By Dr. Karen Relucio, Chief Public Health Officer, County of Napa
This story was published in Ready or Not? 2017.
Responding to two wildfire events has taught me that public health has a significant role in wildfire emergency response. The role of public health includes shelter assessment, coordinating medical and mental health support in the shelter, ensuring environmental health and safety, and public health messaging.
During our first response in September 2015, there was a 75,000 acre fire that destroyed 1,300 structures, resulting in the evacuation of more than 1,000 people, which required us to open and support an evacuation center. The fire was predominantly in Lake County, which is adjacent to Napa County.
When something like this occurs, local public health works with our emergency management agency, fire and law, other County agencies and community partners to respond. Immediately, Napa County opened a shelter at the fairgrounds in Calistoga and stood up the emergency operations center.
Napa County Public Health took on the responsibility of assessing the health needs of most of the evacuees by using a modified community assessment for public health emergency response (CASPER). While Red Cross was on site, they only handled doing health assessments of the people that chose to stay inside the shelter. Surprisingly, we had many people show up in cars or RVs or with their own tents and with pets. Because animals were not allowed inside the building, they stayed outside on the fairgrounds property. It became our job to conduct health needs assessments of the majority of the 1,000 evacuees.
Additionally, our other role was providing medical support within the evacuation center. We worked with our local Federally Qualified Health Center, healthcare providers from our local medical centers and Medical Reserve Corps from Napa and neighboring counties to see patients. Most of the medical visits involved refilling medications and treating people who had respiratory issues from smoke inhalation or exacerbation of underlying health issues (diabetes, allergies and asthma). Thankfully, there were only a few people with slight injuries from the evacuation itself. We also provided flu and Tdap vaccinations.
It was also apparent that mental health needed to be addressed for the evacuees in a comprehensive way. We leaned on other local jurisdictions and nonprofits and were able to enlist a number of mental health professionals to come onsite. We quickly found that it was best to do more ad hoc checks and have the mental health professionals serve as support staff. They found it was easier to talk to folks—and avoid the stigma that might come with needing mental health services.
Another important aspect of our response was environmental health. These professionals ensured the shelter was safe and clean and that food was prepared and served safely. They went into the shelter and found donated food served potluck style, not at the appropriate temperature. In addition, there weren’t enough hand washing stations or bathroom facilities and the pets of evacuees were relieving themselves in areas where people were walking. We felt this was a prime setup for a gastrointestinal virus outbreak, which would make the situation worse. Our folks figured out how to maintain the integrity of food, installed more portable toilets and hand sanitizing stations, and provided bags for pet waste.
Throughout the response, public health information included a smoke advisory, heat advisory, and repopulation safety for evacuees once they went back to their homes. We also had to ensure people knew they shouldn’t sort through the debris without personal protective equipment.
This was great preparation for our recent fire in October 2017—which started at the same time our region was experiencing hurricane level winds of 50 to 90 miles per hour, resulting in rapid spread of the fire to our county and Sonoma County. The first 72 hours was focused on evacuations and safety.
We opened three different evacuation centers on that first evening and immediately began the plans for the type of medical coordination that we did in 2015. We also coordinated ambulance strike teams all over the region to help evacuate residential care and skilled nursing facilities.
In many ways our response was similar to 2015, except the scope of this emergency was much bigger and the recovery is much more complex. We had to declare a local emergency and a local health emergency to receive assistance for toxic ash and debris cleanup which is still in progress. Residential wildfire debris can include toxic materials such as asbestos, heavy metals, dioxins and polycyclic aromatic hydrocarbons that can be harmful to human health, and cleanup needs to be done carefully by experts. At this point, debris cleanup is still underway.
Additionally, we opened a local assistance center to help those who have lost properties, homes, and jobs. And, there are many crews working on erosion control in burn areas around water reservoirs, as we are now having heavy rains and anticipate debris flow and possible water contamination.
While we have begun to create an almost turnkey response plan to wild fires, we could always be better prepared, especially for the recovery phase. And, we really need to know a lot more about the long-term health impact of wildfires. For instance, will we see cancer rates go up? Will health inequities be worsened due to loss of homes and income? If so, is that something public health can work to prevent during the response or in the aftermath?
We also need more information and research on the impact of toxic debris and additional long-term health consequences as a result of repopulating an area that has suffered wildfire damage. The only studies that come close to looking at long-term health impacts of fire debris are the 2001 World Trade Center attacks. We can speculate on health impacts based on knowing what is contained in ash but, to my knowledge, there hasn’t been a long-term health impact study about residential wildfires. It is hard to make decisions and align future resources when we are uncertain about the long-term effects.