Wildfires and Public Health:
Lessons Learned in
Los Angeles County
Jonathan Fielding, MD, MPH
Cyrus Rangan, MD
Deborah Davenport, RN, PHN, MS
Los Angeles County Department of Public Health
January 29, 2008
Learning Objectives
By the end of this presentation, you will be able to:

Discuss 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.
Malibu Fire, Pepperdine University
Used with permission of LA County
Fire Department
Overview

Background

PH Emergency Management System

Surveillance of air quality impacts

Surveillance of adverse health effects

External communications

Addressing sheltering needs

Role of environmental health

Conclusions
The risk of wildfires in my jurisdiction is:
A. Unchanged recently
B. Increasing
C. Decreasing
D. Minimal
Public Health Implications

Profound public health implications

Smoke 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 Risk

Environmental factors that elevate the risk of
wildfires

Drought conditions

Increased residential and commercial development
in high-risk areas

Global warming
History

October 2003


Wildfires across Southern California consumed more
than 750,000 acres and destroyed 3,640 homes.
October 2007

Wildfires again spread across Southern California,
burning 500,000 acres from Santa Barbara to the
U.S. - Mexico border.
History (cont.)


Totals for LA County, 2007

105,000 acres burned.

60 homes and structures destroyed; another 67
damaged.
Largest LA County blazes

Ranch 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.
History (cont.)
Fire
Name
Acres
Properties
Damaged
and
Destroyed
Canyon
Fire
4,500
22
900
October
Fire
35
0
84
Magic
Fire
2,824
0
0
Ranch
Fire
58,401
12
600
Buckweed
Fire
38,356
93
59,000
Properties
Threatened
Evacuated
Fire
Fighters
21,000
2,750
Wildfires: Arial View
View from Santa Clarita Valley
Near Magic Mountain
October 21, 2007
Used with permission of
LA County Fire Department
NASA Satellite Image
October 24, 2007
Wildfires: Arial View (cont.)
NASA Satellite Images
October 21, 2007
(3 hours, 15 minutes between images)
Public Health Emergency
Management System
Activation
LAC DPH Emergency Management:
Activation
County EOC
Community Health
Services/Field
PHN & PHI Staff
Public Health Nursing
CD Control
Environmental
Health Services
Toxics EPI
DPH Emergency Desk
Exec. Duty Officer
24 hour contact &
coordination for
PH emergencies
Initial notification
Health Officer
Director
Primary 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 Management

After 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 DOC
County EOC
Public Health DOC
SPA ECC (Emergency
Control Center)
Environmental Health
ECC
Public Health liaison
has desk at the EOC
to facilitate DPH
resources and
information needs.
SPA ECC
•
ECCs called into action based
on scope of the emergency.
•
EHS routinely sets up an ECC
to manage environmental
health emergencies.
Advantages of Using EMS/ICS
for PH Emergency Management

Use of the Emergency Management System with
ICS provides field staff with organized system for:

Incident tracking

Costs of staff and resources for incident response

Clear chain of command and communication
among field staff, PH management, and LA County
EOC
Surveillance of
Air Quality Impacts
Santa Clarita and Castaic Fires, 2007
Air Quality Surveillance
Simi Valley
Rapid Changes in Air Quality
October 21 to October 22, 2007
Air Quality Index

SCAQMD estimates air quality impacts of criteria
pollutants using the Air Quality Index (AQI) system

AQI 0–50: “Good”

51–100: “Moderate”

101–150: “Unhealthy for Sensitive Groups”

151– 200: “Unhealthy”

201 or above: “Very Unhealthy”
Public Health Alert

TEP 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 Surveillance

Two-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 Concerns

SCAQMD 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 Updates

Updated 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 Effects
Smoke 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 System

Potential 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 System

Data includes chief complaints, not diagnosis.

Potential concerns related to sensitivity and
specificity.
Respiratory Syndrome-Related
ED Visits

Overall respiratory-related visits significantly increased
during the wildfire.

Generated three consecutive signals from October 22 to
October 25.
Hospital
CC
Syndrome
Gender
Age
X
Cough/smoke
filled area
Respiratory
M
2
X
Short of
breath/exp to
environmental
smoke
Respiratory
F
X
Asthma pt,
diff breathing
Respiratory
M
Time
Zip
ID
1510
-
-
48
1610
-
-
14
1310
-
-
Respiratory Syndrome-Related
ED Visits (cont.)
Asthma Syndrome-Related ED Visits

Three 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).
Arrived
Hospital
Syndrome
CC
Zip
Gender
Age Time
10/22/07
X
Asthma
Asthma attack
X
M
9
9:22
10/22/07
X
Asthma
Asthma attack
X
F
28
10:11
10/22/07
X
Asthma
Wheezing
X
F
15
11:07
10/22/07
X
Asthma
Sent by Dr. Fell
Shakey HX
COPD
X
M
73
9:27
Asthma Syndrome-Related ED Visits
(cont.)
External Communications
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 Alerts

Health alert listserv established.

Health alerts posted on County and Department of
Public Health Web sites.

Health alerts sent to:

School districts and private schools

211: LA the County’s information and referral line

311: LA City’s information line

Board of Supervisor offices and other county
departments (Dept of Health Services; Parks and
Recreation)

California National Guard
Other External Communication
Activities

Press 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 Needs
Structural Fire, Santa Clarita,
Used with permission of LA County Fire
Public Health Nurse (PHN) Disaster
Response Roles

Disease surveillance and control

Health education

Mass prophylaxis

Surge capacity for mass care shelters
Shelter Nursing: Role of PHN

Shelter surveillance.

MOU: Back-up American Red Cross (ARC) staffing
for shelter nursing.

PHNs receive ARC training and certification.

Localized incidents provide experience in planning
for mass care shelters.
Staffing Shelters and FEMA Local
Assistance Centers


Two shelters opened in Santa Clarita.

Saugus HS: Approx. 140 sheltered the first night.

Golden Valley HS: Approx. 100-125 residents for two days;
100 residents from a local independent living center and
personal caregivers.

2 PHNs and 1 DMH Counselor for each shelter, 24
hours/day.

No syndromic patterns, only personal health issues such as
diabetic management supplies for a resident and stressrelated issues.
3 FEMA Local Assistance Centers opened and staffed with
PHNs providing resources and referrals for residents for
approx. one week, 12 hours/day.
Lessons Learned in Shelter Nursing

Develop ongoing standby assignments for PHN
off-duty response to public health emergencies.

Standardize emergency staffing procedures/
call-down lists.

Prepare packaged health education and
resource/referral lists for disaster assistance centers.

Ensure that all PHNs receive training/retraining for
mental health debriefing of disaster victims.

Develop protocols for managing special needs
shelters.
Role of
Environmental Health
Fire Camps

Problem

How to ensure health and safety of first responders?


Inspections prevent sickness and spread of disease.
Action

Food, water, and
waste issues
evaluated.

Daily inspections
conducted.

No’ problems
encountered.
Photo: LA Co. DPH Environmental Health Services
Food Facilities

Problem


Fire damage and no power.
Action


114 food facilities assessed.

103 with no problems

2 had exterior fire damage

1 closed for a rodent infestation

1 out of business

7 not in operation
Fire recovery guidance documents issued.
Housing

Problem


Fire damage and accumulation of trash and debris
in multiple family dwellings with 5 or more units.
Action


113 housing facilities assessed.

95 with no problems

2 destroyed by fire

2 with no power

5 with an accumulation of trash and debris

9 unable to be inspected
Fire recovery guidance documents issued.
Vector Populations


Problem

Increased vector population and migrating rodents can spread
diseases.

Mosquitoes breed in standing water and unattended swimming
pools.

Rodents infest homes and businesses seeking food and shelter.
Action

Local mosquito and vector control districts notified to identify,
control, and prevent mosquito breeding.

Surveillance conducted.

Complaint tracking and bait dissemination occurred.

Identified 10 single family dwellings with pools.

Two contained green water.
Solid Waste

Problem


Large amounts of burned debris shorten the life and
compromise the integrity of landfills.

Sorting and recycling extends the life.

Exclusion of hazardous materials ensures integrity.
Action

Created partnerships with CAL/EPA, Integrated Waste
Management Board and LAC Public Works, HazMat, and
Sanitation District.


Created agreements that hazardous materials would be
separated at burn sites and debris disposed at Calabasas
landfill.
Requests granted for landfills to extend operation hours and
exceed daily tonnage.
Conclusions
Conclusions

By early activation of emergency management system,
department can operate as unified response agency.

Reach-back capability is important for deployed
personnel.

Need more communications staff to serve as PIOs.

Need a toll-free number for air quality information.

Need to validate criteria for issuing health alerts.
Primary Prevention Strategies

Recommend use of more fire-resistant landscaping.

Encourage homeowners and developers to establish
defensible spaces around homes.

Establish collaboration between public health and fire
and planning agencies to help improve community
education on wildfire prevention.