is

Who is most affected?

Even with wildfires aside, about 36% of Americans or 119.6 million people live in areas with unhealthy levels of particle pollution and failing grades for air quality levels [11].

Although there are no borders when it comes to wildfire smoke, not all of us are affected equally. Those with underlying health conditions, pediatric patients, the elderly, pregnant women, those who have mobility issues and first responders are particularly vulnerable.

Our patients who require life sustaining equipment, such as oxygen that is dependent on a functioning power grid, are at high risk when electricity fails due to wildfires. A northern California man with underlying COPD and CHF was reported to have died in just 12 minutes after his power was cut due to a wildfire [13].

Our dialysis patients and chemotherapy patients, who’s lives and disease prognosis are tied to being able to receive treatment up to multiple times a week are also at greater risk when their healthcare facility isn’t able to function due to wildfire or they are physically displaced.

In addition, communities that live in areas where there are disproportionate levels of toxic air and environmental degradation due to forces such as systemic racism are exponentially affected when disaster strikes.

The path to clearer skies and breathing easy

While there are a myriad of health effects that come with increased wildfires fueled by climate change, there are several things each of us can do to protect ourselves, our patients and communities we live and work in.

1. Protect yourself

• Pay attention to air quality alerts to know when you should be taking precautionary measures. The Environmental Protection Agency has an application called AirNow that you can download to your smartphone to alert you to when air quality is at dangerous levels. There is also a smoke ready toolbox to proactively educate yourself, reduce your risk and protect yourself.
  
• If you are working or responding to 911 calls, wear a properly fitting respiratory or N95 and try to limit your time outdoors. Do not rely on bandanas or shirts to protect you from smoke.
  
• Reduce smoke in your ambulance by closing windows and vents and run the air conditioning in recirculate mode.
  
• Be aware of evacuation routes and shelters before going out for the day.
  
• Utilize tools such as InciWeb which shows the location of wildfires in your area.

2. Protect your patients

• Ensure that your ambulance is properly stocked, particularly with medications you would give for asthma, COPD and CHF exacerbations.

• Be aware of the nearest shelters to your patients and in your area.

• Take a thorough occupational and social history.
  
  • One of the biggest insights into a patient’s risk is the ability to see a patient’s home environment. First responders are able to do this by the very nature of the work. Relay these observable parts of your history to providers in the emergency department so they also can get a picture of the patient’s environmental and occupational risk factors:
    
    • Does your patient live in a high-risk wildfire zone?
    • Are they dependent on electricity for their medical needs?
    • Were their windows open or closed at their house when you responded?
    • Do they have a portable air filtration system?
    • Where is the patient’s closest shelter and do you think they would be able to evacuate if needed?
    • Do they have family or friends that can check on them?
    • What do they do for work? Are they primarily outdoors?
    • What are their underlying medical conditions that make them particularly vulnerable?

• Educate your patients on risk-mitigation measures.

• Take a course from the Centers for Disease Control for continuing education credits to learn more on how to protect yourself and your patients health during wildfires:
  
  • Wildfire Smoke and Your Patients’ Health
  • Particle Pollution and Your Patients’ Health

3. Get involved and be an advocate for smarter solutions

Healthcare is one of the most energy intensive industries, contributing about 8.5% of national carbon emissions in the United States and ranking highest amongst industrialized nations [7]. If the U.S. healthcare sector were a country, it alone would rank 13th in the world for greenhouse gas emissions, more than that of the entire United Kingdom [8]. These emissions have enormous implications for the quality of the air we breathe and public health.

Health professionals have recognized the detrimental effects of the industry they participate in and have started to take action on a national level. In an extraordinary voice of unification that seldom happens in medicine, over 200 medical journals from all different specialties came together to publish an editorial declaring “climate change as the number one threat to public health” [4].

Every year, more and more health professionals are joining organizations such as The Medical Consortium for Climate and Health, which allows medical professionals to use their voice, advocate on behalf of their patients, and educate local and state policymakers on the health effects of climate change. You can join your state medical professionals’ organization that advocates for climate action and meet other medical professionals advocating for change. The group HealthCare without Harm offers a plethora of resources on how to start embarking on decarbonization efforts within your own system.

Spearheading a hospital, EMS or other first responder Green Team can be a great way to build a local community and start to take collective action. There is even an annual conference that you can attend called CleanMed, dedicated to environmental sustainability in healthcare.In addition to getting involved on an organizational level, there are also governmental funding opportunities offered through the Inflation Reduction Act, many of which hospitals can utilize for infrastructure projects. Some tax credits include opportunities for funding electric vehicles in commercial fleets, which could help healthcare organizations in updating or purchasing more environmentally friendly ambulances and other patient transport vehicles [10]. The Office of Climate Change and Health Equity (OCCHE), through the Department of Health and Humans Services has a webinar series which highlights ways in which healthcare organizations can utilize Inflation Reduction Act funds. You can also encourage your organization to sign the OCCHE Health Care Sector Pledge which aims to cut greenhouse gas emissions by 50% by 2030 and of which more than 116 organizations representing 872 hospitals have signed so far.

In a world that is inundated with catastrophizing news headlines, to hope is one of the most powerful things we can do. As healthcare professionals and first responders, we carry a voice of trust in our communities. We can use this position to be an agent of change and ultimately convey our own message of hope through our action and advocacy. You too can join the community of many medical professionals that are already doing so, so that all of us may one day breathe easier.

About the author

Kate Weber is an emergency medicine physician based out of Rochester, New York, and former Climate and Health Science Policy fellow out of the University of Colorado. She spent her fellowship year working with the federal Office of Climate Change and Health Equity (OCCHE) out of the Department of Health and Human Services as well as the City of Denver, Office of Climate Action, Sustainability and Resiliency. Her interests include advocacy, healthcare system adaptation to climate change, disaster preparedness as well as sustainable healthcare quality improvement-based initiatives.

References

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2. Amjad, S., Chojecki, D., Osornio-Vargas, A., & Ospina, M. B. (2021). Wildfire exposure during pregnancy and the risk of adverse birth outcomes: A systematic review. Environment International, 156, 106644. https://doi.org/10.1016/j.envint.2021.106644
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