Wildfire Smoke
A Guide for Public Health Officials
Revised May 2016
U.S. Environmental Protection Agency * U.S. Forest Service * U.S. Centers for Disease Control
and Prevention * California Air Resources Board

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NOTE: This draft guide, which was last revised in 2008, is designed to help local public
health officials prepare for smoke events, to take measures to protect the public when
smoke is present, and communicate with the public about wildfire smoke and health. The
draft has been updated with the assistance and expertise from a number of federal and state
agencies. Please "test drive" this version during the 2016 wildfire season and send us
feedback. Is the information in the guide clear? Are there additional materials, such as fact
sheets, that would be helpful to you? Let us know what works well for you, and what
doesn't. We'll use that feedback to create a final guide, which we plan to distribute in time
for the 2017 fire season.
Please provide your agency's feedback through the following organizations:
Robert Vanderslice, Association of State and Territorial Health Officials:
rvan dersli ce@asth o. or e
Kelly Poole, Environmental Council of States: kpoole@ecos.ore
Jason Sloan, Association of Air Pollution Control Agencies: isloan@cse.ore
Nancy Krueger, National Association of Clean Air Agencies: nkrueer@4cleanair.ore
Andy Bessler, National Tribal Air Association: Andv.Bessler@nau.edu
Or contact us directly:
Susan Lyon Stone, US Environmental Protection Agency: stone.siisan@epa.eov
Dr. Wayne Cascio, US Environmental Protection Agency: cascio.waYne@epa.eov
Pete Lahm, US Forest Service: plahm@fs.fed.iis
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Acknowledgements
This document, originally developed by the California Air Resources Board (CARB) and
the California Department of Public Health (CDPH), is designed to help local public health
officials prepare for smoke events, to take measures to protect the public when smoke is
present, and communicate with the public about wildfire smoke and health. The version has
been updated with the assistance and expertise from a number of federal and state agencies,
including:
US Centers for Disease Control and Prevention
Dr. Paul Garbe and Scott Damon - Air Pollution and Respiratory Health Branch
US Centers for Disease Control and Prevention - The National
Institute of Occupational Safety and Health
Corey Butler - Western States Division
William Haskell - National Personal Protective Technology Laboratory
US Environmental Protection Agency
Dr. Wayne Cascio and Jason Sacks - Office of Research and Development
Martha Berger - Office of Children's Health Protection
Gregory Brunner - Office of Air and Radiation/Indoor Environments Division
Susan Lyon Stone (Project Lead), Alison Davis, Phil Dickerson, Michelle Wayland and
John White - Office of Air and Radiation/Office of Air Quality Planning and Standards
Lawrence Berkeley National Laboratory
William J. Fisk - Indoor Environment Group
US Forest Service
Peter Lahm - Fire and Aviation Management, Washington Office
Dr. Susan O'Neill - Pacific Northwest Research Station, Forest Service, AirFire Team
Dr. Narasimhan (Sim) Larkin - Pacific Northwest Research Station, Forest Service, AirFire
Team
Roger Ottmar - Pacific Northwest Research Station, Forest Service, FERA Team
Dr. Leland Tarnay - Pacific Southwest Research Station, Forest Service
Mark Fitch - Fire Management Program, National Park Service
Joshua Hyde - University of Idaho College of Natural Resources
Pediatric Environmental Health Specialty Units (PESHU)
Dr. Marissa Hauptman and Dr. Laura Anderko
California Air Resources Board and Department of Public Health
The California Air Resources Board (CARB) and California Department of Public Health
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(CDPH) were the primary authors of the original two versions of this document. Peggy
Jenkins (Indoor Exposure Assessment Section), Greg Vlasek (Office of Emergency
Response) and Charles Pearson (California Air Response Planning Alliance) of CARB and
Dr. Barbara Materna of CDPH provided extensive comments on this draft.
The 2008 version of this document was written by Michael Lipsett and Barbara Materna,
CDPH; Susan Lyon Stone, EPA; Shannon Therriault, Missoula County Health Department;
Robert Blaisdell, California Office of Environmental Health Hazard Assessment; and Jeff
Cook, CARB, with input from individuals in several other government agencies and
academia.
The original document was developed in part as a result of a workshop held at the
University of Washington in June 2001, under the auspices of the U.S. Environmental
Protection Agency, Region X, and the Department of Environmental Health, School of
Public Health and Community Medicine of the University of Washington. Harriet
Ammann, formerly with the Washington Department of Health, was a co-author of the first
version of this Guide, which was written and disseminated in 2001-02.
The viewpoints and policies expressed herein do not necessarily represent those of the
various agencies and organizations listed. Mention of any specific product name is neither
an endorsement nor a recommendation for use.
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Table of Contents
Introduction	7
Composition of smoke	7
Characteristics of wildfire smoke	8
Unified response to wildfire smoke	11
Health effects of smoke	13
Sensitive populations	14
Specific strategies to reduce smoke exposure	17
Stay indoors	17
Reduce activity	18
Reduce other sources of indoor air pollution	19
Use air conditioners and filters	19
Use room air cleaners	20
Avoid ozone generators	22
Create a clean room at home	22
Humidifiers	23
Inside vehicles	23
Respiratory protection	24
Cleaner air shelters	29
Avoiding smoky periods	29
Closures	29
Evacuation	30
Summary of strategies for exposure reduction	30
Communicating particulate matter levels	32
Air Quality Index	32
AirNow	32
U.S. Forest Service wildland fire air quality monitoring website tool	35
Using visual range to assess smoke levels in the interior western United States	36
Recommendations for public health actions	38
Public service announcements	38
Public advisories and protective measures	39
Build strong partnerships	41
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References	46
Additional Resources and Links	48
Appendices	49
Appendix A: Guidance on Protecting Workers in Offices and Similar Indoor Workplaces
from Wildfire Smoke (Adapted from Cal/OSHA)	50
Appendix B: Protect Your Lungs from Wildfire Smoke - Fact Sheet from California
Department of Public Health	54
Appendix C: Hazards during Cleanup Work Following Wildfires from National Institute
for Occupational Safety (NIOSH)	56
Appendix D: Identification and Preparation of Cleaner Air Shelters for Protection of the
Public from Wildfire Smoke	64
Appendix E: Children's Health Fact Sheets from the Pediatric Environmental Health
Specialty Units (PEHSU)	66
Appendix F: Example ARA Report - from Rough Fire, September 9, 2015	75
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Introduction
Smoke rolls into town, blanketing the city, turning on streetlights, creating an eerie and
choking fog. Switchboards light up as people look for answers. Citizens want to know what
they should do to protect themselves. School officials want to know if outdoor events
should be cancelled. The news media want to know how dangerous the smoke really is.
Smoke events can occur without warning - but we can be prepared. This guide is intended
to provide local public health officials with information they need to be prepared for smoke
events and, when wildfire smoke is present adequately communicate health risks, and take
measures to protect the public. This guide is the product of a collaborative effort by
scientists, air quality specialists, land managers and public health professionals from
federal, state, and local agencies.
Composition of smoke
Smoke is a complex mixture of carbon dioxide, water vapor,
carbon monoxide, particulate matter, hydrocarbons and other
organic chemicals, nitrogen oxides, and trace minerals. The
individual compounds present in smoke number in the
thousands. Smoke composition depends on multiple factors,
including how efficiently a fuel burns, the fuel type and
moisture content, the fire temperature, wind conditions and
other weather-related influences, whether the smoke is fresh or
"aged," and other variables. Different types of wood and
vegetation are composed of varying amounts of cellulose,
lignin, tannins and other polyphenols, oils, fats, resins, waxes,
and starches, which produce different compounds that are
released as smoke when burned.
Particulate matter is the principal pollutant of concern from
wildfire smoke for the relatively short-term exposures (hours
to weeks) often experienced by the public. Particulate matter
is a generic term for particles suspended in the air, typically
as a mixture of both solid particles and liquid droplets. The
characteristics, sources, and potential health effects of
particulate matter depend on its source, the season, and
atmospheric conditions. Additionally, the size of particles
affects their potential to cause health effects. Particles larger
than 10 micrometers do not usually reach the lungs, but can
irritate the eyes, nose, and throat. For purposes of
comparison, a human hair is about 60 micrometers in
diameter. Small particles with diameters less than or equal to
10 micrometers, also known as particle pollution or PM10,
can be inhaled deep into the lungs; exposure to the smallest particles can affect the lungs
and heart. Particle pollution includes "coarse particles," also known as PM10-2.5, with
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diameters from 2.5 to 10 micrometers and "fine particles," also known as PM2.5, with
diameters that are 2.5 micrometers and smaller.
Particles from smoke tend to be very small, with a size range near the wavelength of visible
light (0.4 - 0.7 micrometers), and therefore efficiently scatter light and impact visibility.
Moreover, these particles are within the fine particle PM2.5 fraction and can be inhaled into
the deepest recesses of the lung and may represent a greater health concern than larger
particles.
Another pollutant of concern during smoke events is carbon monoxide, which is a colorless,
odorless gas produced by incomplete combustion of wood or other organic materials.
Carbon monoxide levels are highest during the smoldering stages of a fire, especially in
very close proximity to the fire.
Other air pollutants, such as the potent respiratory irritants acrolein and formaldehyde are
present in smoke, but at much lower concentrations than particulate matter and carbon
monoxide.
Characteristics of wildfire smoke
A number of factors, including weather, the stage of the fire, and terrain can all influence
fire behavior and the impact of the smoke plume on the ground. In general, windy
conditions contribute to lower smoke concentrations because the smoke mixes into a larger
volume of air. However, regional weather systems can spread fires quickly and result in
large fires with more smoke generated causing the potential of even greater impacts. Strong
regional weather systems can dominate a fire's behavior for days and be the determining
factor of where and how smoke will affect an area. Santa Ana winds in California, for
example, reverse the typical onshore flow patterns and blow strongly toward the coast from
inland areas, which can result in smoke from mountain fires inundating the heavily
populated communities to the west. Chinook winds in the Rocky Mountains represent
another example of a well-entrenched system that can significantly affect fire behavior and
smoke dispersion.
The intense heat, especially early in a fire, lofts smoke high into the air, where it remains
until it cools and begins to descend. Initial fire plumes tend to be wind-driven events, which
can facilitate prediction of the smoke impact area. As the smoke moves downwind, it
becomes more dilute and often more widespread, eventually reaching ground level. The
amount and type of fuel and its moisture content affect smoke production, as does the stage
of combustion (flaming and smoldering). The smoldering phase of a fire when large rotten
logs and duff consume, for example, can sometimes result in very high particle emissions
due to less complete combustion than when flames are present.
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Figure 1. Discrete smoke plumes early in fire's evolution.
Figure 2. Less dense but more widespread smoke after days of air movement.
Terrain affects weather, as well as fire and smoke behavior, in several ways. For example,
as the sun warms mountain slopes, air is heated and moves upslope, bringing smoke and
fire with it. After sunlight passes from a slope, the terrain cools and the air begins to
descend. This creates a down-slope airflow that can alter the smoke dispersal pattern seen
during the day.
In the evening, especially in mountain valleys and low-lying areas, temperature inversions
are common, in which the air near the ground is cooler than the air above. This prevents
upward air movement. The lid effect of inversions, coupled with a drop in wind speed, can
favor smoke and pollutant accumulation in valleys at night.
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Figure 3. Dense smoke retained in valleys and low lying areas.
Terrain also influences fire behavior by both blocking and promoting wind flow. Mountainous
terrain causes turbulent air flow that can promote plume down-mixing and increased
concentrations of smoke at ground level. Such terrain can inhibit smoke dispersion by
diminishing wind speeds, or it can funnel winds through mountain passes, accelerating fire
movement and smoke transport.
Thus, smoke behavior depends on many factors. Smoke levels in populated areas can be
unpredictable: a wind that usually clears out a valley may simply blow more smoke in, or may
fan the fires, causing a worse episode the next day. Smoke concentrations change constantly.
Sometimes by the time public health officials can issue a warning or smoke advisory, the smoke
may already have cleared. National Weather Service satellite photos, weather and wind
forecasts, and knowledge of the area can all help in predicting how much smoke will come into
an area, but predictions may not be accurate for more than a few hours. The National Weather
Service's website has a lot of information, including satellite photos that are updated throughout
the day. Please see "Additional Resources and Links" at the end of this Guide.
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Unified response to wildfire smoke
Past practices of extinguishing every fire combined with impacts related to climate change are
leading to larger, more intense, more frequent wildfires that threaten life, safety, and property.
Wildfire smoke can result in significant air quality impacts to public health, particularly for at-
risk groups, and impacts to safety and transportation through diminished visibility on roads and
aviation corridors.
As wildfires and impacts of smoke have increased, there has been proactive response to this air
quality impact to the health and safety of the public and fire personnel. The U.S. Forest Service
(USFS) with many interagency partners such as the U.S. National Park Service (NPS) has
developed the Wildland Fire Air Quality Response Program which directly addresses these risks
posed by wildfire smoke. The Program has developed a national cache of smoke monitoring
equipment that can be deployed to incidents to understand the magnitude of smoke impacts. The
monitors were heavily used in western wildfires in 2014 and 2015. Smoke monitors which
measure fine particulate matter, PM2.5 are tied into the GOES satellite system similar to Remote
Automated Weather Stations (RAWS). The near-real time data is available to the public via the
U.S. Environmental Protection Agency's (EPA's) AirNow website as well as smoke monitor
data display systems developed by the Pacific Northwest Research Station's AirFire Team to
support operational smoke forecasting. Generally, orders for monitors are tied to the overall
emergency response to a wildfire and the interagency systems which support incident
management teams.
The AirFire Team with their BlueSky smoke modeling system provides daily smoke impact
modeling of active wildfires throughout the lower 48 states. Alaska BlueSky runs were added
when wildfire smoke needs developed in 2015. The operational model products of BlueSky,
which frequently utilize fine scale meteorological data supplied by U.S. National Oceanic and
Atmospheric Administration (NOAA) for greater resolution and model performance, support
active smoke and air quality impact forecasting downwind of large wildfires.
Combined with the monitoring data, these tools and products can be interpreted by technical
specialists called Air Resource Advisors (ARAs) who craft messages for the public which are
then coordinated with air quality and health agencies as well as other partners (see Appendix F
for an example). These messages are routinely utilized by the incident public information
officers in their fire information duties and outreach efforts as well as included in many state
smoke blogs.
The ARA is a new type of technical specialist position which can operate as part of the incident
management team on individual incidents as well as at larger, multi-fire scales depending on
needs and availability of personnel. As the overall program is new and developing, shortages of
ARAs are anticipated until the pool of qualified technical specialists is larger. The current pool
of ARAs includes staff from the USFS along with many other agencies including EPA, U.S.
Natural Resources Conservation Service (NRCS), U.S. Bureau of Land Management (BLM),
NPS, U.S. Fish and Wildlife Service (FWS), as well as state, tribal and local governments.
These technical specialists are trained in meteorology, atmospheric dispersion, smoke and fire
modelling, air quality monitoring and the air quality effects of smoke to support their efforts in
helping to craft public messages about the wildfire smoke impacts.
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ARAs can be ordered as part of an incident management team responding to a wildfire or by the
agency administrator for the land where the fire is occurring. All orders for ARAs are through
the Resource Order and Status System (ROSS) used by wildland fire management agencies for
movement of all emergency personnel. The Wildland Fire Air Quality Response Program is
managed by the USFS, Fire and Aviation Management Program in Washington, D.C. Ultimately
use and ordering of an ARA is dictated by the agency administrator who manages the land
where the wildfire is occurring and is the key contact when wildfire smoke becomes significant
and there is need for an ARA to be attached to the incident management team responding to the
wildfire. When an ARA is deployed it will be posted at www.wildlandfiresmoke.net with
contact information. This site will also be a repository for the daily one-page smoke impact
forecasts and supporting information useful to others forecasting these impacts or for
exceptional event demonstrations.
The monitoring and modeling of smoke impacts of wildfires can help fire managers, regulators,
and the public understand the magnitude of current air quality impacts while the forecasting of
future impacts allows development of effective messaging so that the public and fire personnel
can respond accordingly and, when needed, take actions to reduce their exposure. Such air
quality messaging and pre-exposure forecasting has been found to be effective especially for
those who are at-risk to high air pollution levels. The focus on these serious wildfire smoke
impacts has helped the public and governmental agencies become more aware of the risk air
quality can pose to public health.
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Health effects of smoke
Wildfires expose populations to a number of environmental hazards, e.g., fire, smoke, and the
byproducts of combustion of wood, as well as, plastics and other chemicals that can be released
from burning structures and furnishings, and also hazards such as psychological stress. During
the acute phase, the major hazards are from the wildfire itself and associated smoke exposure.
Particulate matter exposure is the principal public health threat from short-term exposures to
wildfire smoke. The effects of smoke range from eye and respiratory tract irritation to more
serious disorders, including reduced lung function, bronchitis, exacerbation of asthma and heart
failure, and premature death. Most of our understanding on the health effects of wildfire smoke
are derived from studies of urban particulate matter, specifically fine particulate matter. These
studies have found that short-term exposures (i.e., days to weeks) to fine particles, a major
component of smoke, are linked with increased premature mortality and aggravation of pre-
existing respiratory and cardiovascular disease. Children, pregnant women, and elderly are also
especially vulnerable to smoke exposure. In addition, fine particles are respiratory irritants, and
exposures to high concentrations can cause persistent cough, phlegm, wheezing, and difficulty
breathing. Exposures to fine particles can also affect healthy people, causing respiratory
symptoms, transient reductions in lung function, and pulmonary inflammation. Particulate
matter may also affect the body's physiological mechanisms that remove inhaled foreign
materials from the lungs, such as pollen and bacteria.
Carbon monoxide (CO) enters the bloodstream through the
lungs and reduces oxygen delivery to the body's organs and
tissues. CO concentrations typical of population exposures
related to wildfire smoke do not pose a significant hazard,
except to some sensitive individuals and to firefighters very
close to the fire line. Individuals who may experience health
effects from lower levels of CO are those who have
cardiovascular disease: they may experience chest pain or
cardiac arrhythmias. At higher levels (such as those that occur
in major structural fires), CO exposure can cause headache,
weakness, dizziness, confusion, nausea, disorientation, visual impairment, coma, and death,
even in otherwise healthy individuals.
Wildfire smoke also contains significant quantities of respiratory irritants, which can act in
concert to produce eye and respiratory irritation and potentially exacerbate asthma.
Formaldehyde and acrolein are two of the principal contributors to the cumulative irritant
properties of smoke.
One concern that may be raised by members of the general public is whether they run an
increased risk of cancer or of other chronic health conditions (e.g. heart disease) from short-term
exposure to wildfire smoke. It is well characterized that smoke contains carcinogenic
components with polycyclic aromatic hydrocarbons (PAHs) comprising the largest percent, and
to a lesser extent benzene and formaldehyde. People exposed to toxic air pollutants, such as the
ones mentioned above, at sufficient concentrations and durations may have slightly increased
risks of cancer or of experiencing other chronic health problems. However, in general, the long-
term risks from short-term smoke exposures are quite low. Short-term elevated exposures (i.e.,
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over days to weeks) to carcinogens found in wildfire smoke are also small relative to total
lifetime exposures to carcinogens in other, more common combustion sources. For example,
epidemiological studies have shown that urban firefighters who are occupationally exposed to
smoke over an entire working lifetime are at increased risk of developing lung cancer (Hansen
1990) and other cancers (Daniels et al. 2014).
It is important to recognize that not everyone who is exposed to thick smoke from wildfires will
have health problems. The level and duration of exposure, age, individual susceptibility,
including the presence or absence of pre-existing lung (e.g., asthma, COPD) or heart disease,
and other factors play significant roles in determining whether someone will experience smoke-
related health problems. The types of potential individual responses should be discussed in
public warnings about risks and the need to avoid exposure to smoke.
Sensitive populations
Most healthy adults and children will recover quickly from smoke exposure and will not suffer
long-term health consequences. However, certain sensitive populations may experience more
severe acute and chronic symptoms. Key risk factors that individually and collectively shape a
population's vulnerability to health impacts from extreme events include age, health status,
socioeconomic status, race/ethnicity, and occupation. Much of the information about how fine
particles affect these groups has come from epidemiologic studies involving airborne particles in
cities; however, the studies examining the effects of exposure specifically to smoke suggest that
the health effects due to exposure to wildfire smoke are likely to be similar (Naeher et al. 2007,
Liu et al. 2015). It appears that risk to fine particle-related health effects varies throughout a
lifetime, generally being higher in early childhood, lower in healthy adolescents and younger
adults, and increasing in middle age through old age as the incidence of heart and lung disease
and diabetes increases. Therefore, certain lifestages (e.g., children) and populations (e.g., people
with pre-existing respiratory and cardiovascular disease) should take precautions to limit
exposures to wildfire smoke. If individuals with heart or lung disease are concerned about the
potential health implications of exposure to wildfire smoke and actions they can take to limit
exposures, they should discuss this with their primary healthcare provider and also check the Air
Quality Index (AQI, discussed below) each day for the air quality forecast and for information
about ways to reduce exposure, if necessary. Overall, the potential for increased frequency and
severity of wildfires due to climate change could have important population-level effects. The
following sections provide more specific information on subsets of the population that may be
differentially affected by exposure to wildfire smoke.
Children. All children, even those without any pre-existing illness or chronic conditions, are
considered a sensitive population because their lungs are still developing, making them more
susceptible to air pollution than healthy adults. Major hazards to children during or immediately
following a wildfire include fire and smoke. Other environmental hazards include air pollutants
from burning structures and furnishings. Wildfire smoke can persist for days or even months,
depending on the extent of the wildfire. Symptoms from smoke inhalation can include coughing,
wheezing, difficulty breathing, and chest tightness. Even children who do not have asthma could
experience these symptoms. Air pollution from wildfire can make asthma symptoms worse and
trigger attacks. Research has shown a higher rate of asthma admissions for children during and
after wildfires.
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Several factors lead to increased exposure in children compared with adults: they tend to spend
more time outside; they engage in more vigorous activity; and they inhale more air (and
therefore more smoke constituents) per pound of body weight. These are all reasons to try to
limit children's vigorous outdoor activities during smoky conditions. Studies have shown that
particle pollution is associated with increased respiratory symptoms and decreased lung function
in children, including symptoms such as episodes of coughing and difficulty breathing. These
can result in school absences and other limitations of normal childhood activities.
In addition to the overt health effects and underlying physiologic differences between children
and adults, children may also experience significant emotional distress, resulting from anxiety
and grief following a wildfire. Therefore, it is important to consider not only the potential health
implications of wildfire smoke on children, but also the potential longer term psychological
implications. See factsheets about children's health in Appendix E.
Pregnant women. Pregnant women are at increased risk of the adverse effects of wildfire
smoke both as individuals and the potential for adverse effects to their fetus, during a critical
window of human development. Numerous physiologic changes occur during pregnancy
increasing a woman's vulnerability to environmental exposures, such as increases in blood and
plasma volumes and increased respiratory rates. While there have been a limited number of
studies examining the health effects of exposure to wildfire smoke on pregnancy outcomes,
which tend to be exposures that do not encompass all of pregnancy, there is evidence of some
health effects to other combustion-related air pollution exposures. Specifically, there is
substantial evidence of low birth weight due to repeated exposures to cigarette smoke, including
both active and passive smoking and an emerging body of literature on the health effects of
prenatal exposure to ambient air pollution. Chronic maternal exposure to ambient particulate
matter and indoor biomass smoke during pregnancy has been linked to adverse birth and
obstetrical outcomes (e.g., decreased infant birth weight, preterm birth. Holstius et al. (2012)
conducted the lone epidemiologic study that examined the effect of wildfire smoke on
pregnancy outcomes in Southern California and reported some evidence indicating a potential
reduction in birth weight due to exposure to wildfire smoke while in utero. Additionally,
psychosocial stress exacerbated by wildfires is another mechanism through which wildfire
events may affect health of pregnant women and their fetus (Kumagai et al. 2004).
Older Adults. The proportion of the U.S. population of older adults is projected to almost
double by 2030. Older adults are considered to be at increased risk of health effects attributed to
short-term exposures to wildfire smoke due to a higher prevalence of pre-existing lung and heart
diseases. Older adults may also be more affected than younger people because important
physiologic processes, including defense mechanisms, decline with age. Epidemiologic studies
of short-term exposures to fine particles have often reported a greater risk of health effects,
including hospital admissions and premature mortality, in older adults. Additional evidence
from animal toxicological studies and human clinical studies provide biological plausibility, and
further support that older adults should limit exposures to fine particle sources, such as wildfire
smoke.
Individuals with asthma and other respiratory diseases. More than 36 million people
including more than 6 million children in the US suffer from chronic lung diseases such as
asthma and chronic obstructive pulmonary disease (COPD) (American Lung Association 2008,
CDC 2014). Levels of pollutants that may not affect healthy people may cause breathing
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difficulties for people with asthma, COPD, or other chronic lung diseases. Asthma is a condition
characterized by chronic inflammation of the bronchi and smaller airways, with intermittent
airway constriction, causing shortness of breath, wheezing, chest tightness, and coughing,
sometimes accompanied by excess mucus production. During an asthma attack, the muscles
tighten around the airways and the lining of the airways becomes inflamed and swollen,
constricting the free flow of air. Because children's airways are narrower than those of adults,
irritation that might create minor problems for an adult may result in significant obstruction in
the airways of a young child. Additionally, minority and impoverished children and adults bear
a disproportionate burden associated with asthma and other diseases, which may increase their
susceptibility to the health effects of wildfire smoke (Brim et al., 2008; CDC, 2014). However,
this disease affects all age and sociodemographic groups.
A significant fraction of the population may have airway hyperresponsiveness, an exaggerated
tendency of the large and small airways (bronchi and bronchioles, respectively) to constrict in
response to respiratory irritants, cold dry air, and other stimuli. While airway
hyperresponsiveness is considered a hallmark of asthma, this tendency may also be found in
many individuals without asthma as well; for example, during and following a lower respiratory
tract infection. In such individuals, smoke exposure may cause asthma-like symptoms.
Individuals with COPD, which is generally considered to encompass emphysema and chronic
bronchitis, may also experience worsening of their conditions because of exposure to wildfire
smoke. Patients with COPD often have an asthmatic component to their condition, which may
result in their experiencing asthma-like symptoms. However, because their lung capacity has
typically been seriously compromised, additional constriction of the airways in individuals with
COPD may result in symptoms requiring medical attention. Researchers have reported that
individuals with COPD run an increased risk of requiring emergency medical care after
exposure to particulate matter or wildfire smoke. In addition, because COPD is usually the result
of many years of smoking, individuals with this condition may also have heart and vascular
disease, and are potentially at risk of a health effect due to wildfire smoke exposure from both
conditions.
Individuals with cardiovascular disease. Diseases of the circulatory system include high blood
pressure, heart failure, and vascular diseases, such as coronary artery disease, and
cerebrovascular conditions, such as diseased arteries (atherosclerosis) that bring blood to the
brain. These chronic conditions can render individuals susceptible to attacks of angina pectoris
(transient chest pain), heart attacks, and sudden death due to a cardiac arrhythmia, heart failure,
or stroke.
Cardiovascular diseases are the leading cause of mortality in the United States: about 30 to 40
percent of all deaths each year. The vast majority of these deaths occur in people over age 65.
Studies have linked fine particulate matter to increased risks of heart attacks, heart failure,
cardiac arrhythmias, and other adverse effects in those with cardiovascular disease. In response
to exposure to particulate matter people with chronic lung or heart disease may experience one
or more of the following symptoms: shortness of breath, chest tightness, pain in the chest, neck,
shoulder or arm, palpitations, or unusual fatigue or lightheadedness. Chemical messengers
released into the blood because of particle-related lung inflammation may increase the risk of
blood clot formation, angina episodes, heart attacks, and strokes.
Low Socioeconomic Status (SES). SES is often defined in epidemiologic studies using a
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variety of indicators, such as educational attainment, median household income, percent of
population in poverty, race/ethnicity, and location of residence. Although a variety of individual
indicators have been used as a proxy for SES, it is well recognized that SES is a composite
measure that encompasses a number of individual indicators along with other factors.
Epidemiologic studies of particulate matter using indicators of SES have provided initial
evidence that individuals of low SES are at increased risk of mortality due to short-term
exposures. With respect to wildfire smoke the evidence is much more limited, but Rappold et al.
(2012) demonstrated that counties classified as having the lowest SES were at the greatest risk
of health effects attributed to wildfire smoke.
Additionally, SES may contribute to differential exposures to wildfire smoke across
communities. For example, access to air conditioning reduces infiltration of particle pollution
indoors. Less access to air conditioning due to SES may lead to greater exposure to wildfire
smoke and greater sensitivity to extreme heat and subsequently health disparities across
communities. Moreover, as noted above, minority and impoverished children and adults bear a
disproportionate burden associated with asthma and other diseases, which may increase their
susceptibility to the health effects of wildfires (Brim et al., 2008; CDC, 2014).
Specific strategies to reduce smoke
exposure
Stay indoors
The most common advisory issued during a smoke
episode is to stay indoors. The usefulness of this
strategy depends on how well the building limits
smoke from coming in from outdoors and on
minimizing indoor pollution sources. Staying indoors
therefore provides some protection, especially in a tightly
closed, air-conditioned home in which the air conditioner
re-circulates indoor air. Generally, newer homes are "tighter"
and keep ambient air pollution out more effectively than older
homes.
Staying inside with the doors and windows closed can usually
reduce exposure to ambient air pollution by at least a third or
more. Homes with central air conditioning generally re-
circulate indoor air, though some outdoor smoky air can still
be drawn inside (e.g., when people enter or exit). In homes
without air conditioning, indoor concentrations of fine particles can approach 70 to 100 percent
of the outdoor levels; however, more commonly the indoor concentrations of fine particles that
come from outdoors are 50% or less of outdoor concentrations when windows and doors are
closed. In very leaky homes and buildings, outdoor particles can easily infiltrate indoors, so
guidance to stay inside may offer little protection. In any home, if doors and windows are left
open, particle levels indoors and outdoors will be about the same.
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Sometimes smoke events can last for weeks or (rarely) months. These longer events are usually
punctuated by periods of relatively clean air. When air quality improves, even temporarily,
residents should "air out" their homes to reduce indoor air pollution. People who wish to clean
their residences after or between wildfire smoke events should use cleaning practices that reduce
re-suspension of particles that have settled, including damp mopping or dusting and using a high
efficiency particulate air [HEPA] filter-equipped vacuum.
An important drawback of advising people to stay inside and close windows and doors of homes
without air conditioning during smoke events is the increased risk of heat stress. In many parts
of the country, the fire season typically extends from mid-summer through the early fall, when
high outside temperatures are common. In homes without air conditioning, in which individuals
depend on open windows and doors for ventilation, remaining inside with everything closed can
be dangerous. Older individuals and others in frail health run the risk of heat exhaustion or heat
stroke, which could have dire consequences. If outdoor temperatures are very high, it would be
prudent to advise those without air conditioning to stay with friends or with family members
who do, to go to a cleaner air shelter in their community, or to leave the area. These and other
options are discussed below.
Guidance on protecting workers in offices and similar indoor workplaces from wildfire smoke
has been developed by the California Division of Occupational Safety and Health (Cal/OSHA),
in consultation with technical staff from several other California agencies and has been adapted
to this document in Appendix A, which addresses how to maximize the protection provided by
heating, ventilating and air-conditioning (HVAC) systems common in public and commercial
buildings, as well as other steps to protect occupants.
Reduce activity
Reducing physical activity is an effective strategy to
lower the dose of inhaled air pollutants and reduce
health risks during a smoke event. During exercise,
people can increase their air intake as much as 10 to
20 times over their resting level. Increased breathing
rates bring more pollution deep into the lungs.
Furthermore, people tend to breathe through their
mouths during exercise, bypassing the natural filtering
ability of the nasal passages, again delivering more
pollution to the lungs. They also tend to breathe more
deeply, modifying the usual patterns of lung particle
deposition.
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Reduce other sources of indoor air pollution
Many indoor sources of air pollution can emit large
amounts of pollutants, some of which are also present in
wildfire smoke. Smoking cigarettes, using gas, propane
and wood-burning stoves and furnaces, spraying aerosol
products, frying or broiling meat, burning candles and
incense, and vacuuming can all increase particle levels
in a home and should be avoided when wildfire smoke
is present.
For instance, in a closed standard room of 125 square
feet, it takes only 10 minutes for the side-stream smoke
of 4 cigarettes to generate indoor levels of particles in
the hazardous ranges (644 micrograms of particles per
"3
cubic meter of air or yg/m ). Besides cigarette smoke,
combustion sources that are not properly vented to the
outdoors contribute most to indoor pollutant levels, and are of greatest concern. "Room-vented"
or "vent-free" appliances such as unvented gas or propane fireplaces, decorative logs, and
portable heaters can especially contribute substantial quantities of particles. Frying or broiling
some foods also can produce high levels of particles in the kitchen and dining areas. These
sources can also increase the levels of polycyclic aromatic hydrocarbons (PAHs), carbon
monoxide, acrolein, and nitrogen oxides. Additionally, small sources such as candles and
incense burning can produce surprisingly large quantities of particles and should not be used
during fire events. To avoid re-suspending particles, do not vacuum during a fire event, unless
using a HEPA-filter equipped vacuum. Thus, reducing indoor air pollutant emissions during
smoke events can decrease indoor particle levels, which may partially compensate for the
increased particle loading from the outdoor air.
Use air conditioners and filters
Little is known about the impact of using various types of room air conditioners (e.g., window
units) and their air filters on indoor smoke concentrations in homes. However, homes with
central air conditioners generally have lower amounts of outdoor particles indoors compared to
homes that use open windows for ventilation.
Most air conditioners are designed by default to re-circulate indoor air. Those systems that have
both "outdoor air" and "re-circulate" settings need to be set on "re-circulate" during fire/smoke
events.
Also, central heating and/or air conditioning systems (and some room air conditioners) contain
filters that can remove some airborne particles with different degrees of efficiency. If possible,
one should replace the central air handler filter with a pleated medium- or high-efficiency
particle filter. Higher efficiency filters are preferred as they can capture more of the fine
particles associated with smoke and can further reduce the amount of outside air pollution that
gets indoors. However, caution must be taken to ensure that the central system is able to handle
the increased airflow resistance from a higher efficiency filter. Filters need to be replaced
regularly, and should fit the filter slot snugly. If a filter upgrade has been performed (e.g., a filter
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rated at MERV 8 or higher has been installed), during a wildfire smoke event, the central
system's circulating fan can be set to operate continuously (i.e., fan switch on the thermostat set
to "ON" rather than "AUTO") to obtain maximum particle removal by the central air handler
filter, although this will increase energy use and costs. The thermostat should be reset back to
"AUTO" after the wildfire smoke clears.
To facilitate preparedness, a central air handler filter upgrade can be performed well in advance
of a wildfire event, and extra air filters can be stored for future use. This may especially be an
advisable preparation in homes with susceptible occupants. Wildfire risk is typically discussed
in the media and can be tracked on line where state and federal land management agencies
routinely post such information. When the risk is high, the recommendation of preparing in
advance, such as upgrading the central filter can be developed into a public service
announcement for the area and messages passed to local health care providers.
In addition to high- and medium-efficiency filters, electrostatic precipitators (ESPs) or other
electronic particle air cleaners can sometimes be added by a technician to central air
conditioning systems to keep particle levels in indoor air within acceptable levels during a
prolonged smoke event. However, only ESPs that have been tested and documented not to
produce excess ozone should be used.
For newer air conditioners with a "fresh air ventilation system" that brings in outdoor air
continuously or semi-continuously, the "fresh air" component of the system should be turned off
during smoke events. This may require closing the outdoor air damper or sealing off outdoor air
intakes, setting the system on "re-circulate" only, or turning off the energy- or heat-recovery
ventilator or exhaust fans that are part of the system. If the control system instructions are not
clear or accessible, residents should contact their builder or heating and cooling contractor to
help temporarily adjust the system. However, residents should also place a reminder tag in a
visible spot so that they reset the system once the smoke clears.
Many newer homes currently have mechanical ventilation systems that intentionally bring
outdoor air inside, and mechanical ventilation in new homes is now required by building codes
in some jurisdictions. These may need to be turned off or adjusted during periods of high
outdoor air pollution from wildfires to avoid entry of outdoor air pollutants. Mechanical
ventilation systems used in public and commercial buildings differ, and are discussed further in
Appendix A.
Use room air cleaners
Choosing to buy an air cleaner is a decision that ideally should be made before a smoke
emergency occurs, particularly in homes with susceptible occupants. During a smoke
emergency, it may be hazardous to go outside or drive in an attempt to locate an appropriate
device, which may be in short supply. It is unlikely that local health officials will be able to buy
or supply air cleaners to those who might need them.
High-efficiency particulate air (HEPA) filter air cleaners and ESPs documented not to produce
excess ozone can help reduce indoor particle levels, provided the specific air cleaner is properly
matched to the size of the indoor environment in which it is placed. There are wide ranges of air
cleaners and prices to choose from: air cleaners are available as either less expensive portable
units designed to clean the air in a single room ($90 - $900) or as larger central air cleaners
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intended to clean the whole house ($450 - $1500). Central air cleaners can be more effective
than room air cleaners because they filter a larger amount of air, although two or more well-
placed portable air cleaners can be equally effective and their cost may still be less than the cost
of a large central air cleaner. A good portable air cleaner also may improve the air quality in a
bedroom, for example, which may be helpful to an individual with asthma or COPD. Room air
cleaners will provide the most protection when placed where people spend most of their time.
Most air cleaners are not effective at removing gases and odors, although some specialized
models are available that perform well. The two basic types for particle removal include:
a)	Mechanical air cleaners, which contain a fiber or fabric filter. The filters need to fit
tightly in their holders, and cleaned or replaced regularly. HEPA filters (and Ultra-Low
Penetration Air [ULPA] filters, which are not generally available for residential use) are
most efficient at removing particles.
b)	Electronic air cleaners, such as electrostatic precipitators (ESPs) and ionizers. ESPs use a
small electrical charge to collect particles from air pulled through the device. Electronic
air cleaners usually produce small amounts of ozone (a respiratory irritant) as a
byproduct, though some, especially those that are combined with other technologies, may
produce substantial levels of ozone (see next section on Ozone Generators). Only ESPs
that have been tested and documented not to produce excess ozone should be used.
Ionizers, or negative ion generators, cause particles to stick to materials (such as carpet
and walls) near the device and are also often a source of ozone. Ionized particles
deposited on room surfaces can cause soiling and, if disturbed, can be resuspended into
the indoor air.
Room air cleaner units should be sized to provide a filtered airflow at least two to three times
the room volume per hour. Most portable units will state on the package the unit's airflow rate,
the room size it is suitable for, its particle removal efficiency, and perhaps its Clean Air
Delivery Rate, or CADR. The CADR is a rating that combines efficiency and airflow.
The Association of Home Appliance Manufacturers (AHAM) maintains a certification program
for air cleaners. The AHAM seal on the air cleaner's box lists three CADR numbers - one for
tobacco smoke, one for pollen, and one for dust. The higher the numbers, the faster the unit
filters the air. Choose a unit with a tobacco smoke CADR at least 2/3 of the room's area. For
example, a 10' x 12' room (120 square feet) would require an air cleaner with a tobacco smoke
CADR of at least 80. If the ceiling is higher than 8', an air cleaner rated for a larger room will be
needed.
Only portable (room) air cleaners that do not produce excess ozone should be used. California
Air Resources Board (CARB) certifies air cleaners that produce little or no ozone; see their list
of certified air cleaners at: http://www.arb.ca.eov/research/indoor/aircleaners/certified.htm.
Devices that remove gases and odors can cost more than particle air filters, both to purchase and
maintain. They force air through materials such as activated charcoal or alumina coated with
potassium permanganate. However, with smaller-sized air cleaners, the filtering medium can
become quickly overloaded and may need to be replaced often. Nevertheless, large such devices
may be useful for sensitive individuals and may require less-frequent replacement of the
filtering medium. New models that combine particle and gas removal are available in both
portable and in-duct models.
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Air cleaners can be used in combination with central air system filter upgrades described in the
preceding section to maximize the reduction of indoor particles.
For more information about residential air cleaners:
http://www.epa.gOY/mdoor-air-qiialitv-iaq/giiide-air-cleaners-home
http://www.arb.ca.gov/research/indoor/aircleaners/consiimers.htm
http ://www. cadr. org / consumer, htm
Avoid ozone generators
Some devices, known as ozone generators, personal air purifiers, "super-oxygen" air purifiers,
and "pure air" generators, are sold as air cleaners, but the position of public health agencies,
including the California Air Resources Board and U.S. Environmental Protection Agency, is that
they do more harm than good. These devices are designed to intentionally produce large
amounts of ozone gas. Ozone generator manufacturers claim that ozone can remove mold and
bacteria from the air, but this occurs only when ozone is released at levels many times higher
than those that are known to harm human health.
Relatively low levels of ozone can irritate the airways, causing coughing, chest pain and
tightness, and shortness of breath. It can also worsen chronic respiratory diseases such as
asthma, as well as compromise the body's ability to fight respiratory infections. As a result,
using an ozone generator during a smoke event may actually increase the adverse effects from
the smoke. In addition, ozone gas does not remove particles from the air; in fact, ozone reacts
with certain chemicals commonly found indoors to produce particles and formaldehyde.
California now prohibits sales of air cleaners that emit potentially harmful amounts of ozone.
A list of air cleaners that have been certified to emit little or no ozone is available at
http://www.arb.ca.gov/research/indoor/aircleaners/certified.htm
For more information about ozone generators marketed as air cleaners:
http://www.epa.gov/indoor-air-qiialitY-iaq/ozone-generators-are-sold-air-cleaners
http://www.arb.ca.gov/research/indoor/ozone.htm
Create a clean room at home
People, especially at-risk individuals, who live in areas that are regularly affected by smoke
from wildfires or who are in an area where the wildfire risk has been determined to be high,
would be well advised to create a "clean room" in their home. A good choice is an interior
room, with as few windows and doors as possible, such as a bedroom. Some suggestions for
maintaining a clean room:
•	Keep windows and doors closed.
•	Set up a properly sized room air cleaner (see above), which will help remove particles from
the air while emitting no or minimal levels of ozone.
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•	Run an air conditioner or central air conditioning system if you have one. If the air
conditioner provides a fresh air option, keep the fresh-air intake closed to prevent smoke
from getting inside. Make sure that the filter is clean enough to allow good air flow
indoors.
•	Do not vacuum anywhere in the house, unless using a HEPA-filter equipped vacuum.
•	Do not smoke or burn anything anywhere in the house, including candles or incense.
•	Keep the room clean.
•	If it is too warm to stay inside with the windows closed,
or if you are very sensitive to smoke, seek shelter
elsewhere. Keep in mind that many particles will enter
your home even if you take all of these steps.
Humidifiers
Humidifiers are not air cleaners, and will not significantly
reduce the amount of particles in the air during a smoke
event. Nor will they remove gases like carbon monoxide.
However, humidifiers and dehumidifiers (depending on the
environment) may slightly reduce pollutants through
condensation, absorption and other mechanisms. In an arid
environment, one possible benefit of running a humidifier
during a smoke event might be to help the mucous
membranes remain comfortably moist, which may reduce
eye and airway irritation. However, if not properly cleaned
and maintained, some humidifiers can circulate mold spores.
The usefulness of humidification during a smoke event has
not been studied.
Inside vehicles
Individuals can reduce the amount of smoke in their vehicles by keeping the windows and vents
closed, and, if available, operating the air conditioning in "re-circulate" mode. However, in hot
weather a car's interior can heat up very quickly to temperatures that far exceed those outdoors,
and heat stress or heat exhaustion can result. Children and pets should never be left unattended
in a vehicle with the windows closed. The ventilation system of older cars typically removes a
small portion of the particles coming in from outside, while newer models often have an air
filter that removes most particles. Most vehicles can re-circulate the inside air, which will help
keep the particle levels lower.
Drivers should check the owner's manual and assure that the system is set correctly to minimize
entry of outdoor smoke and particles. However, recent research has shown that carbon dioxide
levels can quickly accumulate to very high levels due to occupants' exhaled breath (more than
5000 parts per million) in newer cars when vents and windows are closed and the recirculation
setting is used. Therefore, if driving a recent model vehicle for more than a short period of time,
it may be a good idea to briefly open windows or vents occasionally when smoke levels are low
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to avoid becoming groggy from carbon dioxide build-up. Finally, vehicles should not be used as
a shelter, but as means to get to one or to leave the area.
Respiratory protection
This section addresses the use of masks and respirators by the public and workers to reduce
inhalation of wildfire smoke, specifically harmful particles. The use of the term "mask" in this
guidance document may cause confusion for public health officials and the general public. The
term mask can refer to one-strap paper masks and surgical masks. Respirators and surgical
masks are designed for different functions and do not provide the same types of levels of
protection (NIOSH 2016). Surgical masks are typically loose-fitting and do not form a tight seal
to the wearers face. Surgical masks are not designed to capture a large percentage of small
particles and will not prevent the wearer from breathing in airborne particles such as contained
in wildland smoke. Covering the mouth with a (damp or dry) bandana, handkerchief, or tissue
also will not prevent the wearer from breathing in airborne particles. N95 particulate filtering
facepiece respirators or respiratory protection devices with a higher level of protection are more
appropriate for the public for this type of inhalation hazard. This discussion emphasizes
appropriate usage of the term "respirator;" however, in Appendix B, which provides guidance in
lay language to the public on respiratory protection, the term "mask" is used.
NIOSH has a searchable web site entitled "Approved N95 Particulate Filtering Facepiece
Respirators" which includes access to NIOSH approved N95's alphabetically by manufacturer.
rhttp://www.cdc.eov/niosh/npptl/topics/respirators/disp part/n951istl.html.l
NIOSH also maintains a "Certified Equipment List" which identifies respiratory protective
devices which conform to the requirements of Title 42, Code of Federal Regulations, Part 84.
[ http://www.cdc.eov/niosh/npptl/topics/respirators/CEL/default.html ]
In order for a respirator to provide protection, it must be able to filter very small particles and it
must fit well, providing a tight seal around the wearer's mouth and nose. For example, adequate
seals cannot be obtained for men with beards or for most children.
Without having had a "fit test" while wearing a respirator, the individual user cannot be sure that
it fits well enough to provide the expected protection. However, because disposable respirators
(N95 or PI00) are increasingly available in hardware and home repair stores and pharmacies,
many people will purchase these devices and use them, either when going outdoors during
smoke events or during fire ash cleanup. Therefore, health officials should consider providing
guidance on the proper selection and use of respirators, which can provide some level of
protection despite the lack of formal fit testing and training (NIOSH, publication No. 2016-109).
Respirators should only be used after first implementing other, more effective methods of
exposure reduction, including staying indoors, reducing activity, and using HEPA air
cleaners indoors to reduce overall smoke exposure. Another option that should be
considered for sensitive individuals is temporary relocation out of the smoky area if
possible.
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Filtering facepiece respirators are a type of respiratory protection in which the entire respirator
is comprised of filter material. The most common types are called N95 (used in health care
settings to protect against inhalation of infectious particles) and P100 (used to protect against
toxic dusts such as lead or asbestos). Filter material rated "95" will capture at least 95% of very
small particles, while material rated "100" filters out at least 99.97%. These respirators must be
certified by the National Institute for Occupational Safety and Health (NIOSH), with the words
"N10S1 f" and the designation "N95" or "P100" appearing on the filter material. P100
respirators are more expensive than N95 respirators and will have somewhat higher resistance to
airflow. The cost difference may make people reluctant to change them out when necessary, so
N95 respirators may be preferable in wildfire smoke situations. Leakage around the respirator
will result in more particles inhaled by someone wearing a respirator than passage through the
filter material. Therefore, in practice, particularly without formal fit testing, N95s and PI00s
will provide similar levels of protection against wildfire smoke.
Figure 4. Two types of recommended N95 Disposable Particulate Respirators. Note the
presence and placement of the two straps above and below the ears.
Other non-disposable NIOSIT-certified respirators, such as those used by painters, may also be
beneficial; they have a tight-fitting flexible half-mask facepiece and replaceable filter cartridges.
These would provide similar protection from particles if they are used with N95 particulate
filters or purple (P100 or HEP A) filter cartridges. This type of respirator may also be purchased
with a combination filter and organic vapor cartridge, which can reduce exposure to irritating
gases in smoke, such as aldehydes.
One drawback to the use of respirators by the public in an area affected by wildfire smoke is that
people may not select or use them correctly and won't understand the importance of having a
tight seal around the face. A one-page fact sheet, "Protect Your Lungs from Wildfire Smoke,"
which is designed for the general public, appears at the end of this Guide as Appendix B. In lay
terms (including using the term "mask" instead of "respirator"), it describes how to correctly
choose and use a disposable N95 or P100 particulate respirator. Guidance to the public on using
respirators should include the following points:
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How to Choose the Right Respirator:
•	Disposable particulate respirators are sold at many hardware and home repair stores
and pharmacies. These respirators only filter out particles. They do not protect
against gases or vapors, and do not provide oxygen.
•	Select a NIOSH-certified N95 or PI00 particulate respirator with two straps that go
around your head. The words "NIOSH" and either "N95" or "PI00" will be printed
on the filter material.
•	Choose a size that will fit over your nose and under your chin. It should seal tightly
to your face. If you cannot get a close face seal, try a different model or size. Fit
testing is the best way to determine if the respirator fits you, but even without fit
testing a respirator will provide some protection to most people.
•	As of May 2016, respirators do not come in sizes that will fit young children.
NIOSH does not certify any respirators for children.
How to Use the Respirator:
•	Place the respirator over your nose and under your chin, with one strap below the ears
and one strap above (see photo above). If you're wearing a hat, it should go over the
straps.
•	Pinch the metal nose clip tightly over the top of your nose.
•	Facial hair will cause the respirator to leak, so you should be clean-shaven.
•	It takes more effort to breathe through a respirator. It can also increase the risk of heat
stress. If you are working outside while wearing a respirator, take frequent breaks,
especially if you are working in the heat or doing heavy work.
•	If you feel dizzy, lightheaded, or nauseated, tell someone, go to a less smoky area,
remove your respirator, and get medical attention.
•	People with heart or lung disease should consult with their doctor before using a
respirator.
•	Discard the respirator when: (1) it becomes more difficult to breathe through it, or
(2) if the inside becomes dirty. If necessary, use a fresh respirator each day.
•	Keep your respirator clean and dry. Be sure to read and follow the
manufacturer's recommendations on use and storage.
As noted above, "mask" means different things to different people. For example, to some people
"dust mask" describes a PI00 particulate respirator used in the construction industry, and to
others it means a one-strap paper mask that is NOT a respirator. A disposable particulate
respirator has been certified by NIOSH to ensure that it can filter out harmful particles. Paper
masks and surgical masks are not certified by NIOSH and cannot provide the protection that
respirators do. Commonly available one-strap paper dust masks, which are designed to keep
larger particles out of the nose and mouth, typically offer little protection. The same is true for
bandanas (wet or dry) and tissues held over the mouth and nose. Surgical masks are designed to
filter air coming out of the wearer's mouth, and do not provide a good seal to prevent inhalation
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of small particles found in wildfire smoke. Incorrect use of respirators, or use of other, less
protective face coverings, may give the wearer a false sense of security and encourage increased
physical activity and time spent outdoors, resulting in increased exposures.
Figure 5. A one-strap paper mask is not a respirator and would provide little or no
protection from smoke particles.
Figure 6. A surgical mask, which is designed to capture infectious particles generated by
the wearer, is not a respirator and would provide little or no protection from smoke
particles.
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N95 and PI00 respirators described in this section would also help to protect people involved in
cleaning up fire ash. Additional guidance for the public on cleaning up ash safely appears as
Appendix C. If respirators are not available during fire ash cleanup, simple paper masks or other
face coverings may help keep grit and dust out of the nose and mouth. Public health official
should make the public aware that these types of products are not providing adequate inhalation
protection to particulates in fire ash.
Use of respirators by workers generally must be under a comprehensive, OSHA- compliant
respiratory protection program. These programs include medical evaluation of employees to
ensure that it is safe and appropriate for them to use respirators; individual fit testing to select a
model and size that fit; and training on respirator use. Employers who anticipate that their
workers may need to wear respiratory protection are expected to put in place a full program
prior to use. However, during emergency situations such as smoke events employees who work
outdoors or indoors (who would not otherwise be required to wear respirators) may request to
use respirators to protect against exposure to smoke, particularly when the local Air Quality
Index (AQI) for PM is rated "unhealthy" or worse. As long as occupational particulate standards
are not exceeded (which is unlikely for workers not performing firefighting duties), the OSHA
respiratory protection standard permits employers to allow voluntary use of N95 or other
disposable filtering facepiece respirators without requiring a medical evaluation or fit test.
Employees must be provided with Appendix D of the federal OSHA respiratory protection
standard, at:
https://www.osha.eov/pls/oshaweb/owadisp.show document?ptable=STANDARDS&p id=97
84 (for workplaces under Cal/OSHA jurisdiction this is available at
http://www.dir.ca.gov/Title8/5144d.html). Employers should also tell employees that the
respirator will provide some protection against the particles in smoke, but without fit testing it
may not provide the maximum level of protection. Although a medical evaluation is not
required, the employer should advise employees to consult their doctor about potential
exposures to smoke and respirator use, particularly if they have respiratory or heart disease.
Public health officials can find additional information on the NIOSH Respirator Trusted-Source
Information web site at:
http://www.cdc.eov/niosh/npptl/topics/respirators/disp part/RespSource.html.
This includes web pages with the following information.
Use of NIOSH-Approved Respirators
•	Respirator Fit Testing
•	Respirator Safety
•	Respirator User Notices
•	Buyer Beware
Respirator Fit Testing
•	What is Fit Testing
•	Fit Testing Procedures
•	OSHA Respiratory Fit Testing Video
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Cleaner air shelters
Public health officials in areas at risk from wildfires should identify and evaluate cleaner air
shelters prior to the fire season. Guidance for identifying and setting up a Cleaner Air Shelter is
provided in Appendix D. During severe smoke events, cleaner air shelters can be designated to
provide residents with a place to get out of the smoke.
Staying inside at home may not adequately protect sensitive individuals, since many houses and
apartments do not have air conditioning, and depend on open windows and doors for cooling.
Other homes may be so leaky that indoor pollution levels will quickly equal those outside.
Cleaner air shelters can be located in large commercial buildings, educational facilities,
shopping malls, or any place with effective air conditioning and particle filtration.
Avoiding smoky periods
Smoke levels from wildfires often change substantially over the course of the day, so there is
often opportunity to avoid the worst periods of smoke. Impacts at the surface are often
forecasted and posted on state smoke blogs and can be found on the inciweb site (see
resources and additional links). During smaller events, impacts often follow a pattern such as
nighttime smoke draining downhill into nearby communities and lifting out the next day.
Either way, it's often possible to plan your day around the smokiest times in order to
minimize exposure, using the visibility estimation tools in combination with Nowcast values
from nearby or representative monitors to identify and avoid the smokiest times of day (see
section 4). Look for links to such forecasts and patterns in your local PSAs (see section 5).
See also appendix F for an example of a smoke forecast from a large wildfire).
Closures
The decision to close or curtail business activities and public events will depend upon predicted
smoke levels and other local conditions. One factor to consider is whether pollutant levels inside
schools and businesses are likely to be similar to or lower than those in homes. Children's
physical activity may also be better controlled in schools than in homes. On the other hand, in
some school districts smoky conditions may make travel to school hazardous. In many areas it
will not be practical to close businesses and schools, although partial closures may be beneficial.
Closures and cancellations can target specific groups (e.g., the sensitive populations described
earlier) or specific, high- risk activities, such as outdoor sporting events and practices. Curtailing
outside activities can reduce exposures, as can encouraging people to stay inside and restrict
physical activity. A decision to restrict industrial emissions should be based on local air
pollution and the emission characteristics of particular industries. Curtailment may not be
necessary if eliminating industrial emissions will not markedly reduce local air pollution.
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Evacuation
The most common call for evacuation during a wildfire is due to the
direct threat of engulfment by the fire rather than by exposure to
smoke. Leaving an area of thick smoke may be a good protective
measure for members of sensitive groups, but it is often difficult to
predict the duration, intensity, and direction of smoke, making this
an unattractive option to many people. Even if smoky conditions are
expected to continue for weeks, it may not be feasible to evacuate a
large percentage of the affected population. Moreover, the process
of evacuation can entail serious risks, particularly if poor visibility
makes driving hazardous. In these situations, the risks posed by
driving with reduced visibility need to be weighed against the
potential benefits of evacuation. Therefore, in areas where fires are
likely to occur, public health officials are encouraged to develop plans for local protection of
sensitive groups.
Where individuals are evacuated to a common center because of fire danger, public health
officials need to pay particular attention to the potential for smoke to affect the evacuation
center itself. It is not always possible to locate evacuation centers far away from smoky areas, or
to expect that evacuees will be able to take the steps necessary to reduce their exposures in their
new surroundings. Public health officials should consider informing incident commanders if this
situation could arise and supplying evacuees with information and materials to further reduce
exposures, including provision of a cleaner air shelter within the evacuation center, if possible,
as well as other means of respiratory protection. (See "Respiratory Protection" above). It is
important to consider smoke levels when allowing those evacuated for fire safety reasons to
return. Medical capability to address smoke induced medical situations should be assessed if
smoke levels are predicted to be high. Additionally, the smoke from smoldering natural and
possibly manmade materials if structures are burned in fires pose additional hazards that should
be considered.
Summary of strategies for exposure reduction
In preparation for the fire season or a smoke event, it is a good idea to have enough food on
hand to last several days, so that driving can be minimized. Foods stored for use during the fire
season should not require frying or broiling, since these activities can add particles to indoor air.
It is also important to have at least a five-day supply of medication for the same reason.
When wildfires are expected to create smoky conditions, people can pursue a number of
strategies to reduce their exposure. Those with moderate to severe heart or lung disease might
consider staying with relatives or friends who live away from the smoke during the fires. If
smoke is already present in substantial quantities, such individuals may want to evaluate
whether they might actually experience greater exposure during evacuation than staying at home
and using other precautions described above. If smoke levels increase to very unhealthy or
hazardous levels, it may be appropriate for some individuals to stay in a clean room in the home,
relocate temporarily to a cleaner air shelter, or to leave the area entirely if it is possible and safe
to do so.
30

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All people in a smoky area (except firefighters or emergency personnel) should avoid strenuous
work or exercise outdoors. They should avoid driving whenever possible. If driving is
necessary, people should run the air conditioner on the "recycle" or re-circulate mode to avoid
drawing smoky air into the car.
Closing up a home by shutting windows and doors can give some protection from smoke. Most
air conditioners are designed by default to re-circulate indoor air. Those systems that have both
"outdoor air" and "re-circulate" settings need to be set on "re-circulate" during fire/smoke
events to prevent smoke-laden air from being drawn into the building (note: this does not apply
to HVAC systems in office and commercial buildings; see Appendix A). Additional protection
in homes can be achieved by operating properly-sized air cleaners and upgrading the filtration
efficiency of air filters in central air conditioning systems. When high efficiency filters (rated at
MERV 8 or higher) are installed, central air conditioning fans can be set to operate continuously
during a wildfire event, and not cycle on and off, although this will increase energy use and
costs.
Once people have closed up the building in which they live, they should avoid strenuous
activity, which can make them breathe harder and faster. They should drink plenty of fluids to
keep their respiratory membranes moist. Vacuuming (except with HEPA filter-equipped
vacuums) should also be avoided, since most vacuum cleaners disperse very fine dust into the
air.
Smoke levels often change substantially over the course of the day, so it's often possible to plan
your day around the smokiest times in order to minimize exposure, using tools and information
in this Guide.
NIOSH-certified disposable respirators (N95 or PI00) available in hardware or other stores may
provide some level of protection from exposure to particles in smoke, as long as a close-fitting
model and size is selected and they are used properly. One-strap paper masks, surgical masks, or
other face coverings are likely to provide far less or no protection.
31

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Communicating particulate matter levels
The goal of particulate matter (PM) measurement during a fire is to relay information to the
public in a timely manner so people can make decisions about how to protect their health when
smoke levels are high. PM levels are measured as micrograms (|ig) of particles per cubic meter
of air. Most particle monitors measure either PMlO or PM2.5 (fine particles). Smoke particles
will show up in either measurement.
Filter-based PM monitors take days to process, but continuous PM monitors give an instant
reading of particulate matter concentrations, usually averaged in time periods such as one hour
or a running 24-hour average. Areas without continuous monitors may be able to get temporary,
portable continuous monitors through their federal, state, tribal, or local air quality agencies or
the Forest Service.
Air Quality Index
The Air Quality Index, or AQI, is a nationally uniform index promulgated by the EPA for
reporting and forecasting daily air quality across the country. It is used to report information
about the most common ambient air pollutants, including particulate matter (PM2.5 or PM10) and
ozone. The AQI tells the public how clean or polluted the air is using standard descriptors
(Good, Moderate, Unhealthy for Sensitive Groups, Unhealthy, Very Unhealthy, and Hazardous).
The index converts ambient concentrations (|ig/m3 or ppb) to an AQI category and number more
easily understood by the public. The AQI uses a normalized scale from 0 to 500 and provides
associated health-based descriptors for each category. An AQI value of 100 corresponds to the
level of the short-term National Ambient Air Quality Standard for a given pollutant. An
3
advantage of using the AQI value over the concentration ((J,g/m ) for particulate matter is that
the AQI value of 100 represents a clear demarcation between satisfactory and unhealthy air
quality, at least with reference to the national standard, which is established at a level that will
protect public health, including the health of at-risk groups. When AQI values exceed 100, air
quality is considered to be unhealthy, at first for members of at-risk (or sensitive) group, then for
everyone as AQI values increase.
AirNow
The AirNow website, at www.airnow.gov, is a multi-agency web site run by EPA that reports
air quality using the AQI. The AirNow program accepts, stores, and displays data provided by
air quality agencies. Agencies submit continuous PM data to AirNow from over 1200 PM2.5
monitors and 500 PM10 monitors, plus temporary monitors, on an hourly basis. These data are
available to the public via national, regional, and local maps on airnow.gov and through email
notifications, widgets, and smart-phone apps. Media outlets and web developers can also access
the data through AirNow's Application Program Interface (aimowapi.ore).
NowCast. By definition, the AQI for PM2.5 and PM10 is based on a full 24 hours of data, so
hourly reporting requires a methodology called the NowCast to estimate the 24-hour AQI for
each hour. The reported hourly value is what AirNow calls "current conditions."
32

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The Nowcast method for reporting each hour's current conditions is designed to be responsive
to rapidly changing air quality such as occurs during a wildfire (Figure 7). The Nowcast uses a
weighted average of the previous 12 hours. When air quality is changing rapidly, the most recent
hours are weighted more heavily. A longer average, approaching 12 hours, is used when air
quality is stable. The Nowcast ensures that AQI maps on AirNow more closely match what
people actually see outdoors (Figure 8).
Air Quality
Less variable
More variable
12-hour average
3-hour average
New
NowCast
Figure 7. Overall concept of the Nowcast.
Hourly AQI (Combined PM and O.)
Wednesday, April 17, 20l6^0l00 AM MOT
.1 1	
/ Action Da/
Current Conditions
Air Quality Index (AQI)
observed at 10:00 MST
7. i Moderate
Health Message: Unusually sensitive people should consider
reducing prolonged or heavy exertion.
Wore.- Values above 500 are considered Beyond cheAQJ. Follow recom.mendarions for
the Hazardous caregory. .Additional information on reducing exposure ro extremely
high levels of particle pollution is available here.
AQI - Pollutant Details
Particles (PM10) I 70 I Moderate
Particles (PM2.5) J 45 j Good
Ozone	I 44 Good
Figure 8. Sample AirNow map and AQI values.
Fires: Current Conditions Map. The wildfire map page on aimow.gov
(http://airnow.gov/index.cfm7actioiFtopics.smoke wildfires) is a one-stop place where the
public can assess current wildfire conditions across the country. The interactive map is a joint
effort of the USFS, EPA, and state and local air quality agencies. The map displays several
layers such as the current network of PM2.5 monitors as well as any temporary PM2.5 monitors
deployed for a fire event. The monitors are shown in the color of their current AQI value. Other
layers include active wildfires and smoke plumes. In addition, the page has important links to
state advisories and smoke blogs, information about smoke and health, as well as a variety of
external web resources pertaining to wildfires.
33

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Santa Rosa
FaQamento
'S\ P .^Stockton
O Antioch Cy
5^ ,Uvermore —
Fremont »«*•'
San Francisco
K
AirNow
Local Air Quality Conditions
Zip Code: Go | State: Alabama ~


—, -jMm
Fires: Current Conditions
Current Advisories
Fires and Health
Before, During, and
After a Wildfire
More Fire Tools
NOAA Smoke Forecast Tool - Maps of surface and vertical smoke can
be found under "Additional Air Quality Forecast Guidance."
NOAA's Fire '/feather Outlook - This tool maps fire watches and
warnings.
GEQMAQ 'Midland pire Sypport - Access maps of current fire
locations using this tool from the Geospatial Multi-Agency
Coordination Group (GEOMAC).
MODIS Active Fire Mapping - This site from the USDA Forest Service
Remote Sensing Applications Center (RSAC) maps active fires.
Air Quality Index (AQI) Information 0
Unit1026
Current Conditions
PM2.5 I M Unhealthy 187
Updated Mon 0M3K015 12:00 PM EOT
\ \CAL. OmiA ,
A
NEVAL
Figure 9. Sample AirNow Fires: Current Conditions map
Enviroflash. EnviroFlash is a system that sends the daily air quality forecast by email to anyone
who signs up. It can also be used by state and local agencies to send an email alert during an
event such as a fire, including suggested safety measures which are included when air quality is
unhealthy. This service is provided by the state or local environmental agency and EPA.
Information about Enviroflash is available at http://www.enviroflash.info/.
Outdoor Activity Guidance. The Air Quality and Outdoor Activity Guidance for Schools table,
developed by the EPA and the US Centers for Disease Control and Prevention (CDC), shows
when and how to modify outdoor physical activity based on the AQI. This guidance can help
protect the health of all children, including teenagers, who are more sensitive than adults to air
pollution. The activity guidance can be found at: https://www3.epa.gov/airnow/flag/school-
chart-2014.pdf. Similar guides for ozone and for PM that include activity guidance for all ages
can be found here: https://airnow.gov/index.cfm?action=flag program.outdoorguid.
34

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Air Quality Flag Program. The activity guidance can be used with the Air Quality Flag
Program. The Air Quality Flag Program
https://airnow.gov/index.cfm?action=flag program.index) is a visual way to alert schools and
organizations to the local air quality forecast. Seeing the fl ag helps people take actions to protect
their health and may be useful to alert the public to forecasted smoke events.
AirNow-Teeh. AirNow has a decision support tool called AirNow-Tech (airnowtech.org).
which allows partner agencies to manage, quality control, query, and visualize not only their
data but also a national dataset of air quality, meteorological and satellite information. One
powerful AirNow-Tech tool for wildfire evaluation is Navigator GIS. Navigator allows the user
to overlay meteorological, fire, and satellite data over air quality observations. In addition, users
can run ITYSPLIT trajectories on any point of the display to see air parcel projections or for post
wildfire event analysis.
Figure 10. AirNow-Tech Navigator
U.S. Forest Service wildland fire air quality
monitoring website tool
The Forest Service Wildland Fire Air Quality Monitoring Website Tool
(http://tools.airfire.org/monitoring) developed by Pacific Northwest Research Station's AirFire
Team provides easy-to-use, rapid access to air quality monitoring data from both publicly
available permanent monitoring sites as well as temporary monitoring sites setup during
wildland fire incidents. The tool allows a user to quickly select and view data from multiple
monitors showing a selection of graphics including monitor location, time series, diurnal
patterns and more. Different sets of graphics are available for different types of users who may
have particular interests. Once a set of monitors of interest are selected, users can bookmark
and share the site's URL to quickly return to this specific set of monitors and view the updated
current data.
35

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Currently the tool is set up to display fine particulate measurements (PM2.5), but other
measurements may be added in the future. The tool uses public data made available from EPA's
AirNow-Tech system; as such there may be additional monitoring data that is not publicly
available through the AirNow-Tech system (http://aimowtech.ore). Additionally, as allowed by
the originating agency, the tool adds data from temporary smoke monitors deployed from the
Forest Service's national smoke monitoring cache and other sources. These include temporary
monitors set up by the Air Resource Advisor community in their role as smoke specialists with
the Incident Management Teams responding to wildfire incidents.
There are a number of on-line resources to aid in making smoke predictions, including
information about current wildfires, satellite images and the National Weather Service. These
websites are listed under "Resources/Links" towards the end of this guide.
Using visual range to assess smoke levels in the
interior western United States
Many communities do not have access to continuous PM monitoring and may need other ways
to evaluate local air quality. Visual range (i.e. how far can be seen?), like other instantaneous
monitoring approaches can inform and help the public respond to smoky conditions. This is true
even in areas that have continuous monitors, because smoke concentrations can vary widely
within a couple miles and can change rapidly.
Basic Approach:
To determine visual range, one must:
•	Use this method only during daylight hours (avoid sunrise and sunset).
•	Use this method only if relative humidity is less than 65%.
•	Focus on the darkest object (e.g. black is better than green)
•	Determine the limit of visual range by looking for targets at known distances (miles).
The visible range is the point at which even high-contrast objects (e.g., a dark forested
mountain viewed against the sky at noon) totally disappear.
•	After determining visual range in miles, use Table 1 to identify actions to take to reduce
exposure.
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Table 1. Visual Range and actions to take to reduce smoke exposure when wildfire smoke
is in the air **
Distance You
Can See
You are:
OR
You have:

A Healthy Adult,
Teenager, or
Older Child
Age 65 and
Over,
Pregnant, or
A Young Child

Asthma,
Respiratory Illness,
Lung or Heart Disease
>10 miles
Watch for changing conditions and
moderate outdoor activity based on personal sensitivity
5-10 miles
Moderate outdoor
activity
Minimize or avoid outdoor activity
< 5 miles
Minimize or avoid
outdoor activity
Stay inside or in a location with good air quality
Often, it is difficult to assess "the point at which even high-contrast objects (e.g., a dark forested
mountain viewed against the sky at noon) totally disappear." Instead, it may be more useful to
use known landmarks at a given distance away to assess possible visual ranges. For example,
target A is 2 miles away and visible, but target B, which is 4 miles away, is not visible Therefore
the visual range is somewhere between 2 miles and 4 miles. Use Table 1 to identify the range of
actions to consider to reduce smoke exposure.
Western United States: An important caveat is that the above visual range categories only
apply in dry air conditions typically found in the interior west and inland of coastal areas. The
combination of water and particulate matter in the atmosphere dramatically reduces visibility,
therefore this method of estimation should not be used when relative humidity is greater than
65%.
Eastern United States and Higher Humidity Locations: Until this approach can be assessed
for humid conditions, individuals may have to rely on common sense in estimating smoke
conditions (e.g., mild, moderate, heavy smoke) and the kinds of protective actions that might be
necessary to address personal response to the smoke.
Other Considerations: This method of estimating a visual range also contains much
uncertainty (as discussed in Malm and Schichtel, 2013), further strengthening the need to use
personal judgment when assessing smoke conditions. Smoke concentrations vary substantially
from minute to minute. By comparison, continuous monitoring devices average their
measurements over 3 or even 24 hours, so what is seen at a particular moment may not be
representative of the average reported at a monitor. More uncertainty stems from sighting on
** Sensitivity to smoke can vary highly from person to person, and individuals can become more sensitive to smoke
after extended periods of exposure. Individuals should pay attention to the advice of medical professional or local
health officials, and adjust activity accordingly to your particular tolerance or sensitivity.
37

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non-black bodies (e.g., green forested landmarks, snow-covered peaks), difficulty at judging
when an object is just barely visible, variations in the atmosphere and thickness of the smoke
across the line of sight, and assuming the atmosphere remains constant after using an
instantaneous "look" to assess conditions. Furthermore, this method is not effective in early
morning or twilight hours when the sun is low on the horizon.
The bottom line is that, no matter how far one can see, it's always prudent to take measures such
as discussed in this Guide to protect oneself if smoke exposure is a concern.
Recommendations for public health
actions
Public service announcements
In areas where fires are likely to occur, state and local public health agencies should consider
running pre-season public service announcements (PSAs) or news releases to advise the public
on how to prepare for the fire smoke season. PSAs should be simple (e.g., the season for
wildfires is approaching; there are things you can do now to help protect your health and
prepare your home in the event of a wildfire), and should list a contact phone number or
website for further information. PSAs are also useful during fire or smoke events to provide
timely updates on the situation, along with advice on protective actions. Effective PSAs
utilize simple, non-technical messages that people can remember, such as "stay indoors" or
"limit outdoor activities." News releases should be used to provide more detailed information,
including information for the general public and for people with chronic diseases.
Consider also reaching out to weather forecasters and news reporters, who are a valuable
resource for promoting your message. Their role as communicators on television, radio, print,
and online outlets makes them an essential partner in any outreach strategy. When reaching
out to news reporters and meteorologists to "pitch" your messages:
•	Tell them who you are, what agency you represent, and that your campaign affects the
health and safety of the community.
•	Make sure they have your contact information, including e-mail address, telephone number,
and if possible, cell phone number.
General recommendations to the public should include at least the following:
1.	Have a several-day supply of nonperishable groceries that do not require cooking,
since cooking (especially frying and broiling) can add to indoor pollutant levels.
2.	If you develop symptoms suggesting lung or heart problems, consult a health care
provider as soon as possible.
3.	Be alert to PSAs, air quality forecasts, and changing smoke conditions.
4.	Be aware that outdoor events, such as athletic games or competitions, may be
postponed or cancelled if smoke levels become elevated.
Recommendations for people with chronic diseases should include at least the following:
38

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1.	Have an adequate supply of medication (more than 5 days).
2.	People with asthma should have a written asthma management plan.
3.	People with heart disease should check with their health care providers about
precautions to take during smoke events. They should do this prior to the fire
season if they live in an area that has the potential for wildfires.
4.	When using one or more portable air cleaners, buy air cleaners that are
appropriately sized for the intended rooms, as specified by the manufacturer,
before a smoke emergency occurs. Be sure they are certified by California as
low-or-no ozone models by checking the CARB website at
http://www.arb.ca.eov/research/indoor/aircleaners/certified.htm.
5.	Contact a health care provider if your condition worsens when you are exposed to
smoke.
6.	A news release could also include recommendations for preparing residences to
keep smoke levels lower indoors, and on the appropriate use of respiratory
protection. See Appendices B, and D.
Public advisories and protective measures
Areas with established air quality programs generally have several ways to alert the public about
air pollution events using the AQI. One approach is to refer the public to the AirNow website
(www.airnow.gov), which is used by states and many communities across the country. Other
methods include state smoke blogs, websites, hotlines, press releases, as well as emails and
faxes to interested parties (such as sports team coaches and daycare providers). Some rural areas
have used door-to-door dissemination of the visibility index (Table 1, above) and the associated
health effects (Table 2).
Table 2 provides a general list of health effects and cautionary statements for altering
behavior for use in public advisories. The advisories are based on the AQI, as well as on
experience and evidence from fire situations. If only PM10 measurements are available
during smoky conditions, it can be assumed that the PM10 is composed primarily offine
particles (PM2.s), and that therefore the AQI and associated cautionary statements and
advisories for PM25 may be used.
Table 3 provides guidance to public health officials regarding measures that can be taken to
protect public health at different AQI categories and the corresponding ambient PM levels.
This information is intended to help health officials, the media, and the general public make
decisions regarding appropriate strategies to mitigate exposure to smoke. As noted above, the
official AQI value for PM2.5 for the previous day is derived exclusively from measured 24-hour
average PM2.5 concentrations. The AQI for PM2.5 that is reported by the media and on AirNow
is the hourly estimate of the 24-hour AQI based on the NowCast. Although Table 3 provides
ambient PM2.5 concentrations, and the AQI values and descriptors associated with the
categories (e.g., Good and Moderate), it is possible that concurrent publication of both the AQI
"3
values and the ambient PM2.5 concentrations (in (j,g/m ) to describe air quality may lead to
confusion among members of the public. To avoid such confusion, it may be preferable to
publish just the AQI values.
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Protection of Children
Protection of children is always a high priority in smoke events. The Air Quality and Outdoor
Physical Activity Guidance for Schools, developed jointly by EPA and CDC, provides
guidelines about when and how to modify outdoor physical activity based on the AQI. If a
smoke event is forecasted, local officials should prepare for implementation of the guidance,
including assessing the availability of indoor spaces with good indoor air quality for children to
be active.
As air quality worsens, or is projected to worsen, additional protective measures may become
necessary. These measures could range from allowing children with asthma, or other conditions
that place them at greater risk, to stay home to closing schools entirely. Several location- and
event-specific factors should be considered in making these decisions. Some of these factors
include the forecast duration of the event, the relative indoor air quality of the homes and
schools in the area, and the ability to transport children safely to and from school. In some
locations, indoor air quality may be better in schools than in local housing stock, making school
closure less beneficial from a public health perspective.
Protection of Other At-Risk Groups
Protection of other at-risk groups, including older adults, pregnant women, people with heart or
lung disease and people of lower SES, is also a high priority for public health officials.
Maintaining good indoor air quality, using the information provided above, is especially
important in locations where these people are located, such as hospitals or residential facilities
for older adults. To protect some at-risk groups, such as people of lower SES who may live in
homes without air conditioning, or in locations where the use of air conditioning may not be
common, it is advisable to consider setting up cleaner air shelters.
In general, these groups should be advised to remain indoors with windows closed if air quality
is categorized as "very unhealthy." Families should consider using a HEPA filter that will help
to reduce indoor air pollution, as well as to avoid smoking tobacco, using wood-burning stoves
or fireplaces, candles, and only using a vacuum with a HEPA filter.
Protection of Pets and Livestock
Many people ask how wildfire smoke affects pets and livestock. The effects of smoke are
similar for humans and animals. High levels of smoke may irritate your animal's eyes and
respiratory tract. Strategies to reduce animals' exposure to smoke are also similar to those for
humans: reduce the time spent in smoky areas, provide animals with plenty of water, limit
activities that will increase breathing and reduce exposure to dust or other air pollutants. If your
pet or livestock is coughing or having difficulty breathing, contact your veterinarian. (OHA
8626, 4/14).
Actions for Consideration by Public Health Officials
The categories in Table 3 contain actions for public health officials to consider at the different
AQI categories. Public health officials may want to take some or all of the recommended actions
associated with these categories, based on a global assessment of the local situation. Some
factors that also should be considered include:
• Predicted fluctuations in PM2.5 levels. Are the peaks of PM2.5 predicted to occur
40

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relatively infrequently, interspersed with longer periods of good air quality, or to occur
multiple times per day, superimposed on higher-than-usual PM2.5 levels?
•	Predicted duration of high PM2.5 levels. For instance, if air quality is predicted to be
in the "Unhealthy for Sensitive Groups" range or worse for an extended period of time,
public health officials might consider evaluating sites for cleaner air shelters or
recommending evacuation plans for individuals with chronic lung or heart disease who
cannot take adequate personal protective actions to reduce exposures.
•	Potential indirect effects. High PM2.5 levels can impair visibility and increase the risk
of traffic accidents. This may be reason enough to cancel an evening indoor event at a
local high school, for example.
Build strong partnerships
To reduce potential public confusion, it's a good idea for health departments, air agencies and
others responding to wildfire smoke to provide joint health advisories informing the public
about smoke from wildfires, when possible. This is easier if you build partnerships in advance.
All agencies working on fire and smoke response should coordinate closely during the incident
to ensure this consistent communication, and to leverage resources for developing and
delivering information to the public. In addition to helping ensure the public receives consistent
messages, this coordination can make it easier for the public to access them - through steps that
can be as simple as cross linking websites to directing public and media inquiries to the
appropriate agency and subject matter expert. And remember that while working with local
media and posting information to the Web is important, it is not the only way to deliver
information during an emergency. Sometimes, providing information through posters, door
hangers or fliers also is effective. Coordinating with other agencies can help you leverage
resources to create and/or deliver these materials when needed.
Resources to help with coordination include:
•	Existing websites: The AirNow website (www.airnow.gov) provides the latest
information on the national Air Quality Index, along with real-time data from state and
local particle pollution and ozone monitors across the country, and next day air quality
forecasts. The AirNow "Fires: Current Conditions" map provides additional data
temporary particle pollution monitors deployed on fires, along with locations of active
wildfires, and smoke plumes. State and local air quality monitoring sites, state smoke
blogs, and some incident websites can provide up-to-the-minute monitor readings. Some
sites include information such as how long smoke is expected to stay in your area, where
it is likely to move, and where the highest levels of particle pollution are occurring or
expected.
•	State and local air quality agencies - Some states have emergency smoke response
plans that outline contact points, roles and resources. These plans contain a range of
information, such as roles and responsibilities, communication plans and
establishment/activation of joint information centers. They also may include information
to help agencies quickly find resources they need during an incident, such as how to
access Air Resource Advisors (ARAs), air quality monitors, and HEPA air filtration
system caches.
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•	EPA Regional Offices and the multi-agency Wildland Fire Air Quality Response
Program may have monitors that can be deployed to smoky areas in some cases. The
Wildland Fire Air Quality Response Program maintains a website
(www.wildlandfiresmoke.net) with tools to help analyze the data from such emergency
monitors and operational smoke model runs for use by ARAs, public health, and air
quality personnel.
•	Federal and state land management agencies - These agencies generally have the lead
in responding to wildfires. In some states and during some large fires, these agencies
and/or air quality agencies may hold daily air quality conference calls to coordinate
messages and efforts, such as the placement of monitoring equipment. Participating in
these internal calls can be valuable for public health agencies - both for sharing air
quality information and coordinating protective messages. If an ARA has been assigned
to an incident, that person also can be an additional source of information to help ensure
consistent communication. If you are not sure whether an ARA has been assigned to a
particular incident, check with your state or local air agency, check the
www.wildlandfiresmoke.net website, or check the incident website for the fire found at
inci web. nwcg. gov.
In addition, during large wildfires, land management agencies' incident management
teams frequently host public meetings, where smoke and appropriate responses may be
discussed. These meetings can be a good forum for providing messages about smoke and
public health.
•	U.S. EPA regional offices and federal land management agencies - Federal agencies
can help provide information to tribes if a fire is on, or smoke is affecting, lands in
Indian country. Federal agencies have a trust responsibility to tribes and have established
contacts who can help deliver information on wildfire smoke and health.
Table 2. Health Effects and Cautionary Statements.
Category
(see Table 3)
Health Effects
Cautionary Statements 1
Other Protective Actions
Good
None expected
None
None
Moderate
Possible
aggravation of heart
or lung disease
Unusually sensitive individuals
should consider limiting
prolonged or heavy exertion.
•	People with heart or lung
disease should pay
attention to symptoms.
•	If you have symptoms of
lung or heart disease,
including repeated
coughing, shortness of
breath or difficulty
breathing, wheezing, chest
tightness or pain,
palpitations, nausea,
unusual fatigue or
lightheadedness, contact
your health care provider.
• If symptomatic, reduce
exposure to particles by
following advice in box
below.
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Category
(sec Table 3)
Health K fleets
Cautionary Statements 1
Other Protective Actions
Unhealthy for
Sensitive
Groups
Increasing
likelihood of
respiratory or
cardiac symptoms in
sensitive individuals,
aggravation of heart
or lung disease, and
premature mortality
in persons with
cardiopulmonary
disease and the
elderly.
Sensitive Groups:
People with heart or lung
disease, the elderly, children,
and pregnant women should
limit prolonged or heavy
exertion.
Limit time spent
outdoors.
Avoid physical exertion.
People with asthma
should follow asthma
management plan.
If you have symptoms of
lung or heart disease that
may be related to excess
smoke exposure,
including repeated
coughing, shortness of
breath or difficulty
breathing, wheezing,
chest tightness or pain,
heart palpitations, nausea,
unusual fatigue or
lightheadedness, contact
your health care provider.
•	Keep doors and windows
closed, seal large gaps as much
as possible.
•	Avoid using exhaust fans
(kitchen, bathrooms, clothes
dryer, and utility room).
•	Keep the garage-to-home door
closed.
•	If cooling is needed, turn air
conditioning to re- circulate
mode in home and car, or use
ceiling fans or portable fans (but
do not use whole house fans
that suck outdoor air into the
home).
•	If a home has a central heating
and/or air conditioning system,
install higher efficiency filters if
they can be accommodated by
the system. If a filter upgrade
has been performed (e.g., filters
rated at MERV 8 or higher), the
system's circulating fan can be
temporarily set to operate
continuously to obtain
maximum particle removal by
the central air system's filter,
although this will increase
energy use and costs.
•	Operate portable air cleaners
to reduce indoor particle
levels.



•	Avoid indoor sources of
pollutants, including tobacco
smoke, heating with wood
stoves and kerosene heaters,
frying or broiling foods,
burning candles or incense,
vacuuming, and using paints,
solvents, cleaning products, and
adhesives.
•	Keep at least 5-day supply of
medication available.
•	Have supply of non- perishable
groceries that do not require
cooking.
43

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Category
(sec Table 3)
Health K fleets
Cautionary Statements 1
Other Protective Actions
Unhealthy
Increased
aggravation of heart
or lung disease and
premature mortality
in persons with
cardiopulmonary
disease and the
elderly; increased
respiratory effects in
general population.
Sensitive Groups: should avoid
prolonged or heavy exertion
Everyone:
should limit prolonged or heavy
exertion
•	Limit time spent
outdoors.
•	If you have symptoms of
lung or heart disease that
may be related to excess
smoke exposure, including
repeated coughing,
shortness of breath or
difficulty breathing,
wheezing, chest tightness
or pain, palpitations,
nausea or unusual fatigue
or lightheadedness, contact
your health care provider.
Sensitive Groups:
Stay in a "clean room" at home
(where there are no indoor smoke
or particle sources, and use a non-
ozone producing air cleaner).
• Go to a "cleaner air" shelter
(see Appendix
D) or possibly out of area
Everyone: Follow advice for
sensitive groups in box above.
Identify potential "cleaner air"
shelters in the community (see
Appendix D).
Very
Unhealthy
Significant
aggravation of
heart or lung
disease,
premature
mortality in
persons with
cardiopulmonary
disease and the
elderly;
significant
increase in
respiratory
effects in general
population.
Everyone: should avoid
prolonged or heavy
exertion
Stay indoors, avoid
exertion
Everyone: If symptomatic,
evacuate to cleaner air shelter or
leave area, if safe to do so.
Hazardous
Serious
aggravation of
heart or lung
disease, premature
mortality in
persons with
cardiopulmonary
disease and the
elderly; serious
risk of respiratory
effects in general
population.
Everyone: should avoid any
outdoor activity.
Everyone: If symptomatic,
evacuate to cleaner air shelter or
leave area, if safe to do so.
1 Higher advisory levels automatically incorporate all of guidance offered at lower levels.
44

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Table 3. Recommended Actions for Public Health Officials.
AQI Category
(AQI Values)
I'M 2.51
iig/m3
24-hr av«
Recommended Actions
Good
(0 to 50)
0-12
• If smoke event forecast, implement communication
plan
Moderate
(51 to 100)
12.1-35.4
•	Prepare for full implementation of School Activity Guidelines
(httos://www3 .eoa. eov/a i rno w/fla g/schoo 1-cha rt-2014.Ddtf)
•	Issue public service announcements (PSAs) advising public
about health effects, symptoms and ways to reduce exposure
•	Distribute information about exposure avoidance
Unhealthy for Sensitive
Groups
(101 to 150)
35.5-55.4
•	Evaluate implementation of School Activity Guidelines
•	If smoke event projected to be prolonged, evaluate and notify
possible sites for cleaner air shelters
•	If smoke event projected to be prolonged, prepare evacuation
plans
Unhealthy
(151 to 200)
55.5-150.4
•	Full implementation of School Activity Guidelines
•	Consider canceling outdoor events (e.g., concerts and
competitive sports), based on public health and travel
considerations
Very Unhealthy
(201 to 300)
150.5-250.4
•	Schools move all activities indoors or reschedule them to
another day.
•	Consider closing some or all schools2
•	Cancel outdoor events involving activity (e.g., competitive
sports)
•	Consider cancelling outdoor events that do not involve
activity (e.g. concerts)
Hazardous
(> 300)
>250.5-500
•	Consider closing schools
•	Cancel outdoor events (e.g., concerts and competitive sports)
•	Consider closing workplaces not essential to public health
•	IfPM level is projected to remain high for a prolonged time,
consider evacuation of at-risk populations
1	If only PMio measurements are available during smoky conditions, it can be assumed that the PMio is
composed primarily of fine particles (PM2.5), and that therefore the AQI and associated cautionary statements
and advisories for PM2 5 may be used.
2	See school considerations above. Newer schools with a central air cleaning filter may be more protective
than older, leakier schools.
45

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References
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http://www.lungusa.Org/site/c.dvLUK9Q0E/b.4136273/k.16D5/Lung Disease Data 2008.
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Barn P. 2014. Evidence Review: Home and community clean air shelters to protect public
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eallerv/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/H.ealth-
Environment/WFSG EvidenceReview Clean AirShelters FINAL v3 edstrs.pdf
Barn P, Larson T, Noullett M, Kennedy S, Copes R, Brauer M. 2007. Infiltration of forest
fire and residential wood smoke: an evaluation of air cleaner effectiveness. J Expo Sci
Environ Epidemiol. 5 December 2007.
Brim SN, Rudd RA, Funk RH, Callahan DB. 2008. Asthma Prevalence Among US
Children in Underrepresented Minority Populations: American Indian/Alaska Native,
Chinese, Filipino, and Asian Indian. Pediatrics, 122, e217-e222.
California Air Resources Board, Fact Sheet on Air Cleaning Devices for the Home.
Available at: http://www.arb.ca.eov/research/indoor/acdsumm.pdf
California Air Resources Board, Consumers' Air Cleaner Portal. Available at:
http://www.arb.ca.eov/research/indoor/aircleaners/consumers.htm
Coefield J, Cain C. 2001. Forest Fire Smoke Categories. Montana Department of
Environmental Quality, PO Box 200901, Helena, MT 59620.
Daniels RD, Kubale TL, Yiin JH, Dahm MM, Hales TR, Baris D, Zahm SH, Beaumont JJ,
Waters KM, Pinkerton LE.(2014). Mortality and cancer incidence in a pooled cohort of
US firefighters from San Francisco. Chicago and Philadelphia (1950-2009). Occup
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14.
Fisk WJ and WR Chan. 2016. Health benefits and costs of filtration interventions that
reduce indoor exposure to PM2.5 during wildfires. Accepted for publication 04 Feb 2016.
http://onlinelibrary.wileY.com/doi	ia.l2285/full
Fisk, WJ. 2013. Health benefits of particle filtration. Indoor Air, 23(5): p. 357-368.
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Hansen, ES. 1990. A cohort study on the mortality of firefighters. Br J Ind Med 47: 805-
809, 1990.
Henderson DE, Milford JB, Miller SL. 2005. Prescribed burns and wildfires in Colorado:
impacts of mitigation measures on indoor air particulate matter. J Air Waste Manag Assoc.
55:1516-26.
Holstius DM, Reid CE, Jesdale BM, Morello-Frosch R. 2012. Birth Weight following
Pregnancy during the 2003 Southern California Wildfires. Environ Health Perspect 120(9):
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1340-1344.
Liu JC, G Pereira, SA Uhl, MA Bravo, ML Bell. 2015. A systematic review of the physical
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Research 136 (2015) 120-132.
Kumagai Y, Caroll M, Cohn P. 2004. Coping with interface wildfire as a human event:
lessons from the disaster/hazards literature. J Forestry 102(6): 28-32.
Malm WC, Schichtel BA. 2013. Uncertainty associated with estimating a short-term (1-3
hr) particulate matter concentration from a human-sighted visual range. Final report to the
Joint Fire Science Program, Project #13-C-01-01.
http://www.firescience.eov/JFSP advanced search results detail.cfm?idbid=%24%26J%2
3%3FWP%20%20C ( accessed 04/29/2016).
Naeher L, Brauer M, Lipsett M, Simpson C, Koenig JQ, Zelikoff J, Smith KR. 2007.
Woodsmoke health effects: a review. Inhal Toxicol 2007;19:67-106.
National Institute of Occupational Health and Safety [NIOSH], 2016. Workplace
Solutions, Preparedness through Daily Practice; The Myths of Respiratory Protection in
Healthcare, DHHS (NIOSH) Publication No. 2016-109.
http://www.cdc.eov/niosh/docs/wp-solutions/2016-109/pdfs/201 10° !f (accessed
05/4/2016).
Oregon Public Health Division. 2014. Wildfire Smoke and Your Health, Oregon Public
Health Division, OHA 8626, 4/14; http ://Public.Health. Ore eon. gov
Rappold AG, Cascio WE, Kilaru VJ, Stone SL, Neas LM, Devlin RB, Diaz-Sanchez D.
2012. Cardio-respiratory outcomes associated with exposure to wildfire smoke are
modified by measures of community health Environmental Health 2012, 11:71
http ://www. ehi ourn al. n et/content/11/1/71
Reinhardt, Timothy and Roger Ottmar. 2000. Smoke exposure at western wildfires. Res.
Pap. PNW-RP-525. U.S. Department of Agriculture, Forest Service, Pacific Northwest
Research Station, Portland, OR. Available at
http://www.fs.fed.us/pnw/pubs/pnw rp525.pdf
U.S. Centers for Disease Control and Prevention, cited 2014: Faststats. Centers for Disease
Control and Prevention. Available at: http://www.cdc.eov/nchs/fastats/asthma.htm ;
http ://www. cdc. eov/n ch s/fastats/ copd. htm
U.S. Environmental Protection Agency. 2015. Ozone Generators that are Sold as Air
Cleaners: An Assessment of Effectiveness and Health Consequences. Available at:
http://www.epa.eov/indoor-air-qiialitY4aq/ozone-eenerators-are-sold-air-cleaners.
U.S. Environmental Protection Agency. 2000. The Air Quality Index Guide to Air Quality
and Your Health. Research Triangle Park, NC. Available at:
http://www.epa.gov/airnow/aqibroch/
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Environmental Protection Agency, Washington, DC, EPA/600/R-08/139F, 2009.
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U.S. Environmental Protection Agency. 2008. Guide to Air Cleaners in the Home. EPA
402-F-08-004. Available at: http://www.epa.eov/indoor-air-qiiality4aq/eiiide-air-cleaners-
home
Additional Resources and Links
Current active wildfire information
California Department of Forestry and Fire Protection, http://www.fire.ca.gov/index.php
Geographic Area Coordination Center's National Portal.
http://gacc.nifc.gov/links/links.htm Provides links to regional geographic centers with
specific information about fires in the region.
Incident Information Center, http://inciweb.nwcg.gov/ Provides updates on all national
fires, often several times a day.
Forest Service Wildland Fire Morning Report, http://www.fs.fed.us/news/fire/
AirNow Fires: Current Conditions.
https://airnow.gov/index.cfm?action=topics.smoke wildfires
Satellite images of fires and smoke
NOAA Fire Events. http://www.ospo.noaa.gov/Products/land/hms.html Satellite images of
fires
Geospatial Multi-Agency Coordination, http://ge0mac.usgs.g0v/# A GIS-based site with
the locations of fires throughout the country.
NASA images, http://modis.gsfc.nasa.gov/
Smoke prediction tools: http://tools.airfire.ore/
U.S. Forest Service AirFire Research Team: http://tools.airfire.ore/
Wildland Significant Fire Potential Outlook:
http://www.predictiveservices.nifc.gov/outlooks/outlooks.htm
Weather information
National Weather Service:
Western Region http://www.wrh.noaa.gov/
Eastern Region http://www.weather, gov/erh/
Southern Region http://www.srh.noaa.gov/
Central Region http://www.crh.noaa.gov/
Websites that report information on wildfire smoke and health effects
Environmental Protection Agency AirNow: http://airnow. gov/
Current Advisories by State:
https://airnow.gov/index.cfm?action=airnow.news item&newsitemid=93
48

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Appendices
•	Appendix A: Guidance on Protecting Workers in Offices and Similar Indoor
Workplaces from Wildfire Smoke (Adapted from Cal/OSHA)
•	Appendix B: Protect Your Lungs from Wildfire Smoke - Fact Sheet from California
Department of Public Health
•	Appendix C: Hazards during Cleanup Work Following Wildfires from National
Institute for Occupational Safety (NIOSH)
•	Appendix D: Identification and Preparation of Cleaner Air Shelters for Protection
of the Public from Wildfire Smoke
•	Appendix E: Children's Health Fact Sheets from the Pediatric Environmental
Health Specialty Units (PEHSU)
•	Appendix F: Example ARA Report - from Rough Fire, September 9, 2015
49

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Appendix A: Guidance on Protecting Workers in
Offices and Similar Indoor Workplaces from
Wildfire Smoke (Adapted from Cal/OSHA)
50

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Guidance on Protecting Workers
in Offices and Similar Indoor Workplaces from Wildfire Smoke
Windborne wildfire smoke can be a hazard for people who work in office and commercial
buildings many miles from evacuation zones. Environmental and public health agencies
have advised people that they should consider setting air conditioners in their homes to
recirculation mode, if possible, in order to reduce the intake of pollutants. Subsequently,
people have asked whether this advice to limit the introduction of outdoor air applies to
office and commercial buildings. Eliminating or substantially reducing the outdoor air
supply in office buildings and other indoor workplaces as a first step to reduce exposure to
smoke is generally not recommended.
The ventilation systems in office buildings and other commercial buildings are more
complicated than home air-conditioning systems. Changing the outdoor air supply in
public and commercial buildings can adversely affect other essential functions of the
building. These buildings typically have heating, ventilating and air conditioning systems
(HVAC systems) that bring outside air into the building through filters, blend it with
building return air, and thermally condition the air before distributing it throughout the
building. These buildings also have exhaust air systems for restrooms and kitchens, and
may also have local exhaust systems for garages, laboratory fume hoods, or other
operations. These exhaust systems require makeup air (outdoor air) in order to function
properly. Also, without an adequate supply of outdoor air, these systems may create
negative pressure in the building. This negative pressure will increase the movement of
unfiltered air into the building through any openings, such as plumbing/sewer vents,
doors, windows, junctions between building surfaces, or cracks. In general, buildings
should be operated at slight positive pressure in order to keep contaminants out, and to
help exhaust air systems function properly.
HVAC systems should be operated continuously while occupied in order to provide the
minimum quantity of outdoor air for ventilation, as required by the standards or building
codes to which the building was designed. For many office buildings, this is often in the
range of 15-20 cubic feet per minute (cfm) per person, although it could be less in older
buildings.1
Using the HVAC Svstem(s) to Protect Building Occupants from Smoke
As a first step to protect building occupants from outdoor air pollution, including the
hazardous conditions resulting from wildfire smoke, building managers and employers
should ensure that the HVAC systems' filters are not dirty, damaged, dislodged, or
leaking around the edges. Before the wildfire season, or during smoke events if
necessary, employers and building operators should ensure that a qualified technician
inspects the HVAC systems, makes necessary repairs, and conducts appropriate
1 Cal/OSHA regulations (8 CC	require that HVAC systems be operated
continuously while occupied in order to provide the minimum quantity of outdoor air
required by the state building code at the time the building permit was issued. These
regulations are currently found in the California Code of Regulations, Title 24, Section
121. For most buildings, this quantity is 15 cubic feet per minute (cfm) per person.
51

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maintenance. Filters should fit snugly in their frames, and should have gaskets or sealants
on all perimeter edges to ensure that air does not leak around the filters.
Building operators should consider installation of the highest efficiency filters that do not
exceed the static pressure limits of the HVAC systems, as specified by the manufacturer
or system designer2@@@. Pressure gauges should be installed across the filter to
indicate when the filter needs replacing, especially in very smoky or dusty areas. Indoor
contaminants can be further reduced by using stand-alone High Efficiency Particulate Air
(HEPA) filtering units. For more information on air cleaners, see the California Air
Resources Board webpage
at: http://www.arb.ca.eov/research/indoor/aircleaners/consumers.htm .
In some circumstances it may be helpful to reduce the amount of outdoor air in order to
reduce smoke pollution inside the building, while still maintaining positive pressure in
the building. Temporary reductions in outdoor air flow rates might be considered when
all of the following conditions are met:
1.	The local outdoor air quality for particulate matter meets the Environmental
Protection Agency (EPA) Air Quality Index definition of Unhealthy, Very
Unhealthy, or Hazardous due to wildfire smoke.
2.	A qualified HVAC technician has inspected the HVAC systems and ensured
that the filters are functioning properly, that the filter bank is in good repair, and
that the highest feasible level of filtration has been provided. This should be
documented in writing.
3.	A qualified HVAC technician or engineer has assessed the building mechanical
systems and determined, in writing, the amount of outside air necessary to prevent
negative pressurization of the building, and to sufficiently ventilate any hazardous
processes in the building (such as enclosed parking garages or laboratory
operations).
4.	The HVAC systems are operated continuously while the building is occupied to
provide at least the minimum quantity of outdoor air needed, as determined by the
HVAC technician or engineer in Item 3 above.
5.	The employer or building operator ensures that the systems are restored to
maintain the minimum quantity of outdoor air for ventilation, as required by the
standards or building codes to which the building was designed, no later than 48
hours after the particulate matter levels fall below the levels designated by the
EPA as Unhealthy.
2 Many existing HVAC systems should be able to accommodate pleated, medium-efficiency filters with particle
removal ratings of MERV 6 to 11, and some may be able to use filters with ratings of MERV 12 or higher.
Consider a low-pressure HEPA filter (MERV 17 plus) if the building occupants have respiratory or heart
disease conditions, or if the building experiences frequent wildfire episodes.
52

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Other Actions to Protect Employees from Wildfire Smoke
In addition to assessing and if necessary modifying the function of the HVAC system,
employers are encouraged to take other reasonable steps to reduce employee exposure to
smoke, including alternate work assignments or relocation and telecommuting. Some
buildings rely on open windows, doors, and vents for outdoor air, and some may have
mechanical ventilation systems that lack a functioning filtration system to remove
airborne particles. In these cases, the employees may need to be relocated to a safer
location. Employees with asthma, other respiratory diseases, or cardiovascular diseases,
should be advised to consult their physician for appropriate measures to minimize health
risks.
Respirators, such as N95s and other filtering facepiece respirators, may provide additional
protection to some employees against environmental smoke. Employees whose work
assignments require the use of respirators must be included in a respiratory protection
program (including training, medical evaluations, and fit-testing). However, employers
may provide filtering facepiece respirators to employees who voluntarily choose to use
them to protect themselves against environmental smoke; in this situation employers are
not required to provide a medical evaluation or fit-test. Employers should tell these
employees that the respirator will provide some protection against the particles in smoke,
but that it will not provide complete protection, and that a respirator that has not been fit-
tested may not provide the maximum level of protection. Employees should be told that
the respirator does not protect against gases or vapors. Although a medical evaluation is
not required, the employer should advise employees to consult their doctor about
potential exposures to smoke and respirator use, particularly if they have certain health
problems such as respiratory or heart conditions. Employees should also be provided any
additional information as required by State and local regulations. In California, employees
should also be provided with a copy of Cal/OSHA Regulation, Title 8, Section 5144,
Appendix D (http://www.dir.ca.gov/Title8/5144d.htmn. The California Department of
Public Health has prepared a fact sheet on the use of N95 respirators called "Protect Your
Lungs from Wildfire Smoke," which can be found at:
http://www.bepreparedcalifornia.ca.eov/Dociiments/Protect%20Your%20Limes%20Res
pirator.pdf.
Additional Information
The Lawrence Berkeley National Laboratory has produced a multi-page summary on air
cleaning and its effects on health and perceived air quality, which can be found at:
https://iaqscience.lbl.eov/air-siimmarv.
53

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Appendix B: Protect Your Lungs from Wildfire
Smoke - Fact Sheet from California Department of
Public Health
54

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Environmental Health Investigations Branch * California Department of Public Health
DPH
Protect Your Lungs from Wildfire Smoke
N95 respirators can help
protect your lungs from
wildfire smoke. Straps
must go above and
below the ears.
A one-strap paper mask
will NOT protect your
lungs from wildfire
smoke.
y
A surgical mask will
NOT protect your lungs
from Wildfire smoke.
Wildfire smoke can irritate your eyes, nose, throat and lungs, it can make you
cough and wheeze, and can make it hard to breathe. If you have asthma
or another lung disease, or heart disease, inhaling wildfire smoke can be
especially harmful.
If you cannot leave the smoky area, good ways to protect your lungs from
wildfire smoke include staying indoors and reducing physical activity.
Wearing a special mask called a "particulate respirator"can also help
protect your lungs from wildfire smoke.
IIow to Choose the Correct Mask to Protect Your Lungs
•	Choose a mask called a "particulate respirator" that has the word
"NiOSH"and either"N95"or"P100" printed on it.These are sold at many
hardwareand home repairstoresand pharmacies.
•	Choose a mask that has two straps that go around your head. DO
NOT choose a mask with only one strap or with straps that just hook
overtheears.
•	Choose a size that will fit over your nose and under your chin. It should seal
tightlyto yourface. These masksdo notcome insizesthatfityoungchildren.
•	Do not use bandanas (wet or dry), paper or surgical masks, or tissues held
over the mouth and nose. These will not protect your lungs from wildfire
smoke.
How to Use a Mask
•	Place the mask over your nose and under your chin, with one strap placed
belowthe ears and one strap above.
•	Pinch the metal part of the mask tightly over the top of your nose.
•	The maskfits best on clean shaven skin.
•	Throw out your mask when it gets harder to breathe through, or if the
inside gets dirty. Use a new mask each day if you can.
•	It is harderto breathe through a mask, so take breaks often if you work outside.
•	If you feel dizzy or nauseated, go to a less smoky area, take off your mask
and get medical help.
If you have a heart or lung problem, ask your doctor before using a mask.
For more information about protecting yourself from wildfire smoke,
call your local health department.
June 30, 2008

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Appendix C: Hazards during Cleanup Work
Following Wildfires from National Institute for
Occupational Safety (NIOSH)
56

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Cleaning up after a wildfire
The purpose of this document is to discuss some of the health and safety hazards that
homeowners and workers may encounter after a wildland fire. This document is not
designed to address health and safety for fire fighters or other emergency response workers
during a wildfire or other emergency event.
After a wildfire has ended, cleanup and recovery activities are often needed. These
activities may pose health and safety hazards that require necessary precautions. In most
cases, it may be more appropriate for professional cleanup and disaster restoration
companies, rather than homeowners or volunteers, to conduct this work. Although the
types of hazards may be different for each wildland fire, some common hazards include:
•	Contact with fire
•	Burnt and unstable structures
•	Burnt and unstable trees
•	Confined spaces
•	Carbon monoxide
•	Electrical dangers
•	Fatigue and stress
•	Hazardous materials
•	Hot environments
•	Musculoskeletal injuries
•	Wildfire smoke and ash
•	Working with and around heavy equipment
57

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Health and Safety Hazards after a Wildland Fire
1.	Contact with Fire
After a wildfire, trained fire fighters will make sure the fire is completely out. If
there is any chance the wildfire could reignite, leave immediately and notify
emergency personnel.
2.	Burnt and Unstable Structures
Be aware of unstable and damaged houses and other structures after a wildfire. Do
not assume that these areas are safe or stable because damage may not be noticeable
and can create a risk for serious injuries from slips, falls, punctures, or being struck
by collapsing materials.
Safety Measures
To prevent injuries from burnt and unstable structures:
•	Conduct a thorough inspection and identify and eliminate hazards before
conducting any work. Avoid work around fire-damaged structures, including
stairs, floors, and roofs, until an engineer or architect examines and certifies the
structure is safe.
•	Wear personal protective equipment, including long sleeved shirts and pants,
hard hats, safety glasses, leather gloves, and steel toe boots, to reduce the risk of
injury.
•	Leave immediately if a structure shifts or makes an unusual noise that could
signal a possible collapse.
3.	Burnt and Unstable Trees
Another common hazard after a wildfire is unstable trees, known as 'snags' or
'hazard trees,' which can fall and injure homeowners and workers. It is important to
assess the stability of all trees before working and driving around them.
Safety Measures
Always contact a professional to evaluate a tree's stability and to safely remove any
suspected hazardous trees from the property and along roadways before conducting
cleanup work.
For more information about potential hazards from tree removal, see: Preventing Chain
Saw Injuries During Tree Removal After a Disaster
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4.	Carbon Monoxide
Wildland fire cleanup activities may involve the use of gasoline or diesel powered
pumps, generators, and pressure washers. This equipment releases carbon
monoxide (CO), a deadly, colorless, odorless gas. It is important that homeowners
and workers protect themselves from CO poisoning.
Safety Measures
To avoid the risk of CO poisoning:
•	Never bring gas or diesel powered machines indoors.
•	Only operate these machines in well-ventilated areas.
•	Do not work near exhaust gases (CO poisoning can occur even outdoors
near exhaust from engines that generate high concentrations of CO).
•	Shut off the equipment immediately and seek medical attention if you
experience symptoms of CO poisoning.
To learn more, visit NIOSH's webpages Carbon Monoxide or Carbon Monoxide
Hazards from Small Gasoline Powered Engines.
5.	Confined Spaces
A confined space is an area that has limited openings for entry or exit, has limited
air flow and is not designed for human occupancy. Examples of confined spaces
include septic tanks, storage tanks, utility vaults and wells. These spaces may
contain toxic gases, may not have oxygen, or may be explosive. In many cases,
these hazards are not easily recognized without proper training and equipment.
Safety Measures:
• Never enter a confined space without proper training and equipment, not
even to rescue a fellow worker. Contact the local fire department for help.
To learn more, visit NIOSH's webpage: Confined Spaces.
6.	Fatigue and Stress
A homeowner may experience emotional stress and mental and physical fatigue
from cleanup and from loss of personal property or valuables. Fatigue and stress
may increase the risk of injury and illness.
Safety Measures:
After a fire, homeowners or other workers may need to:
•	Seek emotional support from family members, neighbors, and local mental
health care workers to help prevent more serious stress-related problems.
•	Set priorities for cleanup tasks and pace work over days or weeks to avoid
physical exhaustion.
•	Rest and take frequent breaks to avoid exhaustion.
•	Begin a normal sleep and eating schedule as quickly as possible.
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•	Take advantage of disaster relief programs and services in the community.
•	Understand physical and mental limitations.
To learn more, visit NIOSH's webpages: Traumatic Incident Stress: Information
For Emergency Response Workers and Stress at Work
7.	Electrical dangers
One common danger after a fire is a downed/damaged power pole with potentially
energized power lines laying on the ground or hanging from the pole. Any type of
work with power lines or other electrical sources must only be conducted by
trained professionals, such as electricians and utility workers. If a potential
electrical danger or a downed power line is identified, avoid all electrical
hazards by stopping work and immediately notifying the local utility company.
Safety Measures
When working near power lines, it is important to follow these steps to prevent
electrical injuries:
•	Do not work or enter any area with any potential for electrocution from a
power line or other electrical hazards.
•	Treat all power lines and cables as energized until proven otherwise.
•	When the power is off, never restore power until a professional inspects and
ensures the integrity of the electrical system.
•	Do not use electrical equipment that has been exposed to heat from a fire
until checked by an electrician.
•	Unless power is off, never enter flooded areas or touch electrical equipment
if the ground is wet.
•	Use extreme caution when equipment is moved near overhead power lines.
For example, contact between metal ladders and overhead power lines can
cause serious and often fatal injuries.
•	Do not stand or work in areas with thick smoke. Smoke hides electrical lines
and equipment.
To learn more, visit NIOSH's electrical safety webpage.
8.	Hazardous and Other Potentially Dangerous Materials
Many homes and other structures may contain or store hazardous materials and
chemicals.
Some common materials include asbestos, lead, pesticides, propane, and gasoline.
These materials may cause health effects, may be explosive, or may react with
other chemicals. Before beginning cleanup activities, contact a professional who is
familiar with hazardous materials to determine the different types of hazards that
are present and how to safely clean up and dispose of them in accordance with local
and state laws.
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Safety Measures:
To reduce the chance of exposure to hazardous and other dangerous materials:
•	Be cautious of chemicals, propane tanks, and other dangerous materials.
•	Wear protective clothing and gear when handling hazardous materials.
•	If exposed to hazardous materials, wash the affected area (e.g., skin, eyes)
and contact your local poison control center or the American Association of
Poison Control Centers at 1 (800) 222-1222. Seek medical care immediately
if the exposure is severe or you experience symptoms.
•	Homes built before 1980 may contain asbestos and lead. Contact your
county health department to learn about local laws and regulations. Because
disturbing lead and asbestos may result in serious health consequences, it is
recommended that only trained professionals test for and clean up materials
that contain lead or asbestos.
•	Fires may also damage tanks, drums, pipes, or equipment that may contain
hazardous materials, such as pesticides, gasoline, or propane. Before
opening or removing containers that may contain hazardous materials,
contact the local fire department or a hazardous materials team to help
assess and remove hazardous waste.
To learn more about chemical safety, visit NIOSH webpages: Pocket Guide to
Chemical Hazards and Chemical Safety
9. Hot environments
While working in hot weather, homeowners and cleanup workers could be at risk
for heat-related illnesses, such as heat stress, heat rash, heat cramps, and heat
stroke. It is important to be aware of the symptoms of heat related illness, how the
illness can affect health and safety, and how it can be prevented.
Safety Measures
To reduce the potential for heat related illnesses, it is important to follow some
basic work practices, such as:
•	Wearing lightweight, light-colored, loose-fitting clothes,
•	If possible, blocking out direct sun or other heat sources,
•	Taking frequent breaks in cool, dry areas ,
•	Acclimatizing before working (getting used to weather conditions),
•	Working during the cooler hours of the day when possible, and
•	Maintaining hydration by drinking plenty of water and other fluids.
If a homeowner or worker displays any signs of heat related illness, it is important
to immediately go to a cool, shaded place, sit or lie down, and drink water. If
possible, cool water may be poured over the homeowner's or worker's head and
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body. Seek medical attention immediately if the symptoms do not subside. To learn
more, visitNIOSH's webpage: Heat Stress
10.	Musculoskeletal Injuries
Homeowners and workers who may be involved in cleanup activities are at risk for
developing stress, strain, and potential musculoskeletal injuries, which are injuries
or disorders of the muscles, nerves, tendons, joints, cartilage, or spinal discs. These
common injuries can occur when moving debris and materials, using hand-held
equipment (e.g., chainsaws) due to repetition, force, vibration, or awkward
postures.
Safety Measures
Some useful tips to prevent these injuries:
•	Use teams of two or more to move bulky objects.
•	Take breaks when conducting repetitive work, especially if experiencing
fatigue.
•	Avoid working in unusual or constricting postures.
•	Use correct tools and equipment for the job and use them properly.
•	Do not lift material weighing 50 pounds or more and use automated lifting
devices for heavier objects.
•	Be sure the area is clear of slip, trip and fall hazards.
To learn more, visit NIOSH's webpage: Ergonomics and Musculoskeletal
Disorders
11.	Wildfire Smoke and Ash
Smoke
Smoke from a wildland fire can pose health risks. Older adults, young children or
individuals with underlying heart or lung disease are the most likely to be affected
by inhaling wildland fire smoke. Healthy individuals may also experience short-
term respiratory irritation symptoms, such as burning eyes and runny nose. If there
is smoke in the area, homeowners and cleanup workers who are sensitive to smoke
should consider leaving the area until the smoke clears.
Ash
Ash from wildland fires can be deposited on indoor and outdoor surfaces in areas
around the fire and can be irritating to the skin, nose and throat, and may cause
coughing.
Safety Measures:
To minimize the health effects that may occur due to exposure to smoke and ash:
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•	Always wear proper personal protective equipment (long sleeve shirts,
pants, gloves and safety glasses) when working around ash. If you do get
ash on your skin, wash it off as soon as possible.
Do not use leaf blowers or take other actions (e.g., dry sweeping) that will
put ash into the air. Shop vacuums and other common vacuum cleaners do
not filter out small particles, but rather blow the particles out the exhaust
into the air. To clean up ash, use vacuums equipped with High Efficiency
Particulate Air (HEPA) filters.
•	Do not consume any food, beverages, or medication that has been exposed
to burn debris or ash.
•	Well-fitting respirators may provide some protection during cleanup.
Please visit NIOSH's Respirator Trusted-Source Information web site at:
•	If the presence of asbestos, lead, CO or other hazardous material is
suspected, do not disturb the area. Dust masks or filtering facepiece
respirators do not protect against asbestos or gases such as CO.
•	Avoid burned items that may contain hazardous chemicals, such as
cleaning products, paint and solvent containers.
•	Avoid ash from wooden decks, fences, and retaining walls pressure treated
with chromated copper arsenate (CCA) as it may contain lethal amounts of
arsenic.
12.Working	With And Around Heavy Equipment
Do not operate heavy equipment, such as bulldozers, backhoes, and tractors, unless
you are properly trained. Serious and fatal injuries can occur when equipment is
used improperly. To learn more about motor vehicle safety, visit NIOSH's
webpages: Motor Vehicle Safety and Fatality Assessment Control and Evaluation.
13.First	Aid
First aid, even for minor cuts and burns, is extremely important as workers are
exposed to smoke and burned materials. For more information, please visit
NIOSH's webpage: NIOSH's First Aid Procedures
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Appendix D: Identification and Preparation of
Cleaner Air Shelters for Protection of the Public
from Wildfire Smoke
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Identification and Preparation of Cleaner Air Shelters for Protection of the Public
from Wildfire Smoke
1.	Identify one or more facilities with tight-sealing windows and doors and public access
(for example, public schools, fire stations, or hospitals). As a rule of thumb, newer
buildings will generally be more desirable than older ones.
2.	At a minimum, a Cleaner Air Shelter should have central air conditioning with
filtration that is at least medium or high efficiency. If needed, filters should be
upgraded prior to the fire season, after assuring that the system can handle the
increased airflow resistance. Ideally, the ventilation system should also be capable of
reducing outdoor air intake, if needed. For more information on operation of the
HVAC system during smoke events, see Appendix A.
3.	Install/inspect a room air cleaner or preferably a central air cleaner with sufficient
capability, i.e., a Clean Air Delivery Rate (CADR) that is twice the room volume for
room units, or ASHRAE filter rating of MERV 12 or higher for central air cleaners*.
Ensure proper maintenance of air cleaners, keep spare filters on hand, and provide
instructions on changing the filter to trained personnel.
4.	Assure that the facility can handle the increased cooling load due to high occupancy.
5.	Install a properly calibrated carbon monoxide (CO) alarm that has a digital display
and battery backup function (available at most hardware stores).
6.	Provide a radio for updates on fire status and access to a telephone in case of
emergency.
* ASHRAE Standard 52.2-2012. "Method of Testing General Ventilation Air-Cleaning Devices for Removal
Efficiency by Particle Size".
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Appendix E: Children's Health Fact Sheets from the
Pediatric Environmental Health Specialty Units
(PEHSU)
66

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mPEHSU
¦ . ¦ fl Pediatric Environmental
4.1 Health Specialty Units
PEHSU Information on Health Risks of Wildfires for Children Guidance for
Parents and Community Members - Acute phase
The Pediatric Environmental Health Specialty Units (PEHSU) Network encourage
families, pediatricians, and communities to work together to ensure that children are
protected from exposure to environmental hazards.
Wildfires expose children to a number of environmental hazards like fire, smoke,
psychological stress, and the byproducts of burnt wood, plastics, and other chemicals
released from burning structures and furnishings. During or immediately after the
wildfire, the major hazards to children are fire and smoke. Stress from seeing the fires
and the emotional responses of those around them can also impact children during this
time. Although some of the exposures children may encounter in this setting may cause
or worsen health problems (described later), there are important ways that parents can
protect their children.
Children, individuals with pre-existing lung or cardiovascular problems, pregnant
women, elderly, and smokers are especially vulnerable to environmental hazards such
as smoke. Children are in a critical period of development when toxic exposures can
have profound negative effects, and their exploratory behavior often places them in
direct contact with materials that adults would avoid.
The environmental hazards during or immediately after the wildfire are:
•	smoke consists of very small particles, liquid droplets, and gases such as
carbon monoxide, carbon dioxide, and other volatile organic compounds such
as formaldehyde and acrolein. The actual contents of smoke depends on the
substance that is burning.
•	health effects of smoke: Symptoms from smoke inhalation can include chest
tightness, shortness of breath, wheezing, coughing, respiratory tract and eye
burning, chest pain, dizziness or lightheadedness, and other symptoms.
Asthma symptoms may flare up. The risk of developing cancer from short-term
exposures to smoke is very small.
RECOMMENDATIONS
•	Stay indoors with windows and doors closed and any gaps in the building
envelope sealed. Avoid strenuous activity.
•	If available and if needed for comfort, run an air-conditioner on the "re-
circulate" setting. Be sure to change the filter at appropriate intervals. Some
electronic air cleaners and ozone generating "filters" can generate dangerous
amounts of ozone indoors (see the Wildfire Smoke -A Guide for Public Health
Officials resource). These ozone filtration systems do not remove harmful
contaminants from the air and are not recommended.
August, 2011
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•	Never operate gasoline powered generators indoors - they produce
dangerous carbon monoxide. Avoid smoking, using wood stoves, and other
activities that add to indoor air contamination.
•	If there is a period of improved air quality, open up (air out) the house and
clean to remove dust particles that have accumulated inside.
•	Humidifiers or breathing through a wet washcloth may be useful in dry climates
to keep mucous membranes moist, although this does nothing to prevent
inhalation of contaminants.
•	When riding in a car, keep the windows and vents closed. If comfort requires air
circulation, turn the air-conditioning on "re-circulate" to reduce the amount of
outside air drawn into the car.
•	Children with asthma, heart disease, and others considered at high risk
from health effects from contaminant inhalation should be moved to an
adequate "clean air" shelter, which may be in their home, in the home of a
friend or relative, or in a publicly-provided "clean air" shelter.
Use of Masks
Paint, dust, and surgical masks are not effective obstacles to inhalation of the fine
particles generated by wildfires. For information on use of respiratory protection for
adults see "Wildfire Smoke - A Guide for Public Health Officials."
Although smaller sized masks may appear to fit a child's face, none of the
manufacturers of masks recommend their use in children. If your child is in air quality
severe enough to warrant wearing a mask, you should remove them to an indoor
environment with cleaner air.
CLOSING OF SCHOOLS AND BUSINESSES may become necessary when air quality
is so poor that even traveling outside from place to place puts people at risk. However,
in some situations the school may be a relatively protected indoor environment with
better air quality and where children's activity can be monitored.
CONSIDERATION OF EVACUATION because of smoke should weigh the effects of
smoke exposure during the evacuation versus what the exposure would be while
resting quietly inside one's home. A disorderly evacuation can increase the duration of
smoke exposure. Remember to bring with you at least 5 days of any medications
taken by family members.
ASH: Recent fires may have deposited large amounts of ash on indoor and outdoor
surfaces. This ash may be irritating to the skin and may be irritating to the nose and
throat and may cause coughing. The following steps are recommended:
•	Do not allow children or animals to play in ash.
•	Wear gloves, long sleeved shirts, and long pants when handling ash, and
avoid skin contact.
•	Wash any home-grown fruits or vegetables before eating.
•	Avoid spreading the ash in the air; wet down the ash before attempting
removal; do not use leaf blowers or shop vacuums.
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PSYCHOLOGICAL EFFECTS ON CHILDREN: Parents and caregivers should
also be alert to children's emotional health and psychological wellbeing. It is
important to keep in mind the youngest members of our society may easily
become saturated with graphic images and incessant talk of smoke, flames and
destruction. Resulting stress and anxiety may be manifested in a variety of
ways:
•	Clinging, fears
•	Uncooperative behaviors, irritability
•	Nightmares
•	Health complaints
•	Changes in eating or sleeping patterns
•	Regression to babyish behaviors
•	Indifference
Parents and caregivers can support children in a number of ways:
•	Maintain previously established routines as much as possible.
•	Provide a listening ear for children; encourage the expression of feelings
through music, art, journaling, and talking.
•	Answer questions openly and honestly, remaining mindful of the age of
the child.
•	Reassure and hug when hugs are wanted; practice patience and have a
peaceful demeanor, as children take their cues from their parents.
To contact your local Pediatric Environmental Health Specialty Unit with any
questions about this fact sheet please visit www.pehsu.net
RESOURCES
More details on the health effects of wildfires and ash cleanup are available at
the following sites, from which some of this material was adopted:
Fires and Wildfires (National Library of Medicine):
sis.nlm.nih.aov/enviro/californiafires.html#al
National Association of School Psychologists: Helping Children after a Wildfire:
www.nasponline.org/resources/crisis safetv/wildfire teachers.pdf
Acknowledgement: James M. Seltzer, M.D., Mark Miller, M.D., M.P.H., and Diane L. Seltzer,
M.A., Pediatric Environmental Health Specialty Unit Region 9
This document was developed by the Association of Occupational and Environmental Clinics (AOEC)
and funded under the cooperative agreement award number 1U61TS000118-02 from the Agency for
Toxic Substances and Disease Registry (ATSDR).
Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing
funds to ATSDR under Inter-Agency Agreement number DW-75-92301301-0. Neither EPA nor ATSDR
endorse the purchase of any commercial products or services mentioned in PEHSU publications.
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rnPEHSU
¦ . ¦ m Pediatric Environmental
¦Alii Health Specialty Units
PEHSU Information on Health Risks of Wildfires for Children - Aftermath
Guidance for Parents and Community Members
The Pediatric Environmental Health Specialty Units (PEHSU) Network encourage
families, pediatricians, and communities to work together to ensure that children
are protected from exposure to environmental hazards.
Wildfires expose children to a number of environmental hazards like fire, smoke,
psychological stress, and the byproducts of burnt wood, plastics, and other
chemicals released from burning structures and furnishings. During or
immediately after the wildfire, the major hazards to children are fire and smoke
(described in the fact sheet Health risks of wildfires for children - acute phase).
In the aftermath of wildfires - the recovery phase - children may be exposed to
a different set of environmental hazards involving not only their homes, but
also nearby structures, land, and recovery activities. Some of these are easy to
see, such as broken glass and exposed electrical wires, and others are not,
such as soil contaminated with hazardous materials like lead or persisting hot
spots which can flare without warning. Stress from seeing the fires and the
emotional responses of those around them can also impact children during this
time. Although some of the exposures children may encounter in this setting
may cause or worsen health problems (described later), there are important
ways that parents can protect their children.
Children, individuals with pre-existing lung or cardiovascular problems, pregnant
women, elderly, and smokers are especially vulnerable to environmental hazards
such as smoke. Children are in a critical period of development when toxic
exposures can have profound negative effects, and their exploratory behavior
often places them in direct contact with materials that adults would avoid.
Key requirements for children to return to an area impacted by wildfires include
restored drinking water and sewage removal, safe road conditions, removal of
ash and debris, and structurally sound homes. Schools and outdoor play areas
should be cleaned, cleared of hazards. Children, and whenever possible, teens,
should only be permitted to return after affected areas have been cleaned up.
Children should be the last group to return. These recommendations also
apply to pregnant women.
BEFORE RETURNING TO YOUR HOME
• Know the location and status of your nearest medical treatment facility
and verify the route to reach it is passable.
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•	Be sure a clean water supply, electricity, and communication system
(including 911 access) is restored, reliable, and readily accessible.
•	Be certain areas not yet cleaned or not safe are not accessible to children.
•	Homes and outdoor areas where children play (e.g., parks,
playgrounds, yards) should be clean and free of environmental
hazards.
•	Thoroughly remove ash at sites where pressure treated wood was
present, such as wooden decks, play structures, and wood chips. Clean
the area, as the ash may contain high levels of arsenic if these were pre-
2002 structures.
•	Carbon monoxide: NEVER use generators, space heaters, or
any gas or kerosene appliances in enclosed spaces as this may
result in carbon monoxide poisoning.
POTENTIAL HAZARDS FROM FIRE DAMAGE
•	Ash: Recent fires may have deposited large amounts of ash on indoor and
outdoor surfaces in areas near the fires. This ash may cause irritation of
the skin, nose, and throat, and may cause coughing. Ash and dust
(particularly from burned buildings) may contain toxic and cancer causing
chemicals including asbestos, arsenic, and lead. For these reasons
children should not be in the vicinity while cleanup is in progress. Even if
you are careful it is easy to stir up dust that may contain hazardous
substances.
•	Debris: Broken glass, exposed electrical wires (whether or not they are
"live"), nails, wood, metal, plastics, and other solid objects commonly
found in areas of fire damage can cause puncture wounds, cuts,
electrical injuries, and burns from smoldering materials.
•	Watch for ash pits and mark them for safety. Ash pits are holes full of
hot ashes, created by burned trees and stumps. Falling into ash pits or
landing in them with your hands or feet can cause serious burns. This
underscores the need for children to only enter areas that have been
cleaned and examined for safety.
•	Children should not be permitted in the residence or permitted to play on
nearby fire- damaged buildings or structures until these have been
cleared by their local authorities. Unstable building structures include:
flooring, stairways, railings, balconies, roofing, and fire escapes.
•	Materials in storage areas may have moved into unstable positions and
could fall. Doors and entryways to storage areas should be opened
carefully.
HAZARDS FROM WATER DAMAGE
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•	Water damage to building materials and personal belongings can
release potentially hazardous chemicals that could cause rashes,
infections, or exposures to toxic substances.
•	Wet materials are breeding grounds for bacteria and fungi. Potentially
harmful microorganisms grow readily on or in non-refrigerated food and
liquids. They can also grow on damp building materials, personal
belongings, and dead animals.
UTILITIES
•	Water: In areas impacted by the fires water pressure may have been lost
or entirely out for periods of time. Check with your water provider to be
sure that your water is safe to drink. If your water comes from a private
well that has had damage it may require disinfection. If you are uncertain
of the cleanliness of your water you may heat it to a rolling boil for 1
minute to kill potentially harmful bacteria and other microscopic
organisms before drinking. If your water looks dirty do not drink it.
•	Electricity: Electrical hazards need to be repaired. Avoid downed or
damaged electrical lines.
•	Propane: If your home propane tank is damaged and leaking call 911
and your propane service provider. Do not transport leaking BBQ
propane tanks in your car or dispose of them in the trash. Contact the
hazardous materials section of your local health department for
information.
PREVENTIVE MEASURES
•	Personal hygiene: If your child has had contact with any potentially
hazardous substance in a fire-damaged area, wash their hands and any
other exposed body part thoroughly with soap and water or bathe them.
Remove any exposed clothing and wash separately as soon as possible.
MASKS
•	Use of protective masks is recommended for adults cleaning up areas at
which ash particles cannot be controlled (see Respiratory Protection in
Wildfire Smoke: a Guide for Public Health Official's). Although smaller
sized masks may appear to fit a child's face, no manufacturer
recommends their use in children. If your child is in an area that
warrants wearing a mask, you should take them to an area with cleaner
air.
FOOD
•	Loss of power to refrigeration and freezer units can cause food to spoil,
for example, meats, milk, and egg products. Do not feed children such
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foods that have warmed close to room temperature for more than 2
hours. Immediately discard cooked and uncooked foods that may have
spoiled. Frozen foods that have thawed to room temperature for more
than 2 hours should also be thrown away. If food smells bad or looks
bad, or if you're just not sure it's safe, throw it out. Also, discard any food
that may have come in contact with hazardous materials, such as fire
retardant or ash. When in doubt, throw it out!
PSYCHOLOGICAL HAZARDS
•	During the recovery phase, children may experience significant anxiety
and grief from the loss and trauma related to having lived through a
natural disaster. Children may suffer from fears connected to the smell
of smoke, feelings of anxiety when weather conditions indicate a
potential for fires, or overwhelming guilt at having survived the wildfires
with little or no damage to their property. If children experience the loss
of a loved one or their home, their sense of personal safety and security
is often destroyed as well.
•	Parents and caregivers may observe children displaying one or
several of the following reactions during the recovery stage:
•	Irritability, fatigue, indifference
•	Health complaints such as stomach aches, headaches, general
complaints of feeling unwell
•	Clinging; difficulty separating, returning to "babyish" behaviors
•	Eating or sleeping too much or too little, nightmares
•	Difficulty concentrating or focusing at home and/or on school work
•	Aggression or outbursts of anger, fears
•	Parents and caring adults can provide significant support to children
during times of emotional distress. Even if the family relocates to
temporary housing, the sooner routines previously in place are re-
established, the more quickly children will begin to experience the return
of feelings of security and safety. Parents should reassure children that
their feelings and fears are normal and should encourage them to
express their emotions with words, play and writing.
The following recommendations will help children experiencing significant
emotional challenges as a result of the recent wildfires.
•	Maintain continuity and familiar routines in the child's life, both at home
and school.
•	Listen, listen, listen with an open heart and mind, without judging or
attempting to fix the problem.
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•	Imagine how the child feels; let children know their feelings are normal.
•	Encourage expression of feelings through conversation, role-playing,
music, visual art, and writing (letters, diaries, journals).
•	Provide honest and accurate answers to the questions children ask,
keeping in mind the child's age and ability to make sense of your
response.
•	Reassure them with words, for children gain confidence and comfort from
your strength.
•	Provide hugs and comforting touches, remembering children
thrive on loving human contact.
•	Practice patience. Children may need a bit more time and
encouragement, as well as overall understanding at this time.
•	Emphasize a child's personal strengths and help the child recognize
his/her coping skills already in place.
•	Help children to see there were heroes and helpers who tried to make
things better for the community during a time of need.
To contact your local Pediatric Environmental Health Specialty Unit with any
questions about this fact sheet please visit www.pehsu.net
RESOURCES
Safe Cleanup of Fire Ash: www.calepa.ca.aov/Disaster/Fire2003/FireAsh.pdf
Fire Response and Recovery: Cal/EPA Emergency Response and Disaster
Preparedness: www.calepa.ca.aov/Disaster/Fire/#DebrisCleanup
U.S.D.A. Forest Service: Wildland Fire - chemical clean-up:
www.fs.fed.us/rm/fire/wfcs/documents/cleanup.pdf
National Association for the Education of Young Children: Helping Young Children
After a Disaster:
http://www.naevc.org/newsroom/Resources on coping with disasters
National Association of School Psychologists: Helping Children after a Wildfire:
www.nasponline.org/resources/crisis safety/wildfire teachers.pdf
National Association of School Psychologists: Responding to Natural
Disasters: Helping Children and Families:
www.nasponline.org/resources/crisis safetv/naturaldisaster teams ho.aspx
Acknowledgement: James M. Seltzer, M.D., Mark Miller, M.D., M.P.H., and Diane L. Seltzer,
M.A. Pediatric Environmental Health Specialty Units (PEHSU) Region IX
This document was developed by the Association of Occupational and Environmental Clinics (AOEC) and funded
under the cooperative agreement award number 1U61TS000118-02 from the Agency for Toxic Substances and
Disease Registry (ATSDR).
Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing funds to
ATSDR under Inter-Agency Agreement number DW-75-92301301-0. Neither EPA nor ATSDR endorse the
purchase of any commercial products or services mentioned in PEHSU publications
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Appendix F: Example ARA Report - from Rough
Fire, September 9, 2015
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Forecast conditions represent impacts from smoke from the Rough Fire. Contributions from ozone and other
pollutants are not reflected.
Fire: Fire activity increased yesterday with warmer temperatures and lower relative humidity. Most of the smoke produced was
from interior islands that ignited. Fire remains active in the Converse Basin, near Cedar Grove, and in the area north of Buck
Rock. The fire is 103,244 acres and remains at 31% contained.
Air Quality Today: Heavy concentrations of smoke are expected near the fire today. Smoke will be slow to lift and transport will
be primarily terrain and diurnally driven. Light and variable transport winds are expected primarily from the southeast, with
continued increased impacts expected in the San Joaquin Valley west of fire. Residual smoke that has not cleared the area will add
to impacts from new smoke being produced. Unhealthy to Hazardous conditions are expected in communities near the fire.
Smoke Impacts 1
rom Local Fires
Site
Yesterday
Observed
Today Forecast
24-Hr AQI
Tomorrow
Outlook 24-Hr
Worst Time of Day
Impacts

Midnight-
Midnight 24-Hr
AQI
September 9,2015
AQI
September 10,
2015
3-Hour AQI and Period

September 8,2015



Trimmer
Unhealthy
Hazardous
Hazardous
Unhealthy, 12 A.M. to 1 P.M.
Prather
Unhealthy
Unhealthy
Unhealthy
Unhealthy, 12 A.M. to 1 P.M.
Shaver Lake

Moderate
USG
Unhealthy, 12 A.M. to 1 P.M.
Oakhurst
Moderate
Moderate
USG
Unhealthy, 4 P. M. to 8 P.M.
Wishon Reservoir
Unhealthy
Unhealthy
Unhealthy
Very Unhealthy, midnight, to 2 P.M.
Hume Lake
Very Unhealthy
Hazardous
Very Unhealthy
Hazardous, 3 A.M. to 7 P.M.
Cedar Grove

No data
Hazardous
Hazardous
Hazardous, Midnight to 2 P.M.
Grant Grove

Moderate
Unhealthy
Unhealthy
Unhealthy, Midnight to Noon
Garnet Spike

Hazardous
Hazardous
Hazardous, Midnight to 2 P.M.
Devils Post
Pile/Mammoth Lakes
Moderate
USG
Moderate
USG, 9 A.M. to 3 P.M.
Aspendell
Moderate
USG
Moderate
USG, 1 P.Mto 7 P.M.
Bishop
Moderate
USG
USG
USG, 1 P.M. to 9 P.M.
Big Pine

Moderate
USG
Moderate, 3 A.M. to 9 A.M.
Independence

USG
USG
Moderate, 3 A.M. to 9 A.M.
Pinehurst
Moderate
Unhealthy
Unhealthy
Unhealthy, 7 A.M. to 10 A.M.
Montecito-Sequoia
Lodge
Moderate
Unhealthy
Unhealthy
Unhealthy, 10 pm Midnight
Lodgepole
Good
Moderate
USG
Moderate 6 P.M. to 11 PM
Three Rivers
Moderate
Moderate
USG
USG, 7 PM to 11PM
Ash Mountain
Good
Moderate
USG
USG, 7 PM to 11PM
Kemville
Good
Good
Moderate
USG evening hours
Disclaimer: Conditions may change quickly, these projections are based on anticipated weather and fire activity. Sensitive
groups including individuals with Asthma, lung or heart disease, children, older adults, and pregnant women should take
precautions to avoid exposure to smoke. If you feel as though you are having health effects from smoke see your doctor or
health professional as needed. In some cases your eyes are your best tools, if it is smoky outside you are being impacted. Use
caution when driving in or around smoky areas.
AQI Index
Actions to Protect Yourself
Good
None
Moderate
Unusually sensitive people should consider reducing prolonged or heavy outdoor exertion.
Unhealthy for Sensitive
Groups - USG
People with heart or lung disease, children and older adults should reduce prolonged or heavy
outdoor exertion. Everyone else should limit prolonged or heavy exertion.
Unhealthy
The following groups should avoid all physical outdoor activity: People with heart or lung disease,
children and older adults. Everyone else should avoid prolonged or heavy exertion.
Very Unhealthy
Everyone should avoid any outdoor exertion; people with respiratory or heart disease, the elderly and
children should remain indoors.
Hazardous
Hie following groups should remain indoors and keep activity levels low: People with heart or lung
disease; children and older adults. Everyone else should avoid prolonged or heavy exertion
California Smoke Blog - htti)://californiasmokeinfo.blogsi)ot.com/
Interagency Real Time Smoke Monitoring - tti)://ai)i).airsis.com/usfs/fleet.asi)
AirNow - htti)://airnow. gov/index.cfm?action=airnow.main
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