Wildfires%20and%20Public%20Health:%20Lessons%20Learned%20in%20Los%20Angeles%20County

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Wildfires and Public HealthLessons Learned in
Los Angeles County

• Jonathan Fielding, MD, MPH
• Cyrus Rangan, MD
• Deborah Davenport, RN, PHN, MS
• Los Angeles County Department of Public Health
• January 29, 2008

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Learning Objectives
By the end of this presentation, you will be able
to

• Discuss the growing public health importance of
  wildfires.
• List three roles for local public health
  departments in responding to wildfires.
• Describe how the use of a public health
  emergencymanagement system cansupport wildfire
  responseefforts.

Malibu Fire, Pepperdine University Used with
permission of LA County Fire Department
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Overview

• Background
• PH Emergency Management System
• Surveillance of air quality impacts
• Surveillance of adverse health effects
• External communications
• Addressing sheltering needs
• Role of environmental health
• Conclusions

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The risk of wildfires in my jurisdiction is

• A. Unchanged recently
• B. Increasing
• C. Decreasing
• D. Minimal

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Public Health Implications

• Profound public health implications
• Smoke and ash exposures lead to acute respiratory
  symptoms, exacerbations of cardiac conditions,
  and mental health effects.
• Affects vulnerable populations children,
  seniors, people with chronic diseases such as
  asthma, emphysema, and heart disease.
• Creates major disruptions in services secondary
  to evacuations school closures and increased
  traffic congestion.

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Environmental Factors Increase Risk

• Environmental factors that elevate the risk of
  wildfires
• Drought conditions
• Increased residential and commercial development
  in high-risk areas
• Global warming

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History

• October 2003
• Wildfires across Southern California consumed
  more than 750,000 acres and destroyed 3,640
  homes.
• October 2007
• Wildfires again spread across Southern
  California, burning 500,000 acres from Santa
  Barbara to the U.S. - Mexico border.

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History (cont.)

• Totals for LA County, 2007
• 105,000 acres burned.
• 60 homes and structures destroyed another 67
  damaged.
• Largest LA County blazes
• Ranch Fire (Castaic/Piru) 58,000 acres burned
  1 home and 9 structures destroyed.
• Buckweed Fire 40,000 acres burned 63 homes
  destroyed. Fire started by child playing with
  matches.

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History (cont.)
Fire Name Acres Properties Damaged and Destroyed Properties Threatened Evacuated Fire Fighters
Canyon Fire 4,500 22 900 21,000 2,750
October Fire 35 0 84 21,000 2,750
Magic Fire 2,824 0 0 21,000 2,750
Ranch Fire 58,401 12 600 21,000 2,750
Buckweed Fire 38,356 93 59,000 21,000 2,750
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Wildfires Arial View
NASA Satellite Image October 24, 2007
View from Santa Clarita Valley Near Magic
Mountain October 21, 2007Used with permission of
LA County Fire Department
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Wildfires Arial View (cont.)
NASA Satellite Images October 21, 2007 (3 hours,
15 minutes between images)
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Public Health Emergency Management System
Activation
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LAC DPH Emergency ManagementActivation
County EOC
24 hour contact coordination for PH emergencies
DPH Emergency DeskExec. Duty Officer
Community HealthServices/Field PHN PHI Staff
Initial notification
Health OfficerDirector
Public Health Nursing
CD Control
Primary DPH units that provide initial response
to public health emergencies
EnvironmentalHealth Services
Toxics EPI
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Los Angeles County Emergency Operations Center
(EOC)

• The EOC is hub for coordinating all emergency
  incidents in L.A. County.
• All county departments, as well as other
  agencies, have liaisons at the EOC to ensure
  resources are matched to needs, and departments
  can collaborate to ensure needs are met.
• DPH desk notifies Dept of Mental Health (DMH)
  that public health nursesare staffing shelters
  and collaborate with DMH staff for stress
  debriefing of shelter residents.
• LA Co. Fire notifies DPH that new base camps are
  opening for EHSinspections of food facilities.

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LAC DPH Emergency Management

• After information is provided to immediate
  response program group, decision is made by
  director, through the Emergency Desk, to stand up
  Department Operations Center (DOC).
• DOC is the Incident Command System
  (ICS)-formatted emergency management operations
  unit, dedicated to managing the incident for
  Public Health.

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The DOC
County EOC
Public Health liaison has desk at the EOC to
facilitate DPH resources and information needs.
Public Health DOC
SPA ECC (Emergency Control Center)


Environmental Health ECC

SPA ECC

• ECCs called into action based on scope of the
  emergency.
• EHS routinely sets up an ECC to manage
  environmental health emergencies.

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Advantages of Using EMS/ICS for PH Emergency
Management

• Use of the Emergency Management System with ICS
  provides field staff with organized system for
• Incident tracking
• Costs of staff and resources for incident
  response
• Clear chain of command and communication among
  field staff, PH management, and LA County EOC

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Surveillance of Air Quality Impacts
Santa Clarita and Castaic Fires, 2007
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Air Quality Surveillance
Simi Valley Rapid Changes in Air Quality October
21 to October 22, 2007
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Air Quality Index

• SCAQMD estimates air quality impacts of criteria
  pollutants using the Air Quality Index (AQI)
  system
• AQI 050 Good
• 51100 Moderate
• 101150 Unhealthy for Sensitive Groups
• 151 200 Unhealthy
• 201 or above Very Unhealthy

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Public Health Alert

• TEP initiates a Public Health Alert if any one
  region will have an AQI gt 150, or three or more
  regions will have an AQI gt100.
• Health alerts may be initiated at discretion of
  health officer.
• Each morning, Alert is revised, based on new
  information from AQMD.

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Air Quality Surveillance

• Two-way communication established between LADPH
  and South Coast Air Quality Management District
  (SCAQMD).
• SCAQMD formulates regional A.M. air quality
  report, based on results from air monitoring
  stations, field testing, and mathematical models.
• LADPH Toxics Epidemiology Program (TEP) reviews
  air quality reports and smoke advisories issued
  by SCAQMD.

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Air Quality Surveillance Concerns

• SCAQMD regions based on topography, not
  population centers.
• Lack of published standards to predict health
  impacts based on these measurements.
• Potential to validate our internal judgments
  based on Syndromic Surveillance data.

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Air Quality Surveillance Updates

• Updated air quality data reviewed throughout day,
  and preparations made for potential alerts for
  next day.
• Daily communication occurs with Los Angeles
  Unified School District (LAUSD) and Los Angeles
  County Office of Education (LACOE) to coordinate
  outside physical activity messaging.
• Local school districts outside of LAUSD and
  private schools added to distribution list
  depending on location.
• TEP available throughout day for media inquiries
  about health effects of adverse changes to air
  quality.

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Surveillance of Adverse Health Effects
Smoke Off Pepperdine Dorms, MalibuUsed with
permission of LA County Fire
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Pre-existing Syndromic Surveillance System

• Collects daily chief complaint data from 35
  hospital emergency departments (ED).
• Reviews and categorizes presenting complaints
  into syndromes (GI, neuro, rash, respiratory).
• Transmits data electronically each day, including
  weekends.
• Tracks syndrome counts over time.
• Statistical increase in syndrome counts triggers
  a signal.

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Strengths of the Syndromic System

• Potential for early detection of major outbreaks
  or public health events.
• Useful in defining location and scope of an
  outbreak or public health event in near-real
  time.
• Can customize syndromes such as heat-related and
  asthma syndrome during wildfires.
• Detects major trends from baseline patterns, not
  individual cases.

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Limitations of Syndromic System

• Data includes chief complaints, not diagnosis.
• Potential concerns related to sensitivity and
  specificity.

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Respiratory Syndrome-Related ED Visits

• Overall respiratory-related visits significantly
  increased during the wildfire.
• Generated three consecutive signals from October
  22 to October 25.

Hospital CC Syndrome Gender Age Time Zip ID
X Cough/smoke filled area Respiratory M 2 1510 - -
X Short of breath/exp to environmental smoke Respiratory F 48 1610 - -
X Asthma pt, diff breathing Respiratory M 14 1310 - -
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Respiratory Syndrome-Related ED Visits (cont.)
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Asthma Syndrome-Related ED Visits

• Three signals generated during October 21 to 24.
• Average asthma syndrome-related daily ED visits
  changed from 69 in week before fires began to 87
  during week after fires began (p0.0115).

Arrived Hospital Syndrome CC Zip Gender Age Time
10/22/07 X Asthma Asthma attack X M 9 922
10/22/07 X Asthma Asthma attack X F 28 1011
10/22/07 X Asthma Wheezing X F 15 1107
10/22/07 X Asthma Sent by Dr. Fell Shakey HX COPD X M 73 927
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Asthma Syndrome-Related ED Visits (cont.)
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External Communications
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Public Information Officers (PIO)

• One PIO stationed at Public Health Department
  Operations Center at all times.
• One PIO stationed at County Emergency Operations
  Center for 36 hours.
• Coordinated with TEP to develop air quality
  alerts distributed to internal and external
  audiences.
• Participated in daily conference calls with state
  Emergency Operations Management communication
  team and other affected county PIOs.

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Health Alerts

• Health alert listserv established.
• Health alerts posted on County and Department of
  Public Health Web sites.
• Health alerts sent to
• School districts and private schools
• 211 LA the Countys information and referral
  line
• 311 LA Citys information line
• Board of Supervisor offices and other county
  departments (Dept of Health Services Parks and
  Recreation)
• California National Guard

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Other External Communication Activities

• Press releases/fact sheets on wildfire smoke and
  safe ash clean-up created in English and Spanish.
• Public service announcement, created by CDC on
  safe ash clean-up, disseminated to local radio
  stations. Ran on 13 AM and FM stations (news
  radio and music format).
• Participated in hot wash call sharing lessons
  learned from state OES and other impacted
  counties.
• Emergency management personnel from CDC and other
  CA county PIOs listened in as observers.

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Addressing Sheltering Needs
Structural Fire, Santa Clarita, Used with
permission of LA County Fire
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Public Health Nurse (PHN) Disaster Response Roles

• Disease surveillance and control
• Health education
• Mass prophylaxis
• Surge capacity for mass care shelters

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Shelter Nursing Role of PHN

• Shelter surveillance.
• MOU Back-up American Red Cross (ARC) staffing
  for shelter nursing.
• PHNs receive ARC training and certification.
• Localized incidents provide experience in
  planning for mass care shelters.

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Staffing Shelters and FEMA Local Assistance
Centers

• Two shelters opened in Santa Clarita.
• Saugus HS Approx. 140 sheltered the first night.
• Golden Valley HS Approx. 100-125 residents for
  two days 100 residents from a local independent
  living center and personal caregivers.
• 2 PHNs and 1 DMH Counselor for each shelter, 24
  hours/day.
• No syndromic patterns, only personal health
  issues such as diabetic management supplies for a
  resident and stress-related issues.
• 3 FEMA Local Assistance Centers opened and
  staffed with PHNs providing resources and
  referrals for residents for approx. one week, 12
  hours/day.

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Lessons Learned in Shelter Nursing

• Develop ongoing standby assignments for PHN
  off-duty response to public health emergencies.
• Standardize emergency staffing procedures/call-do
  wn lists.
• Prepare packaged health education and
  resource/referral lists for disaster assistance
  centers.
• Ensure that all PHNs receive training/retraining
  for mental health debriefing of disaster victims.
• Develop protocols for managing special needs
  shelters.

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Role of Environmental Health
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Fire Camps

• Problem
• How to ensure health and safety of first
  responders?
• Inspections prevent sickness and spread of
  disease.
• Action
• Food, water, and waste issues evaluated.
• Daily inspections conducted.
• No problems encountered.

Photo LA Co. DPH Environmental Health Services
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Food Facilities

• Problem
• Fire damage and no power.
• Action
• 114 food facilities assessed.
• 103 with no problems
• 2 had exterior fire damage
• 1 closed for a rodent infestation
• 1 out of business
• 7 not in operation
• Fire recovery guidance documents issued.

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Housing

• Problem
• Fire damage and accumulation of trash and debris
  in multiple family dwellings with 5 or more
  units.
• Action
• 113 housing facilities assessed.
• 95 with no problems
• 2 destroyed by fire
• 2 with no power
• 5 with an accumulation of trash and debris
• 9 unable to be inspected
• Fire recovery guidance documents issued.

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Vector Populations

• Problem
• Increased vector population and migrating rodents
  can spread diseases.
• Mosquitoes breed in standing water and unattended
  swimming pools.
• Rodents infest homes and businesses seeking food
  and shelter.
• Action
• Local mosquito and vector control districts
  notified to identify, control, and prevent
  mosquito breeding.
• Surveillance conducted.
• Complaint tracking and bait dissemination
  occurred.
• Identified 10 single family dwellings with pools.
  
• Two contained green water.

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Solid Waste

• Problem
• Large amounts of burned debris shorten the life
  and compromise the integrity of landfills.
• Sorting and recycling extends the life.
• Exclusion of hazardous materials ensures
  integrity.
• Action
• Created partnerships with CAL/EPA, Integrated
  Waste Management Board and LAC Public Works,
  HazMat, and Sanitation District.
• Created agreements that hazardous materials would
  be separated at burn sites and debris disposed at
  Calabasas landfill.
• Requests granted for landfills to extend
  operation hours and exceed daily tonnage.

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Conclusions
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Conclusions

• By early activation of emergency management
  system, department can operate as unified
  response agency.
• Reach-back capability is important for deployed
  personnel.
• Need more communications staff to serve as PIOs.
• Need a toll-free number for air quality
  information.
• Need to validate criteria for issuing health
  alerts.

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Primary Prevention Strategies

• Recommend use of more fire-resistant landscaping.
• Encourage homeowners and developers to establish
  defensible spaces around homes.
• Establish collaboration between public health and
  fire and planning agencies to help improve
  community education on wildfire prevention.

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