Health impacts of fire smoke inhalation

Off-gassing from firefighter suits (nomex) as an indoor source of BTEXS

The clothes and special equipment of firefighters can be a source of indoor air pollution. Nevertheless, it has not been investigated so far what the scale of the release of various compounds from such materials into the indoor air can be. The following study analysed the results of an experiment involving the passive measurement of concentrations of selected compounds, i.a. benzene, toluene, ethylbenzene, m,p-xylene, o-xylene, styrene, isopropylbenzene and n-propylbenzene (BTEXS) in the air of a room where firefighters' special clothing, which had been previously exposed to emissions from simulated fires, was stored. The study included simulations of fires involving three materials: wood, processed wood (OSB/fibreboard) and a mixture of plastics. After being exposed to the simulated fire environment, special clothing (so-called nomex) was placed in a sealed chamber, where passive collection of BTEXS was carried out using tube-type axial passive samplers and a gas chromatograph. Irrespective of which burned material special clothing was exposed to, the compound emitted into the air most intensively was toluene. Its rate of release from a single nomex ranges from 4.4 to 28.6 μg h-1, while the corresponding rates for the sum of BTEXS are between 9.97 and 44.29 μg h-1.

The Effects of Trash, Residential Biofuel, and Open Biomass Burning Emissions on Local and Transported PM2.5 and Its Attributed Mortality in Africa

Long-term exposure to ambient fine particulate matter (PM_2.5) is the second leading risk factor of premature death in Sub-Saharan Africa. We use GEOS-Chem to quantify the effects of (a) trash burning, (b) residential solid-fuel burning, and (c) open biomass burning (BB) (i.e., landscape fires) on ambient PM_2.5 and PM_2.5-attributable mortality in Africa. Using a series of sensitivity simulations, we excluded each of the three combustion sources in each of five African regions. We estimate that in 2017 emissions from these three combustion sources within Africa increased global ambient PM_2.5 by 2%, leading to 203,000 (95% confidence interval: 133,000-259,000) premature mortalities yr^-1 globally and 167,000 premature mortalities yr^-1 in Africa. BB contributes more ambient PM_2.5-related premature mortalities per year (63%) than residential solid-fuel burning (29%) and trash burning (8%). Open BB in Central Africa leads to the largest number of PM_2.5-attributed mortalities inside the region, while trash burning in North Africa and residential solid-fuel burning in West Africa contribute the most regional mortalities for each source. Overall, Africa has a unique ambient air pollution profile because natural sources, such as windblown dust and BB, contribute strongly to ambient PM_2.5 levels and PM_2.5-related mortality. Air pollution policies may need to focus on taking preventative measures to avoid exposure to ambient PM_2.5 from these less-controllable sources.

A novel fire smoke removal technology using electric agglomeration: The concept, experimental verification and mechanisms

Electric agglomeration technology is effective in removing particulate matter from the environment and has been widely used in the field of dust removal. For the first time, this technology is applied to the field of fire smoke removal at lab scale. By varying applied electric potential and initial concentration of smoke, the removal characteristics and mechanisms during the electric agglomeration process are systematically studied. The results show that when the applied electric potential is higher than 4 kV, the smoke transmittance increases from 4% to 90% in just 10 s, and the threshold for people safe escape can be reached in only 5 s. Three main mechanisms involved in the process of smoke removal using electric agglomeration are proposed. In addition to the conventional Coulomb agglomeration of charged particles, the turbulence-enhanced agglomeration induced by ionic wind and dipole chainization at the grounded plate are also observed. This study demonstrates the feasibility and potential of electric agglomeration technology to remove fire smoke.

Use of machine learning as a tool for determining fire management units in the brazilian atlantic forest

Geoprocessing techniques are generally applied in natural disaster risk management due to their ability to integrate and visualize different sets of geographic data. The objective of this study was to evaluate the capacity of classification and regression tree (CART) to assess fire risk. MCD45A1 product of the burnt area, relative to a 16-year period (2000-2015) was used to obtain a fire occurrence map, from center points of the raster, using a kernel density approach. The resulting map was then used as a response variable for CART analysis with fire influence variables used as predictors. A total of 12 predictors were determined from several databases, including environmental, physical, and socioeconomic aspects. Rules generated by the regression process allowed to of define different risk levels, expressed in 35 management units, and used to produce a fire prediction map. Results of the regression process (r = 0.94 and r² = 0.88) demonstrate the capability of the CART algorithm in highlighting hierarchical relationships among predictors, while the model's easy interpretability provides a solid basis for decision making. This methodology can be expanded in other environmental risk analysis studies and applied to any area of the globe on a regional scale.

Queer and present danger: understanding the disparate impacts of disasters on LGBTQ+ communities

LGBTQ+ communities comprise 16 million individuals in the United States, yet this population is often rendered invisible within disaster policies. Bias in federal disaster response programmes, a lack of recognition of LGBTQ+ families, and the prevalence of faith-based organisations in disaster relief services together heighten the risks that LGBTQ+ individuals face. This paper describes the ways in which this reality combines with the contextual vulnerability of LGBTQ+ communities, whereby existing inequalities and marginalisation are exacerbated during disasters and in their aftermath. As a result, the immediate trauma of a disaster, such as physical injury or the loss of loved ones or possessions, is compounded in multiple ways for LGBTQ+ individuals, making them less likely to benefit from disaster relief services. To address these inequalities, the paper concludes with a set of policy recommendations to inform prevention, mitigation, and recovery planning, as well as to reduce the impacts of disasters on LGBTQ+ individuals.

Potential impacts of Washington State's wildfire worker protection rule on construction workers

Driven by climate change, wildfires are increasing in frequency, duration, and intensity across the Western United States. Outdoor workers are being exposed to increasing wildfire-related particulate matter and smoke. Recognizing this emerging risk, Washington adopted an emergency rule and is presently engaged in creating a permanent rule to protect outdoor workers from wildfire smoke exposure. While there are growing bodies of literature on the exposure to and health effects of wildfire smoke in the general public and wildland firefighters, there is a gap in knowledge about wildfire smoke exposure among outdoor workers generally and construction workers specifically-a large category of outdoor workers in Washington totaling 200,000 people. Several data sources were linked in this study-including state-collected employment data and national ambient air quality data-to gain insight into the risk of PM2.5 exposure among construction workers and evaluate the impacts of different air quality thresholds that would have triggered a new Washington emergency wildfire smoke rule aimed at protecting workers from high PM2.5 exposure. Results indicate the number of poor air quality days has increased in August and September in recent years. Over the last decade, these months with the greatest potential for particulate matter exposure coincided with an annual peak in construction employment that was typically 9.4-42.7% larger across Washington counties (one county was 75.8%). Lastly, the 'encouraged' threshold of the Washington emergency rule (20.5 μg m-3) would have resulted in 5.5 times more days subject to the wildfire rule on average across all Washington counties compared to its 'required' threshold (55.5 μg m-3), and in 2020, the rule could have created demand for 1.35 million N-95 filtering facepiece respirators among construction workers. These results have important implications for both employers and policy makers as rules are developed. The potential policy implications of wildfire smoke exposure, exposure control strategies, and data gaps that would improve understanding of construction worker exposure to wildfire smoke are also discussed.

Comprehensive characterization of firing byproducts generated from small arms firing of lead-free frangible ammunition

Following the introduction of lead-free frangible ammunition in United States Air Force small arms firing ranges, Combat Arms instructors have routinely reported experiencing adverse health symptoms during live fire training exercises, including sore throat, cough, and headache. Previous studies have found that these symptoms occur despite occupational exposure limits not being exceeded. To better characterize the potential source and mechanisms for health symptoms, a comprehensive characterization of the physicochemical properties of gases and aerosols emitted during the firing of the M9 pistol and M4 rifle using lead-free frangible ammunition was completed. Weapons were fired within a sealed chamber using a remote firing mechanism. A suite of direct-reading instruments and collection-based analytical methods were used to determine the composition of the emissions. Emissions were dominated by carbon monoxide and ultrafine particles. Other prevalent gases included carbon dioxide, ammonia, formaldehyde, hydrogen cyanide, and nitric oxide when measured using Fourier-transform infrared spectroscopy. An electrical, low-pressure impactor showed that, on average, the count median diameter immediately after firing was 36 ± 4 nm (n = 10 rounds) and 32 ± 3 nm (n = 14 rounds) for the M9 pistol and M4 rifle, respectively. Analytical methods were used to determine that emitted particles were primarily composed of soot, copper, and potassium, with trace amounts of calcium, silicon, sodium, sulfur, and zinc. Results from this research confirm prior work and expand upon the characterization of emissions generated from firing lead-free frangible ammunition. By employing multiple methods to measure and analyze data we were able to quantify both total and respirable particle fractions and determine particle morphology and composition. Characterization of the emissions provides insight into potential exposure risks that may lead to the development of adverse health symptoms allowing for the development of strategies for risk mitigation.

The Occupational Health Effects of Responding to a Natural Gas Pipeline Explosion Among Emergency First Responders - Lincoln County, Kentucky, 2019

OBJECTIVE

The aim of the study was to assess occupational health effects 1 month after responding to a natural gas pipeline explosion.

METHODS

First responders to a pipeline explosion in Kentucky were interviewed about pre- and post-response health symptoms, post-response health care, and physical exertion and personal protective equipment (PPE) use during the response. Logistic regression was used to examine associations between several risk factors and development of post-response symptoms.

RESULTS

Among 173 first responders involved, 105 (firefighters [58%], emergency medical services [19%], law enforcement [10%], and others [12%]) were interviewed. Half (53%) reported at least 1 new or worsening symptom, including upper respiratory symptoms (39%), headache (18%), eye irritation (17%), and lower respiratory symptoms (16%). The majority (79%) of symptomatic responders did not seek post-response care. Compared with light-exertion responders, hard-exertion responders (48%) had significantly greater odds of upper respiratory symptoms (aOR: 2.99, 95% CI: 1.25-7.50). Forty-four percent of responders and 77% of non-firefighter responders reported not using any PPE.

CONCLUSIONS

Upper respiratory symptoms were common among first responders of a natural gas pipeline explosion and associated with hard-exertion activity. Emergency managers should ensure responders are trained in, equipped with, and properly use PPE during these incidents and encourage responders to seek post-response health care when needed.

Exposure to Particulate Matter and Estimation of Volatile Organic Compounds across Wildland Firefighter Job Tasks

Wildland firefighters are exposed to smoke-containing particulate matter (PM) and volatile organic compounds (VOCs) while suppressing wildfires. From 2015 to 2017, the U.S. Forest Service conducted a field study collecting breathing zone measurements of PM₄ (particulate matter with aerodynamic diameter ≤4 μm) on wildland firefighters from different crew types and while performing various fire suppression tasks on wildfires. Emission ratios of VOC (parts per billion; ppb): PM₁ (particulate matter with aerodynamic diameter ≤1 μm; mg/m³) were calculated using data from a separate field study conducted in summer 2018, the Western Wildfire Experiment for Cloud Chemistry, Aerosol Absorption, and Nitrogen (WE-CAN) Campaign. These emission ratios were used to estimate wildland firefighter exposure to acrolein, benzene, and formaldehyde. Results of this field sampling campaign reported that exposure to PM₄ and VOC varied across wildland firefighter crew type and job task. Type 1 crews had greater exposures to both PM₄ and VOCs than type 2 or type 2 initial attack crews, and wildland firefighters performing direct suppression had statistically higher exposures than those performing staging and other tasks (mean differences = 0.82 and 0.75 mg/m³; 95% confidence intervals = 0.38-1.26 and 0.41-1.08 mg/m³, respectively). Of the 81 personal exposure samples collected, 19% of measured PM₄ exposures exceeded the recommended National Wildland Fire Coordinating Group occupational exposure limit (0.7 mg/m³). Wildland fire management should continue to find strategies to reduce smoke exposures for wildland firefighters.

ATS Core Curriculum 2020. Pediatric Pulmonary Medicine

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine, in a 3- to 4-year recurring cycle of topics. These topics will be presented at the 2020 International Conference. Below is the pediatric pulmonary medicine core, including pediatric hypoxemic respiratory failure; modalities in noninvasive management of chronic respiratory failure in childhood; surgical and nonsurgical management of congenital lung malformations; an update on smoke inhalation lung injury; an update on vaporizers, e-cigarettes, and other electronic delivery systems; pulmonary complications of sarcoidosis; pulmonary complications of congenital heart disease; and updates on the management of congenital diaphragmatic hernia.

Hydrogen cyanide and carboxyhemoglobin assessment in an open space fire-related fatality

Hydrogen cyanide (HCN) can be a major contributory factor in death from fire-related inhalation injury. Although carbon monoxide (CO) is considered the lethal agent of smoke in fires, its liability as a cause of death is sometimes debatable. The purpose of this report is to present the case of an 80-year-old man with locomotor disabilities who died due to an open space fire of vegetation debris and household waste in his yard. We evaluated here the concentrations of HCN and carboxyhemoglobin (COHb) and their contribution to the mechanism of death. In addition, the risk factors and the contributing effect of the factors that compose the complex toxic environment that develops in fires were discussed. COHb was determined by spectrophotometry as recommended by Katsumata et al. in 1982. HCN was determined with ninhydrin in postmortem blood samples after removal with 20% phosphoric acid and capture in a potassium carbonate solution. A toxic concentration of 1.3 μg ml^-1 HCN and a lethal COHb level of 73.7% were determined in the blood samples. Although death was mainly attributed to CO poisoning and extremely severe burns in this open space burning case, the additive effect of HCN in the mechanism of death was also highlighted. The results suggested the possibility that the man's clothing may have played an important role in the production of HCN in this open space fire, as well as other types of garbage that were burned.

Thermo-Fluid Dynamics Analysis of Fire Smoke Dispersion and Control Strategy in Buildings

Smoke is the main threat of death in fires. For this reason, it becomes extremely important to understand the dispersion of this pollutant and to verify the influence of different control systems on its spread through buildings, in order to avoid or minimize its effects on living beings. Thus, this work aims to perform thermo-fluid dynamic study of smoke dispersion in a closed environment. All numerical analysis was performed using the Fire Dynamics Simulator (FDS) software. Different simulations were carried out to evaluate the influence of the exhaust system (natural or mechanical), the heat release rate (HRR), ventilation and the smoke curtain in the pollutant dispersion. Results of the smoke layer interface height, temperature profile, average exhaust volumetric flow rate, pressure and velocity distribution are presented and discussed. The results indicate that an increase in the natural exhaust area increases the smoke layer interface height, only for the well-ventilated compartment (open windows); an increase in the HRR accelerates the downward vertical displacement of the smoke layer and that the 3 m smoke curtain is efficient in exhausting smoke, only in the case of poorly ventilated compartments (i.e., with closed windows).

The Changing Nature of Wildfires: Impacts on the Health of the Public

Catastrophic wildfires are increasing around the globe as climate change continues to progress. Another risk factor for large wildfires in the western United States is a legacy of fire suppression that has allowed overgrowth of underbrush and small trees in forests where periodic lightning-sparked wildfires are part of the natural ecosystem. Wildfire smoke contains CO₂, CO, NOx, particulate matter, complex hydrocarbons (including polycyclic aromatic hydrocarbons), and irritant gases, including many of the same toxic and carcinogenic substances as cigarette smoke. The public need clear and consistent messaging to understand that wildland fire smoke poses a health risk.

The (in)visible victims of disaster: Understanding the vulnerability of undocumented Latino/a and indigenous immigrants

As climate change advances, communities across the United States are adapting to the increased threat of wildfires, drought, heatwaves, and infectious diseases. Such disasters are expected to become more frequent and severe. Now more than ever, it is crucial to understand how these events amplify existing inequalities, and how to lessen the resulting harms. Differences in human vulnerability to disaster stem from a range of social, economic, historical, and political factors. We argue that given their social status, undocumented Latino/a and Indigenous immigrants are particularly vulnerable to disasters and require special consideration in disaster planning. They are disproportionately affected by racial discrimination, exploitation, economic hardships, less English and Spanish proficiency, and fear of deportation in their everyday lives- their pre-disaster marginalized status. In the case of the Thomas Fire in California's Ventura and Santa Barbara counties, we show that emergency response and recovery efforts ignored their needs. Resources were directed toward privileged individuals, leaving local immigrant rights and environmental justice groups to provide essential services such as language access to emergency information in Spanish and Indigenous tongues; labor protections for farmworkers endangered in the fields; and a private disaster relief fund for undocumented immigrants ineligible for federal aid. The article concludes with preliminary participant observations from the COVID-19 pandemic response in the region, indicating how lessons from the fire have informed official actions. As governments grapple with the increasing severity of disasters, understanding the differential impacts on undocumented immigrants can help improve disaster planning to protect the most vulnerable and stigmatized populations.

Nacre-Mimetic Green Flame Retardant: Ultra-High Nanofiller Content, Thin Nanocomposite as an Effective Flame Retardant

A nacre-mimetic brick-and-mortar structure was used to develop a new flame-retardant technology. A second biomimetic approach was utilized to develop a non-flammable elastomeric benzoxazine for use as a polymer matrix that effectively adheres to the hydrophilic laponite nanofiller. A combination of laponite and benzoxazine is used to apply an ultra-high nanofiller content, thin nanocomposite coating on a polyurethane foam. The technology used is made environmentally friendly by eliminating the need to add any undesirable flame retardants, such as phosphorus additives or halogenated compounds. The very-thin coating on the polyurethane foam (PUF) is obtained through a single dip-coating. The structure of the polymer has been confirmed by proton nuclear magnetic resonance spectroscopy (1H NMR) and Fourier transform infrared spectroscopy (FTIR). The flammability of the polymer and nanocomposite was evaluated by heat release capacity using microscale combustion calorimetry (MCC). A material with heat release capacity (HRC) lower than 100 J/Kg is considered non-ignitable. The nanocomposite developed exhibits HRC of 22 J/Kg, which is well within the classification of a non-ignitable material. The cone calorimeter test was also used to investigate the flame retardancy of the nanocomposite's thin film on polyurethane foam. This test confirms that the second peak of the heat release rate (HRR) decreased 62% or completely disappeared for the coated PUF with different loadings. Compression tests show an increase in the modulus of the PUF by 88% for the 4 wt% coating concentration. Upon repeated modulus tests, the rigidity decreases, approaching the modulus of the uncoated PUF. However, the effect of this repeated mechanical loading does not significantly affect the flame retarding performance.

Organic contaminants formed during fire extinguishing using different firefighting methods assessed by nontarget analysis

During a fire event, potentially hazardous chemicals are formed from the combustion of burning materials and are released to the surrounding environment, both via gas and soot particles. The aim of this investigation was to study if firefighting techniques influence the emission of chemicals in gas phase and soot particles. Five full-scale fire tests were extinguished using four different firefighting techniques. A nontarget chemical analysis approach showed that important contaminants in gas and soot separating the different tests were brominated flame retardants (BFRs), organophosphate flame retardants (OPFR), polycyclic aromatic hydrocarbons (PAHs) and linear hydrocarbons. Reproducibility was evaluated by a field replicate test and it was determined that the temperature curve during the event had a bigger impact on the released chemicals than the firefighting technique used. However, despite fire intensity being a confounding factor, multivariate statistics concluded that water mist with additive resulted in less BFR emissions compared to foam extinguishing. The analysis also showed that the conventional spray nozzle method released more PAHs compared with the water mist method. The comprehensive chemical analysis of gas and soot released during fire events was able to show that different firefighting techniques influenced the release of chemicals.

Experimental study on eliminating fire smokes using acoustic agglomeration technology

Acoustic agglomeration is a process in which an intense sound field is applied to promote relative motion and rapid agglomeration among aerosol particles. This technology is able to improve significantly and rapidly the visibility of the smoke in a fire situation, and therefore assists the quick evacuation of evacuees. In this paper, the elimination effect of polystyrene smoke using acoustic agglomeration technology is experimentally investigated. The results show that the smoke transmittance will be increased to 0.75 from the initial value of 0.24 in only 0.5 min, in a 1.5 kHz acoustic field at a sound pressure level of 141 dB. The agglomeration rate is sensitive to acoustic frequency and there is an optimal operation frequency, which indicates that the predominant mechanism is orthokinetic interaction. Under the conditions of our experiments, the optimal frequency for eliminating soot particles is determined to be 1.5 kHz. As an energy consuming process, the agglomeration efficiency increases proportionally with the acoustic power until the corresponding nonlinear acoustic effects become significant. Moreover, it is found that the agglomeration rate of thicker smoke is much higher than thin ones at the early stage of the process, but the discrepancy tends to vanish at the later stage.

Atherosclerotic and Hypertensive Cardiovascular Disease are Associated with Death at Sublethal Carboxyhemoglobin Levels: A Postmortem Study

Residential fires are a significant cause for morbidity and mortality in the United States. Death is often the result of soot and smoke inhalation causing carbon monoxide (CO) toxicity. The approximate lethal level of carboxyhemoglobin (COHb) in healthy adults has been well described. However, a significant number of medical examiner cases involve infirmed decedents, often elderly, with complex cardiovascular disease burdens. It is well known that death in these cases will occur at sublethal levels of COHb; however, increased lethality has been largely documented via anecdotal experience and lacks quantification. Fifty-five cases were identified where death resulted from smoke and soot inhalation suffered in a residential fire. The control group, with no cardiovascular disease, had an age-adjusted mean COHb level of 61.6% at the time of death. Presence of hypertensive cardiovascular disease showed a 30% reduction in COHb (age-adjusted mean 43.2%), atherosclerotic disease showed a 33% reduction (age-adjusted mean 41.5%), and combined disease presentation accounted for 41% reduction (age-adjusted mean 36.3%). When controlling for age, atherosclerotic and hypertensive cardiovascular diseases were each associated with statistically significant decreases in COHb (p < 0.01). Increasing age was associated with decreased COHb levels at 2.8% per 10 years of life (p < 0.01), even when modeled with hypertensive and atherosclerotic disease. These findings carry important public health significance, as well as practical significance for the medical examiner when interpreting COHb levels in cases of suspected deaths due to smoke and soot inhalation.

Methods, availability, and applications of PM2.5 exposure estimates derived from ground measurements, satellite, and atmospheric models

Fine particulate matter (PM2.5) is a well-established risk factor for public health. To support both health risk assessment and epidemiological studies, data are needed on spatial and temporal patterns of PM2.5 exposures. This review article surveys publicly available exposure datasets for surface PM2.5 mass concentrations over the contiguous U.S., summarizes their applications and limitations, and provides suggestions on future research needs. The complex landscape of satellite instruments, model capabilities, monitor networks, and data synthesis methods offers opportunities for research development, but would benefit from guidance for new users. Guidance is provided to access publicly available PM2.5 datasets, to explain and compare different approaches for dataset generation, and to identify sources of uncertainties associated with various types of datasets. Three main sources used to create PM2.5 exposure data are ground-based measurements (especially regulatory monitoring), satellite retrievals (especially aerosol optical depth, AOD), and atmospheric chemistry models. We find inconsistencies among several publicly available PM2.5 estimates, highlighting uncertainties in the exposure datasets that are often overlooked in health effects analyses. Major differences among PM2.5 estimates emerge from the choice of data (ground-based, satellite, and/or model), the spatiotemporal resolutions, and the algorithms used to fuse data sources.Implications: Fine particulate matter (PM2.5) has large impacts on human morbidity and mortality. Even though the methods for generating the PM2.5 exposure estimates have been significantly improved in recent years, there is a lack of review articles that document PM2.5 exposure datasets that are publicly available and easily accessible by the health and air quality communities. In this article, we discuss the main methods that generate PM2.5 data, compare several publicly available datasets, and show the applications of various data fusion approaches. Guidance to access and critique these datasets are provided for stakeholders in public health sectors.

Elevated Neuroglobin Lessens Neuroinflammation and Alleviates Neurobehavioral Deficits Induced by Acute Inhalation of Combustion Smoke in the Mouse

Acute inhalation of combustion smoke produces long-term neurologic deficits in survivors. To study the mechanisms that contribute to the development of neurologic deficits and identify targets for prevention, we developed a mouse model of acute inhalation of combustion smoke, which supports longitudinal investigation of mechanisms that underlie the smoke induced inimical sequelae in the brain. Using a transgenic mouse engineered to overexpress neuroglobin, a neuroprotective oxygen-binding globin protein, we previously demonstrated that elevated neuroglobin preserves mitochondrial respiration and attenuates formation of oxidative DNA damage in the mouse brain after smoke exposure. In the current study, we show that elevated neuronal neuroglobin attenuates the persistent inflammatory changes induced by smoke exposure in the mouse brain and mitigates concordant smoke-induced long-term neurobehavioral deficits. Specifically, we found that increases in hippocampal density of GFAP and Iba-1 positive cells that are detected post-smoke in wild-type mice are absent in the neuroglobin overexpressing transgenic (Ngb-tg) mice. Similarly, the smoke induced hippocampal myelin depletion is not observed in the Ngb-tg mice. Importantly, elevated neuroglobin alleviates behavioral and memory deficits that develop after acute smoke inhalation in the wild-type mice. Taken together, our findings suggest that the protective effects exerted by neuroglobin in the brains of smoke exposed mice afford protection from long-term neurologic sequelae of acute inhalation of combustion smoke. Our transgenic mouse provides a tool for assessing the potential of elevated neuroglobin as possible strategy for management of smoke inhalation injury.

Targeted GC-MS analysis of firefighters' exhaled breath: Exploring biomarker response at the individual level

Biomarker measurements can provide unambiguous evidence of environmental exposures as well as the resultant biological responses. Firefighters have a high rate of occupational cancer incidence, which has been proposed to be linked in part to their increased environmental exposure to byproducts of combustion and contaminants produced during fire responses. In this article, the uptake and elimination of targeted volatile organic compounds were investigated by collecting the exhaled breath of firefighters on sorbent tubes before and after controlled structure burns and analyzing samples using automated thermal desorption-gas chromatography (ATD-GC/MS). Volatile organic compounds exposure was assessed by grouping the data according to firefighting job positions as well as visualizing the data at the level of the individual firefighter to determine which individuals had expected exposure responses. When data were assessed at the group level, benzene concentrations were found to be elevated post-exposure in both fire attack, victim search, and outside ventilation firefighting positions. However, the results of the data analysis at the individual level indicate that certain firefighters may be more susceptible to post-exposure volatile organic compounds increases than others, and this should be considered when assessing the effectiveness of firefighting protective gear. Although this work focuses on firefighting activity, the results can be translated to potential human health and ecological effects from building and forest fires.

Pilot study on the efficiency of water-only decontamination for firefighters' turnout gear

Firefighters are exposed to toxic environments upon entering burning structures. Many structures contain synthetic materials which release toxic chemicals when on fire. These chemicals can enter the body through multiple routes of exposure, including inhalation and skin absorption. Thus, according to the fire departments included in this study, firefighters now conduct on-site decontamination procedures to remove hazardous chemicals, including polycyclic aromatic hydrocarbons (PAHs) from the surface of firefighter turnout gear. Several methods are being practiced at the local level, including decontamination with soap and water, and decontamination with water alone. The water-only decontamination method requires less time and supplies yet has not been investigated as a suitable method for removing polycyclic aromatic hydrocarbons from turnout gear. Therefore, we evaluated the efficiency of this method by measuring PAH concentration levels before and after water-only decontamination. The calculated efficiency displays the percentage of PAHs removed (or not removed) at post-decontamination in relation to the initial sample collected at pre-decontamination. The turnout gear was sampled after live residential structure fires. Firefighter turnout gear was worn throughout Attack, Overhaul Search and Rescue, and Rescue from Fire operations. All firefighters came to a central location for sampling after completing their job responsibilities. Water only decontamination did not appear to be effective, resulting in an overall 42% increase in PAH contamination. The unexpected increase may have been due to disparate pre- and post-decontamination sampling sites on turnout gear.

Priority focus areas for a sub-national response to climate change and health: A South African provincial case study

INTRODUCTION

The intersection of health and climate change is often absent or under-represented in sub-national government strategies. This analysis of the literature, using a new methodological framework, highlights priority focus areas for a sub-national government response to health and climate change, using the Western Cape (WC) province of South Africa as a case study.

METHODS

A methodological framework was created to conduct a review of priority focus areas relevant for sub-national governments. The framework encompassed the establishment of a Project Steering Group consisting of relevant, sub-national stakeholders (e.g. provincial officials, public and environmental health specialists and academics); an analysis of local climatic projections as well as an analysis of global, national and sub-national health risk factors and impacts.

RESULTS

Globally, the discussion of health and climate change adaptation strategies in sub-national, or provincial government is often limited. For the case study presented, multiple health risk factors were identified. WC climatic projections include a warmer and potentially drier future with an increased frequency and intensity of extreme weather events. WC government priority focus areas requiring further research on health risk factors include: population migration and environmental refugees, land use change, violence and human conflict and vulnerable groups. WC government priority focus areas for further research on health impacts include: mental ill-health, non-communicable diseases, injuries, poisonings (e.g. pesticides), food and nutrition insecurity-related diseases, water- and food-borne diseases and reproductive health. These areas are currently under-addressed, or not addressed at all, in the current provincial climate change strategy.

CONCLUSIONS

Sub-national government adaptation strategies often display limited discussion on the health and climate change intersect. The methodological framework presented in this case study can be globally utilized by other sub-national governments for decision-making and development of climate change and health adaptation strategies. Additionally, due to the broad range of sectoral issues identified, a primary recommendation from this study is that sub-national governments internationally should consider a "health and climate change in all policies" approach when developing adaptation and mitigation strategies to address climate change.

Where there's smoke, there's fire: focal points for risk communication

Large fires involving hazardous materials are often characterized by failing crisis communication. In this study, we compared opinions of experts regarding the risks of major fires to lay beliefs using a mental models approach. Amongst lay people this revealed relevant knowledge gaps and beliefs in opposition to those held by experts. While, experts considered the chance of getting cancer from inhaling smoke from a chemical fire extremely small, most lay people thought that even at a great distance, the chance of getting cancer to be large. To improve crisis communication about risk in a case of large chemical fires, and reduce the potential for messages to be misunderstood, distrusted or dismissed, we recommend a clarification of cancer risk in communications about public health emergencies such as chemical fires, for which lay people equate even small exposures to carcinogenic chemicals make one more likely to get cancer later in life.

Natural Disasters and Injuries: What Does a Surgeon Need to Know?

PURPOSE OF REVIEW

Natural disasters have injured more than 2 million people in the last 10 years and led to significant international medical relief deployment. Knowledge of expected injury patterns following these disasters is an important part of planning for type and size of outside surgical assistance. This review aims to summarize what is known about injury patterns following natural sudden-onset disasters (SODs).

RECENT FINDINGS

Several systematic reviews have concluded that data on injury patterns and surgical needs following natural SODs is scarce. Studies on earthquakes indicate that earthquakes generate large numbers of injured, out of which limb injuries are most common. Tsunamis, floods, storms, and wildfires do not generate a significant burden of injuries in relation to numbers affected.

SUMMARY

Earthquake may require surgical assistance, especially for limb injuries; therefore, mainly orthopedic and plastic surgeries are priority specialist areas. Major injuries seem to be few in other natural disasters. However, more detailed data is needed on specific injury patterns to determine if additional surgical assistance is needed and to what extent it is needed to cater for normal surgical conditions if existing health care has seized to function.

Wood smoke exposure of Portuguese wildland firefighters: DNA and oxidative damage evaluation

Portugal is among the European Union countries most devastated by forest fires each year. In the last three decades, more than 3.8 million hectares of forest were burned. Wildland firefighters are exposed to a variety of hazards, including many toxic combustion products that may lead to deleterious health effects. Epidemiological studies showed a positive association between firefighting and several chronic diseases, including cancer. Results from biomonitoring studies in firefighters, particularly concerning genotoxicity evaluation, constitute a valuable tool for investigating important occupational hazards. Thus, the aim of this study was to assess genotoxicity in a group of wildland firefighters using the comet assay for DNA damage and oxidative stress. Both parameters were increased in firefighters compared to controls, but significance was only found for basal DNA damage. No significant influence was found regarding major confounding variables on the genotoxic endpoints studied, with the exception of age. Data obtained provide preliminary information on human health effects of wildland firefighting exposure at genetic and molecular levels. These findings may also provide new important data to serve as public awareness to the potential adverse health risks involving wildland firefighting. Implementation of security and hygiene measures in this sector as well as good practices campaigns may be crucial to decrease risk.

Medical and biological factors affecting mortality in elderly residential fire victims: a narrative review of the literature

For older people (aged over 65 years), the risk of dying in a residential fire is doubled compared to the general population. Obvious causes of death mainly include smoke inhalation and burn injuries. That older people are more fragile and have more concurrent diseases is inherent, but what is it that makes them more vulnerable? It is known that the number of elderly people is increasing globally and that the increased risk of death in fires can be explained, at least in part, by physical and/or cognitive disabilities as well as socioeconomic and behavioural factors. The possibility that medical illnesses and an aging organism/tissues might explain this increased risk has not been shown to the same extent. Therefore, this narrative literature review focuses on medical and biological explanations. An initial search using the terms ‘elderly’, ‘fatal’, ‘residential’ and ‘fire’ yielded some interesting articles. Using a broader snowball search also accepting grey literature, several additional risk factors could be identified. Cardiovascular diseases, in particular atherosclerotic heart disease, greatly increases the vulnerability to, for example, carbon monoxide and probably also other asphyxiating gases. Cardiovascular diseases and lack of physical fitness may also increase vulnerability to heat. Burned elderly patients are also at a higher risk of death than younger patients, but it is controversial whether it is age itself or the pre-existing illnesses that come with age that increase the risk. Immunosenescence, malnutrition and female gender are other risk factors for poorer outcome after burns, all of which are common among older people.

Elderly people have an increased risk of dying in house fires for several known reasons. This review explores possible medical/biological explanations and finds heart disease to be an important explanation.

Large-scale, thick, self-assembled, nacre-mimetic brick-walls as fire barrier coatings on textiles

Highly loaded polymer/clay nanocomposites with layered structures are emerging as robust fire retardant surface coatings. However, time-intensive sequential deposition processes, e.g. layer-by-layer strategies, hinders obtaining large coating thicknesses and complicates an implementation into existing technologies. Here, we demonstrate a single-step, water-borne approach to prepare thick, self-assembling, hybrid fire barrier coatings of sodium carboxymethyl cellulose (CMC)/montmorillonite (MTM) with well-defined, bioinspired brick-wall nanostructure, and showcase their application on textile. The coating thickness on the textile is tailored using different concentrations of CMC/MTM (1-5 wt%) in the coating bath. While lower concentrations impart conformal coatings of fibers, thicker continuous coatings are obtained on the textile surface from highest concentration. Comprehensive fire barrier and fire retardancy tests elucidate the increasing fire barrier and retardancy properties with increasing coating thickness. The materials are free of halogen and heavy metal atoms, and are sourced from sustainable and partly even renewable building blocks. We further introduce an amphiphobic surface modification on the coating to impart oil and water repellency, as well as self-cleaning features. Hence, our study presents a generic, environmentally friendly, scalable, and one-pot coating approach that can be introduced into existing technologies to prepare bioinspired, thick, fire barrier nanocomposite coatings on diverse surfaces.

Chronic occupational exposures can influence the rate of PTSD and depressive disorders in first responders and military personnel

BACKGROUND

First responders and military personnel experience rates of post-traumatic stress disorder (PTSD) far in excess of the general population. Although exposure to acute traumatic events plays a role in the genesis of these disorders, in this review, we present an argument that the occupational and environmental conditions where these workers operate are also likely contributors.

PRESENTATION OF THE HYPOTHESIS

First responders and military personnel face occupational exposures that have been associated with altered immune and inflammatory activity. In turn, these physiological responses are linked to altered moods and feelings of well-being which may provide priming conditions that compromise individual resilience, and increase the risk of PTSD and depression when subsequently exposed to acute traumatic events. These exposures include heat, smoke, and sleep restriction, and physical injury often alongside heavy physical exertion. Provided the stimulus is sufficient, these exposures have been linked to inflammatory activity and modification of the hypothalamic-pituitary axis (HPA), offering a mechanism for the high rates of PTSD and depressive disorders in these occupations.

TESTING THE HYPOTHESIS

To test this hypothesis in the future, a case-control approach is suggested that compares individuals with PTSD or depressive disorders with healthy colleagues in a retrospective framework. This approach should characterise the relationships between altered immune and inflammatory activity and health outcomes. Wearable technology, surveys, and formal experimentation in the field will add useful data to these investigations.

IMPLICATIONS OF THE HYPOTHESIS

Inflammatory changes, linked with occupational exposures in first responders and military personnel, would highlight the need for a risk management approach to work places. Risk management strategies could focus on reducing exposure, ensuring recovery, and increasing resilience to these risk contributors to minimise the rates of PTSD and depressive disorders in vulnerable occupations.

A dynamic smoke generation and nose-only inhalation exposure system for rats: preliminary results from studies of selected transportation materials

CONTEXT

Smoke inhalation injury is the main cause of fatalities for fire victims. Understanding in the pathophysiology of the injury has not been fully explored in recent years. To further explore the pathophysiological mechanism, a dynamic and controllable animal model is necessary.

OBJECTIVE

To develop a rat model of smoke inhalation injury to simulate human victims in air-restricted vehicle cabin fires.

MATERIALS AND METHODS

Smoke concentration, including CO, O2, VOCs and smoke temperature under different combustion conditions, were detected. Levels of COHb, respiratory function, lung wet-to-dry weight ratio and protein concentration in BALF and blood were measured. Pathological evaluations of lung in tissues were conducted at 1, 6, 24 and 48 h post-exposure.

RESULTS

Smoke concentration rose with the increase of combustion temperature and decrease of oxygen flow. Further, 215 kinds of VOCs in the smoke were detected, and the concentrations of benzene, methylbenzene, ethylbenzene, dimethylbenzene, phenylethylene and trimethylbenzene was 32.93, 402.06, 764.03, 113.73, 1006.61 and 89.28 mg/m(3), respectively. Significant hypoxemia and CO poisoning occurred in rats. The FCOHb after exposure for 14 min immediately rose to (44.2 ± 12.3) % and then gradually decrease to a normal level at 300 min post-exposure. At 24 h post-exposure, Penh increased significantly (p < 0.05), and high pulmonary vascular permeability and significant lung edema (p < 0.05) were observed in the smoke inhalation group.

DISCUSSION AND CONCLUSION

In summary, the novel rat model of smoke inhalation injury system used in the study is dynamic and controllable, and appropriate for use in smoke inhalation injury studies of air-restricted cabins in vehicles.

Risk of cancer among firefighters in California, 1988-2007

BACKGROUND

Most studies of firefighter cancer risks were conducted prior to 1990 and do not reflect risk from advances in building materials.

METHODS

A case-control study using California Cancer Registry data (1988-2007) was conducted to evaluate the risk of cancer among firefighters, stratified by race.

RESULTS

This study identified 3,996 male firefighters with cancer. Firefighters were found to have a significantly elevated risk for melanoma (odds ratio [OR] = 1.8; 95% confidence interval [CI] 1.4-2.1), multiple myeloma (OR 1.4; 95%CI 1.0-1.8), acute myeloid leukemia (OR 1.4; 95%CI 1.0-2.0), and cancers of the esophagus (OR 1.6; 95%CI 1.2-2.1), prostate (OR 1.5; 95%CI 1.3-1.7), brain (OR 1.5; 95%CI 1.2-2.0), and kidney (OR 1.3; 95%CI 1.0-1.6).

CONCLUSIONS

In addition to observing cancer findings consistent with previous research, this study generated novel findings for firefighters with race/ethnicity other than white. It provides additional evidence to support the association between firefighting and several specific cancers.

Neuroglobin mitigates mitochondrial impairments induced by acute inhalation of combustion smoke in the mouse brain

CONTEXT

Acute inhalation of combustion smoke adversely affects brain homeostasis and energy metabolism. We previously showed that overexpressed neuroglobin (Ngb), neuron specific globin protein, attenuates the formation of smoke inhalation-induced oxidative DNA damage, in vivo, in the mouse brain, while others reported protection by Ngb in diverse models of brain injury, mainly involving oxidative stress and hypoxic/ischemic insults.

OBJECTIVE

To determine to what extent elevated Ngb ameliorates post smoke-inhalation brain bioenergetics and homeostasis in Ngb overexpressing transgenic mouse.

METHODS

Smoke inhalation induced changes in bioenergetics were measured in the wild type and Ngb transgene mouse brain. Modulations of mitochondrial respiration were analyzed using the Seahorse XF24 flux analyzer and changes in cytoplasmic energy metabolism were assessed by measuring enzymatic activities and lactate in the course of post smoke recovery.

RESULTS

Cortical mitochondria from Ngb transgene, better maintained ATP synthesis-linked oxygen consumption and unlike wild type mitochondria did not increase futile oxygen consumption feeding the proton leak, reflecting lesser smoke-induced mitochondrial compromise. Measurements revealed lesser reduction of mitochondrial ATP content and lesser compensatory increases in cytosolic energy metabolism, involving pyruvate kinase and lactate dehydrogenase activities as well as cytosolic lactate levels. Additionally, induction of c-Fos, the early response gene and key neuronal stress sensor, was attenuated in Ngb transgene compared to wild type brain after smoke.

CONCLUSION

Considered together, these differences reflect lesser perturbations produced by acute inhalation of combustion smoke in the Ngb overexpressing mouse, suggesting that Ngb mitigates mitochondrial dysfunction and neurotoxicity and raises the threshold of smoke inhalation-induced brain injury.

The Impact of Disasters on Populations With Health and Health Care Disparities

Context:A disaster is indiscriminate in whom it affects. Limited research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden.

Objective:To review the literature on the combined effects of a disaster and living in an area with existing health or health care disparities on a community's health, access to health resources, and quality of life.

Methods:We performed a systematic literature review using the following search terms: disaster, health disparities, health care disparities, medically underserved, and rural. Our inclusion criteria were peer-reviewed, US studies that discussed the delayed or persistent health effects of disasters in medically underserved areas.

Results:There has been extensive research published on disasters, health disparities, health care disparities, and medically underserved populations individually, but not collectively.

Conclusions:The current literature does not capture the strain of health and health care disparities before and after a disaster in medically underserved communities. Future disaster studies and policies should account for differences in health profiles and access to care before and after a disaster.

(Disaster Med Public Health Preparedness. 2010;4:30-38)

Prior exposure to acrolein accelerates pulmonary inflammation in influenza A-infected mice

The combustion product acrolein contributes to several smoke-related health disorders, but whether this immunomodulatory toxicant alters pulmonary susceptibility to viruses has received little attention. To study the effects of prior acrolein dosing on the severity of influenza A viral infection, male BALB/c mice received acrolein (1mg/kg) or saline (control) via oropharyngeal aspiration either 4- or 7-days prior to intranasal inoculation with either influenza A/PR/8/34 virus or vehicle. At 0, 2, 4 and 7 days post-inoculation, lung samples were assessed for histological changes while pulmonary inflammation was monitored by estimating immune cell numbers and cytokine levels in bronchoalveolar lavage fluid (BALF). After viral challenge, animals that were exposed to acrolein 4 days previously experienced greater weight loss and exhibited an accelerated inflammatory response at 2 days after viral inoculation. Thus compared to saline-pretreated, virus-challenged controls, BALF recovered from these mice contained higher numbers of macrophages and neutrophils in addition to increased levels of several inflammatory cytokines, including IL-1α, IL-1β, IL-6, TNF, IFN-γ, KC, and MCP-1. The acrolein-induced increase in viral susceptibility was suppressed by the carbonyl scavenger bisulphite. These findings suggest acute acrolein intoxication "primes" the lung to mount an accelerated immune response to inhaled viruses.

Transgenic overexpression of neuroglobin attenuates formation of smoke-inhalation-induced oxidative DNA damage, in vivo, in the mouse brain

Acute inhalation of combustion smoke causes neurological deficits in survivors. Inhaled smoke includes carbon monoxide, noxious gases, and a hypoxic environment, which disrupt oxygenation and generate free radicals. To replicate a smoke-inhalation scenario, we developed an experimental model of acute exposure to smoke for the awake mouse/rat and detected induction of biomarkers of oxidative stress. These include inhibition of mitochondrial respiratory complexes and formation of oxidative DNA damage in the brain. DNA damage is likely to contribute to neuronal dysfunction and progression of brain injury. In the search for strategies to attenuate the smoke-initiated brain injury, we produced a transgenic mouse overexpressing the neuronal globin protein neuroglobin. Neuroglobin was neuroprotective in diverse models of ischemic/hypoxic/toxic brain injuries. Here, we report lesser inhibition of respiratory complex I and reduced formation of smoke-induced DNA damage in neuroglobin transgenic compared to wild-type mouse brain. DNA damage was assessed using the standard comet assay, as well as a modified comet assay done in conjunction with an enzyme that excises oxidized guanines that form readily under conditions of oxidative stress. Both comet assays revealed that overexpressed neuroglobin attenuates the formation of oxidative DNA damage, in vivo, in the brain. These findings suggest that elevated neuroglobin exerts neuroprotection, in part, by decreasing the impact of acute smoke inhalation on the integrity of neuronal DNA.

Surveying the Ashes: Experience from the 2007 Peloponnese Wildfires Six Months after the Disaster

Introduction: Major disasters disrupt the infrastructure of communities and have lasting psychological, economic, and environmental effects on the affected areas. The psychological status and community effects of the devastating 2007 wildfires on the Peloponnese Peninsula of Greece were assessed six months following the disaster.

Methods:Adult inhabitants, 18–65 years of age, living in villages affected by the wildfires were selected randomly and compared with a demographically similar group living in neighboring villages that were unaffected by the fires. Regions were chosen based on the extent of fire damage in that area. There were 409 participants in the fire group, and 391 in the control group. Participants completed a questionnaire that included the SCL-90-R symptom checklist, a subjective perception of health status, and a series of items assessing views about current problems, personal values, and trust in different institutions.

Results:The fire group scored significantly higher on psychological distress compared to the control group. Both groups viewed their health status in the previous year as better than at the present time. There were few significant differences between groups in the designation of regional problems, attitudes, and values. In the total sample, 41.6% listed unemployment, and 15.0% listed poverty as the most important problem in their region. The Church was indicated as the most trusted institution by 36.7% of the group and the Government by 13.3%. A total of 30.2% did not have a trusted institution.

Conclusions:The hardiness and resilience of the fire-impacted group was evident. However, an improvement in economic conditions is needed to maintain the health and enhance the quality of life of the population living in the Peloponnese region. This improvement likely would have a positive effect on the attitude of trust in government institutions.

Differential inhibition of mitochondrial respiratory complexes by inhalation of combustion smoke and carbon monoxide, in vivo, in the rat brain

Combustion smoke contains gases and particulates, which act via hypoxia and cytotoxicity producing mechanisms to injure cells and tissues. While carbon monoxide (CO) is the major toxicant in smoke, its toxicity is exacerbated in the presence of other compounds. Here, we examined modulations of mitochondrial and cytosolic energy metabolism by inhalation of combustion smoke versus CO, in vivo, in the rat brain. Measurements revealed reduced activities of respiratory chain (RC) complexes, with greater inhibition by smoke than equivalent CO in ambient air. In the case of RC complex IV, inhibition by CO and smoke was similar--suggesting that complex IV inhibition is primarily by the action of CO. In contrast, inhibition of complexes I and III was greater by smoke. Increases in cytosolic lactate dehydrogenase and pyruvate kinase activities accompanied inhibition of RC complexes, likely reflecting compensatory increases in cytosolic energy production. Together, the data provide new insights into the mechanisms of smoke inhalation-induced perturbations of brain energetics, which impact neuronal function and contribute to the development of neuropathologies in survivors of exposures to CO and combustion smoke.