&EPA
www.epa.gov/research
science   in   ACTION
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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