Smoke inhalation, Forest Fires and Swine Flu respiratory risks

James Tad Geiger MD

Lungs are a big part of my job.  As an anesthesiologist I use an anesthesia machine to breathe for patients undergoing surgery, administering anesthetic  gases  into the patients lungs.  Smoke from fire contains toxic gases plus particulate matter that injures the entire respiratory system. When I saw the pictures of monstrous clouds of billowing smoke over Los Angeles it made me wonder what are the consequences of breathing that air. What are the risks of smoke inhalation to people with heart diseases or respiratory diseases,  like asthma?  Does it predispose to influenza complications? Perhaps you are even asking yourself if you should see a doctor after breathing what that smoke contains.

LA Times Pulitzer Reporter Julie Cart, has  described the emotional and physical costs of wild fire management. The Australian property protection “stay or go” policy during wildfires rests on the homeowner to decide if they will defend their home or not. In Southern California, the evacuations have been mandatory for tens of thousands of people.

Climates have changed and so have the global health risks due to effects of massive firestorms burning the earth’s biomass. Newscasters are broadcasting prescription weather conditions to inform humanity of  new health worries impacted by events of global warming. Medical science has learned from the injuries fire damage  has caused to  firefighter and civilians from the firestorms of Southeast Asia, Darwin Australia, Athens Greece and now Southern California again. Fire fatalities are more commonly the result of  inhalation of the toxic gases produced during combustion of vegetation producing mucosal irritants such as acrolein and formaldehyde, rather than actual burns. The following  studies of patients  describes how inhalation of airborne pollutants has caused ongoing health problems.

• Short-term exposure to Fine Particulate Matter less than 2.5microns  increases the risk for hospital admission for cardiovascular and respiratory diseases in Medicare patients.
• Emergency Room Visits: Ambient levels of elemental carbon (EC) and organic carbon matter (OCM), which are generated primarily from vehicle emissions, diesel, and wood burning, were associated with the largest risks of emergency hospitalization for Medicare patients across the major chemical constituents of fine airborne particulate matter less than 2.5 microns.
• Smoke Inhalation and Hospital Admissions: Airborne coarse particulate matter of less than 10 microns derived from vegetation fires of ambient biomass producing smoke pollution were predominantly associated with more respiratory than cardiovascular admissions.  The indigenous peoples of Australia in this study appear to be at higher risk of respiratory as well as cardiac hospital admissions associated with exposure to particulate matter less than 10 microns.

There is increased lung injury caused by air polluted with small and large airborne particulate matter resulting in acute and chronic respiratory aliments that require ER visits and hospital admissions. These events coinciding with flu season may contribute to future increased morbidity and possibly mortality of these patients when exposed to  influenza and swine flu. Descriptions of  when to seek medical help after exposure to inhalation of smoke are found in extensive detail on WEBMD and emedicine.

Firefighters are special people. Fire fighters have  increased short term and long term health concerns including respiratory and  risk of urogenital cancer. There are few jobs in which people willingly go  into risky situations like firestorms, risking everything,  to save people and their property. Special thanks for a job well-done.

This post is a dedicated tribute to Capt. Tedmund Hall and Specialist Arnaldo Quinones and the brave public servants both men and women  of  fire, EMS and police, taking enormous risks even loss of life to protect and serve.

James Tad Geiger MD

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