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Friday Sep 29, 2017

Up in Smoke: Western Fires Pose Public Health Hazard

Emily, 8, sat on the exam table looking sad. She wasn't able to attend school because of her asthma. Emily uses an albuterol inhaler to manage her asthma, but until now she had never missed school because of wheezing. Then again, this was the first time she had witnessed ash raining on our city.

The Eagle Creek fire rages Sept. 4 in Oregon. The fire was started by fireworks Sept. 2 and merged with the Indian Creek Fire four days later. By Sept. 29, it had consumed nearly 50,000 acres.

Emily's asthma flared up because the air quality in Portland, Ore., was the worst it had been in her lifetime due to wildfires raging through our state. Although hurricanes and subsequent flooding have garnered more headlines elsewhere in the United States, Oregon, Washington, California, Utah and Montana have been battling our own natural disasters with sweeping swaths of land on fire for months. More than 8 million acres burned(www.cbsnews.com) this summer. By mid-September, there were more than 60 fires burning in nine western states. In 2016, Oregon, Washington, California, Utah and Montana lost than 10 million acres to fires.

Los Angeles battled the La Tuna fire, the largest the city has ever seen at more than 7,200 acres. Montana lost a favorite historic building in its Sprague fire. Because of the Western fires and local geography, Missoula, Mont., abuts one of the worst areas for air quality in the nation, rated as 'hazardous,"(www.vox.com) where people are cautioned to stay indoors and not exercise.

The U.S. Forest Service has already spent more than $2 billion(www.opb.org) trying to contain wildfires, and there is still much work that needs to be done. Many states have requested federal assistance but received little help.

Even our neighbors to the north are not spared. In Canada, British Columbia has suffered 158 wildfires this summer alone, leading to three unfortunate records: the largest wildfire in its history, the greatest number of evacuees (more than 45,000), and the most land lost (nearly 3 million acres).

The fire near and dear to my heart, though, is here at home. Oregon's Eagle Creek fire is only a few miles away from Portland in an area of rich forest that is full of memories of hiking and adventures. That fire has spread to more than 48,000 acres and is less than half contained. It is close enough to town that some of my patients were put on notice to evacuate their homes. One firefighter lost his life after battling the flames.

The Eagle Creek fire cast a haze of smoke and rained ash over Portland on days when temperatures were forecast to exceed 100 degrees. It was hard on my patients with respiratory conditions. Kids were pulled from school; people wore masks to work or skipped it entirely; many came to the office with wheezing and chest tightness.

Weather has become more extreme across the country. In the Pacific Northwest, that means longer, hotter, dryer summers -- the perfect recipe for wildfires. A 2012 report from the U.S. Department of Agriculture(www.usda.gov) projected that wildfires will become more common because of climate change and will claim twice as many acres by the year 2050. Right on cue, the problem has gotten worse since that report was published.

Patients like Emily show me that patient care and advocacy must meet to best serve my patients and my community. I need to fight to protect them from environmental hazards like wildfires, not just treat their asthma when it flares up.

But how can a family physician prevent wildfires?

Well, I'm not saying I can do that directly. After all, I'm not Smokey Bear. But family physicians can advocate for environmental policies that protect our patients, and we can work to prevent environmental hazards.

First, educate yourself about environmental hazards like wildfires, and how to be safe should they occur. The Federal Emergency Management Agency offers great resources, like this website about wildfire safety(www.ready.gov).

Be prepared to educate your patients about natural disasters using handouts like this one from healthychildren.org on wildfires(www.healthychildren.org).

Then, learn about climate change and how it affects your community. In the Pacific Northwest, that might mean learning about policies regarding logging and public land management. You can learn about regulation of air quality, whether it is related to smog or smoke.

Talk to your legislators. Although climate change may be a controversial issue, health and patient safety should not be. Advocate for your state government to work with the private sector to prevent environmental problems that adversely affect health. Tell legislators how environmental hazards affect their constituents. Share your stories.

You can also work with your state chapter to have an even louder voice. As a group, we are more powerful and we can advocate more broadly. Your chapter can track local, state and regional issues, and keep members informed of opportunities to be involved.

Then it won't be only you who can prevent forest fires.

Melissa Hemphill, M.D., is faculty at Providence Oregon Family Medicine Residency and practices in an urban underserved clinic in Portland, Ore. You can follow her on Twitter at @MhemphillMD(twitter.com).

Posted at 04:16PM Sep 29, 2017 by Melissa Hemphill, M.D.

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