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INNOVATIVE RESEARCH FOR A SUSTAINABLE FUTURE
ER Visits for Respiratory and Cardiovascular Problems Linked to Wildfire
Smoke Exposure in Eastern North Carolina
What Was the Problem?
In June 2008, a lightning
strike initiated a fire in the
coastal plain of North Carolina
(NC), which lasted for several
weeks. Burning deposits of
peat produced haze and air
pollution far in excess of
EPA's National Ambient Air
Quality Standards,
encroaching on rural
communities of eastern NC.
Each year NC experiences
more than 100 wildfires. Two
similar peat bog wildfires,
started May 5 and June 19,
2011, and consumed 66,000
acres by mid-summer,
impacting coastal and inland
counties continuously.
Why is There Concern
About Wildfires?
The World Health
Organization estimates that
each year more than 2 million
people worldwide die because
of air pollution. Previous
studies have examined the
effects of air pollution caused
by fossil fuel combustion such
as pollution from car engines,
coal or oil burning power
plants, and diesel engines.
Yet, there are very few studies
that have examined health
effects that might be caused
by exposure to wildfires.
The 2008 NC wildfire was a
peat fire. These fires are
different in that they consume
underground peat (decayed
vegetable matter).
Peat fires tend to burn slowly
and close to the ground so that
the smoke is not as easily
moved upward into the
atmosphere. They are also
very difficult to extinguish and
can last for weeks or months.
EPA scientists felt it was
important to determine if the
health of the population of
eastern NC was adversely
impacted by exposure to air
pollutants from peat wildfires.
What Was Done?
EPA scientists conducted a
study using satellite imagery
to identify counties in eastern
NC impacted by the 2008
wildfire, and emergency room
visits for cardiac and
respiratory problems in
exposed and nearby
unexposed counties to
determine the health impact of
the fire. The scientists used
data from three days of dense
smoke and the following five
The study was conducted in
collaboration with researchers
from the University of North
Carolina at Chapel Hill, The
Brody School of Medicine at
East Carolina University, Pitt
County Memorial Hospital
and the NC Division of Public
Health.
What are the Findings?
This was the first study to
report increased visits for
symptoms of heart failure in
counties exposed to wildfire
smoke. The study found a 37
percent increase in emergency
room visits for people with
symptoms of heart failure
during a three day period of
dense smoke exposure and the
following five days.
The EPA study also showed
an increase in emergency
department visits for problems
relating to asthma, chronic
obstructive pulmonary disease
(COPD), pneumonia, and
bronchitis.
The study does not examine
health effects from other fires
such as controlled or
Continued on back
days.
U.S. Environmental Protection Agency
Office of Research and Development
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prescribed fires or other fires
that burn vegetation, but not
peat. Results from the NC
peat fire study cannot be
extrapolated to other wildfires.
The study, published in
Environmental Health
Perspectives on June 27,
2011, is entitled Peat Bog
Wildfire Smoke Exposure in
Rural North Carolina is
Associated with
Cardiopulmonary Emergency
Department Visits Assessed
Through Syndromic
Surveillance.
How Can People Protect
Themselves?
The particles in wildfire
smoke can pose significant
health concerns, especially for
people with heart or lung
disease, older adults, and
children. EPA's color-coded
Air Quality Index for particles
includes general guidelines to
help people reduce their
exposure. Those guidelines are
available at:
http://www.epa. gov/airnow/pa
rticle/pm-color.pdf and below:
• If air quality is Code
Orange, sensitive groups
(people with heart or lung
disease, older adults, and
children) should reduce
prolonged exertion
outdoors. Use common
sense: if it looks and smells
smoky outside, it's
probably not a good time to
go for a run. Take a walk
instead or consider
exercising indoors.
• Pay attention to symptoms-for
example, shortness of
breath, airway irritation,
coughing and wheezing. If
you experience any of these,
reduce your exposure. If
symptoms are severe or
persistent seek medical
assistance. If you feel chest
pain or discomfort lasting
for more than a few minutes
that comes back, particularly
if associated with shortness
of breath, nausea, sweating
or lightheadedness seek
medical assistance
immediately.
• Code Red means air quality is
unhealthy for everyone. If
you're in one of the sensitive
groups, avoid prolonged or
heavy outdoor exertion.
Everyone else should reduce
it.
• Code Purple means air quality
is very unhealthy. People
with heart or lung disease,
older adults, and children
should avoid all outdoor
exertion. Everyone else
should avoid prolonged or
heavy exertion outdoors.
Additional Tips:
• Pay attention to local air
quality air quality reports,
and stay alert to any news
coverage or health warnings
related to smoke.
• If you have heart or lung
disease, if you are an older
adult, or if you have
children, talk with your
health care provider or your
County Public Health
Department about actions
you can take to reduce
exposure to smoke. Be sure
to follow your health care
provider's advice about
medicines and your
respiratory management plan
if you have asthma or other
lung disease.
• If you're advised to stay
indoors, keep windows and
doors closed—unless you
don't have air conditioning.
Keep the air conditioner on,
and if your air conditioner
has a fresh air intake close it.
Keep the filter clean. If you
do not have air conditioning
and it is too warm to stay
inside with the windows
closed, consider seeking
shelter elsewhere.
• Masks labeled "N95"
(available at many home
improvement stores) will
offer some protection, if
worn properly. Paper dust
masks will not protect
against particles from smoke.
Masks shouldn't be a
substitute for taking
precautions to reduce your
exposure to smoke.
Contact:
Dr. Wayne Cascio, EPA's Environmental
Public Health Division, 919-966-0617,
cascio.waynetgjepa.gov,
June 2011
U.S. Environmental Protection Agency
Office of Research and Development
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