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Baseline measurements of smoke exposure among wildland firefighters

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Wild Fires

3: J Occup Environ Hyg. 2004 Sep;1(9):593-606.

Baseline measurements of smoke exposure among wildland firefighters.

Reinhardt TE, Ottmar RD.

Extensive measurements of smoke exposure among wildland firefighters are summarized, showing that firefighters can be exposed to significant levels of carbon monoxide and respiratory irritants, including formaldehyde, acrolein, and respirable particulate matter. Benzene was also measured and found to be well below permissible exposure limits, with the highest concentrations occurring among firefighters working with engines and torches burning petroleum-based fuel. Exposures to all pollutants were higher among firefighters at prescribed burns than at wildfires, while shift-average smoke exposures were lowest among firefighters who performed initial attack of wildfires in the early stages of the fires. Smoke exposure reaches its highest levels among firefighters maintaining fire within designated firelines and performing direct attack of spot fires that cross firelines. These events and the associated smoke exposures were positively correlated with increasing ambient wind speeds, which hamper fire management and carry the convective plume of the fire into firefighters' breathing zone. The pollutants measured in smoke were reasonably well-correlated with each other, enabling estimation of exposure to multiple pollutants in smoke from measurements of a single pollutant such as carbon monoxide.

5: Am Ind Hyg Assoc J. 1992 Jan;53(1):69-76.

Occupational exposures in California wildland fire fighting.

Materna BL, Jones JR, Sutton PM, Rothman N, Harrison RJ.

Industrial hygiene measurement of exposures to wildland fire fighters was conducted in northern California during three consecutive fire seasons (1986-1989) in conjunction with three separate health effects studies. Chemicals that were monitored included carbon monoxide, total and respirable particulates, polyaromatic hydrocarbons (PAHs), crystalline silica, aldehydes, and benzene.

Measurements were taken at both wildland fires and prescribed (planned) burns. A variety of collection methods were employed--colorimetric detector tubes and a COmonitor were used for direct-reading area measurements; colorimetric diffusion

tubes, filter cassettes, sorbent tubes, and passive vapor monitors were used for determining personal time-weighted average exposures. A new screening method (National Institute for Occupational Safety and Health Method 2539) was used to identify the presence of specific aldehydes. Results show that wildland firefighters may at times be exposed to concentrations of carbon monoxide, total or

respirable particulates, or silica at levels near or higher than recommended occupational exposure limits, although group means were generally well below the limits. Time-weighted average formaldehyde levels, measured in a few instances above 0.37 mg/m3 (0.3 ppm), indicate a potential for formaldehyde-induced eye or respiratory irritation under these conditions. Certain characteristics of the

work such as high altitude, temperature, and breathing rate; extended work shifts; and additional off-shift exposures suggest that adjustment of 8-hr exposure limits may be necessary to provide adequate protection. In part, because of the rigors of performing industrial hygiene measurements under fire fighting conditions, data are limited and could not be considered representative of the

full range of exposures fire fighters may encounter
8: Am Ind Hyg Assoc J. 1990 Apr;51(4):234-40.

Fire fighters' exposure to carbon monoxide during Australian bushfires.

Brotherhood JR, Budd GM, Jeffery SE, Hendrie AL, Beasley FA, Costin BP, Wu ZE.

Fatal entrapments of Australian bushfire fighters have led to suggestions that carbon monoxide (CO) poisoning could have contributed to these accidents by impairing the fire fighters' judgement. Carboxyhemoglobin saturation (COHb%) levels were assessed from alveolar CO levels in 24 fire fighters working with handtools and in 12 accompanying scientific observers, before and after fire fighting (duration 37-187 min) on 15 experimental bushfires. Carboxyhemoglobin levels increased on average by 0.7% per hour in the fire fighters and by 0.3% per hour in the observers. Nonsmoking fire fighters had lower COHb% after fires than the smokers had before fires. Estimates of environmental CO concentrations (including cigarette smoke) during the fires averaged 31 parts per million (ppm) for the smokers, 17 ppm for the nonsmoking crew members, and 11 ppm for the observers, none of whom smoked. The highest estimates of environmental CO arising solely from bushfire smoke were 40 to 50 ppm. Smokers were exposed to as much CO from their cigarettes as from bushfire smoke. Carboxyhemoglobin levels at the end of 8-hr fire fighting shifts, predicted from these levels of environmental CO, averaged about 5% (maximum 11%) in smokers and about 3% (maximum 7%) in nonsmokers. Acute levels of COHb% of this degree are not considered to have significant effects on health or performance. These results indicate that bushfire fighters are generally unlikely to experience hazardous levels of COexposure.

16: Occup Med. 1995 Oct-Dec;10(4):857-70.

Respiratory health hazards and lung function in wildland firefighters.

Harrison R, Materna BL, Rothman N.

The authors discuss the multitude of contaminants to which wildland firefighters are exposed, including carbon monoxide, sulfur dioxide, particulate and silica, polyaromatic hydrocarbons, aldehydes, and benzene. They examine the respiratory effects of these contaminants and then present their recommendations for an occupational health program for wildland firefighters.

20: Toxicology. 2007 Jul 1;236(1-2):103-13. Epub 2007 Apr 24.

Particle size-dependent radical generation from wildland fire smoke.

Leonard SS, Castranova V, Chen BT, Schwegler-Berry D, Hoover M, Piacitelli C,Gaughan DM.

Firefighting, along with construction, mining and agriculture, ranks among the most dangerous occupations. In addition, the work environment of firefighters is unlike that of any other occupation, not only because of the obvious physical hazards but also due to the respiratory and systemic health hazards of smoke inhalation resulting from combustion. A significant amount of research has been

devoted to studying municipal firefighters; however, these studies may not be useful in wildland firefighter exposures, because the two work environments are so different. Not only are wildland firefighters exposed to different combustion products, but their exposure profiles are different. The combustion products wildland firefighters are exposed to can vary greatly in characteristics due to

the type and amount of material being burned, soil conditions, temperature and exposure time. Smoke inhalation is one of the greatest concerns for firefighter health and it has been shown that the smoke consists of a large number of particles. These smoke particles contain intermediates of hydrogen, carbon and oxygen free radicals, which may pose a potential health risk. Our investigation looked into the involvement of free radicals in smoke toxicity and the relationship between particle size and radical generation. Samples were collected in discrete aerodynamic particle sizes from a wildfire in Alaska, preserved and then shipped to our laboratory for analysis. Electron spin resonance was used to measure carbon-centered as well as hydroxyl radicals produced by a Fenton-like reaction with wildfire smoke. Further study of reactive oxygen species was conducted using analysis of cellular H(2)O(2) generation, lipid peroxidation of cellular membranes and DNA damage. Results demonstrate that coarse size-range particles contained more carbon radicals per unit mass than the ultrafine particles; however, the ultrafine particles generated more *OH radicals in the acellular Fenton-like reaction. The ultrafine particles also caused significant increases in H(2)O(2) production by monocytes and lipid peroxidation. All

particle sizes showed the ability to cause DNA damage. These results indicate that the radical generation and the damage caused by them is not only a function of surface area but is also influenced by changing chemical and other characteristics due to particle size.
21: J Occup Environ Hyg. 2004 May;1(5):296-305.

A screening-level assessment of the health risks of chronic smoke exposure for wildland firefighters.

Booze TF, Reinhardt TE, Quiring SJ, Ottmar RD.

A screening health risk assessment was performed to assess the upper-bound risks of cancer and noncancer adverse health effects among wildland firefighters performing wildfire suppression and prescribed burn management. Of the hundreds of chemicals in wildland fire smoke, we identified 15 substances of potential concern from the standpoints of concentration and toxicology; these included aldehydes, polycyclic aromatic hydrocarbons, carbon monoxide, benzene, and respirable particulate matter. Data defining daily exposures to smoke at prescribed burns and wildfires, potential days of exposure in a year, and career lengths were used to estimate average and reasonable maximum career inhalation exposures to these substances. Of the 15 substances in smoke that were evaluated, only benzene and formaldehyde posed a cancer risk greater than 1 per million, while only acrolein and respirable particulate matter exposures resulted in hazard indices greater than 1.0. The estimated upper-bound cancer risks ranged from 1.4 to 220 excess cancers per million, and noncancer hazard indices ranged from 9 to 360, depending on the exposure group. These values only indicate the likelihood of adverse health effects, not whether they will or will not occur. The risk assessment process narrows the field of substances that deserve further assessment, and the hazards identified by risk assessment generally agree with those identified as a concern in occupational exposure assessments.

22: Am Ind Hyg Assoc J. 1992 Apr;53(4):265-72.

Forest worker exposure to airborne herbicide residues in smoke from prescribed fires in the southern United States.

McMahon CK, Bush PB.

Occupational safety and health concerns have been raised in a number of southern states by workers conducting prescribed burns on forest lands treated with herbicides. Modeling assessments coupled with laboratory experiments have shown that the risk of airborne herbicide residues to workers is insignificant, even if the fire occurs immediately after herbicide application. However, no field studies had been conducted to confirm these findings. To bridge that gap, a field validation study was conducted in Georgia to measure breathing zoneconcentrations of smoke suspended particulate matter (SPM), herbicide residues, and carbon monoxide (CO) on 14 operational prescribed fires. Smoke was monitored on sites treated with labeled rates of forestry herbicides containing the active ingredients imazapyr, triclopyr, hexazinone, and picloram. The sites were burned within 30-169 days after herbicide application. Tract size ranged from 2.4 to 154 hectares. Personal monitors and area monitors employing glass fiber filters and polyurethane foam collection media were used. No herbicide residues were detected in the 140 smoke samples from the 14 fires conducted in this study. The sensitivity of the monitoring methods was in the 0.1 to 4.0 micrograms/m3 range, which is several hundred to several thousand times less than any established occupational exposure limit for herbicides. The SPM and CO monitored on these fires is the first time breathing zone concentrations of these smoke constituents have been measured in the South. As expected, concentrations were highly variable depending on fire conditions and the location of personnel. Worker respirable (2.3-microns particle cut point) SPM concentrations ranged between 0.2 and 3.7mg/m3

30: J Expo Anal Environ Epidemiol. 2004 Mar;14(2):120-8.

Assessment of urinary metals following exposure to a large vegetative fire, NewMexico, 2000.

Wolfe MI, Mott JA, Voorhees RE, Sewell CM, Paschal D, Wood CM, McKinney PE, Redd

INTRODUCTION: In May 2000, a vegetative fire burned 47,000 acres in northern New

Mexico, including 7500 acres of land administered by the Los Alamos National Laboratory. We evaluated potential human exposures from the fire. METHODS: We surveyed two populations (firefighters and the general population) in four cities for urine heavy metal concentrations. Reference concentrations were based on the Third National Health and Nutrition Examination Survey (NHANES III). Multivariate linear regression assessed the association of urinary metal concentrations with smoke exposure. We also performed isotopic analysis of uranium and cesium on a subset of specimens.
31: J Air Waste Manag Assoc. 2001 Mar;51(3):443-50.

Smoke impacts from agricultural burning in a rural Brazilian town.

Reinhardt TE, Ottmar RD, Castilla C.

Agricultural and silvicultural biomass burning is practiced in many undeveloped portions of the Amazon basin. In Rond nia, Brazil, such burning is restricted to a brief period in the dry season of August and September to minimize the duration of air quality impacts and to attempt to control escaped fires. During this period, much of the region and the communities within it experience significant

exposure to smoke from agricultural and forest fires. In cooperation with Brazilian scientists of the University of Brasilia, the Brazilian Organization for Agricultural Research (EMBRAPA), and the Alternative to Slash and Burn Program coordinated by the International Center for Research in Agroforestry (ICRAF), ambient air quality was measured in Theobroma, a small town in Rond nia, during one week of the open burning period of 1995 to supplement available air quality data and to foster public awareness of the impacts of widespread fires. Personal sampling equipment was used to measure ambient levels of formaldehyde (HCHO), acrolein, CO, benzene, and respirable PM in outdoor air
41: Inhal Toxicol. 2007 Jan;19(1):67-106.

Woodsmoke health effects: a review.

Naeher LP, Brauer M, Lipsett M, Zelikoff JT, Simpson CD, Koenig JQ, Smith KR.

The sentiment that woodsmoke, being a natural substance, must be benign to humans is still sometimes heard. It is now well established, however, that wood-burning stoves and fireplaces as well as wildland and agricultural fires emit significant quantities of known health-damaging pollutants, including several carcinogenic compounds. Two of the principal gaseous pollutants in woodsmoke, CO and NOx, add to the atmospheric levels of these regulated gases emitted by other combustion sources. Health impacts of exposures to these gases and some of the other woodsmoke constituents (e.g., benzene) are well characterized in thousands of publications. As these gases are indistinguishable no matter where they come from, there is no urgent need to examine their particular health implications in woodsmoke. With this as the backdrop, this review approaches the issue of why woodsmoke may be a special case requiring separate health evaluation through two questions. The first question we address is whether woodsmoke should be regulated and/or managed separately, even though some of its separate constituents are already regulated in many jurisdictions. The second question we address is whether woodsmoke particles pose different levels of risk than other ambient particles of similar size. To address these two key questions, we examine several topics: the chemical and physical nature of woodsmoke; the exposures and epidemiology of smoke from wildland fires and agricultural burning, and related controlled human laboratory exposures to biomass smoke; the epidemiology of outdoor and indoor woodsmoke exposures from residential woodburning in developed countries; and the toxicology of woodsmoke, based on animal exposures and laboratory tests. In addition, a short summary of the exposures and health

effects of biomass smoke in developing countries is provided as an additional line of evidence. In the concluding section, we return to the two key issues above to summarize (1) what is currently known about the health effects of inhaled woodsmoke at exposure levels experienced in developed countries, and (2) whether there exists sufficient reason to believe that woodsmoke particles are sufficiently different to warrant separate treatment from other regulated particles. In addition, we provide recommendations for additional woodsmoke research.
44: Arch Environ Occup Health. 2005 Jan-Feb;60(1):40-3.

Application of real-time particle sensors to help mitigate exposures of wildland firefighters.

Edwards R, Johnson M, Dunn KH, Naeher LP.

High particulate exposures have been demonstrated to decrease lung function among firefighters. In this article, the authors demonstrated the feasibility of using small real-time particle sensors to inform wildland firefighters so they may make informed decisions on the use of personal respiratory protection. Using 1 mg/m3 as an indicator point for use of appropriately designed respiratory protection, such sensors could help prevent 16% to 74% of particulate exposure during prescribed burns when firefighters assess exposure as low or medium. Adherence to such a guideline for the use of respiratory protection would involve its deployment during 3% to 22% of individual 8-hour shifts. In addition, data-logging sensors would provide a valuable tool for tracking exposure to

particulates among wildland firefighters for occupational health monitoring.
46: Rev Environ Contam Toxicol. 1991;119:1-46.

Acute toxicology of components of vegetation smoke.

Dost FN.

Only in recent times, systematic attention has been paid to the occupational health of forest firefighters and workers who manage prescribed fire. Two parts of the effort to learn the impact on worker health are medical observation of those workers, and study of occupational hygiene. It is also necessary to learn what components of smoke are most likely to affect firefighters, and to learn something of the manner in which those substances might compromise health; this review is a step toward that end. The number of possible products of vegetation combustion is almost limitless, and every fuel and condition of burning produces a unique pattern. Nonetheless, it is possible and practical to select a limited number of products that are most likely to be involved in the acute toxicity of smoke. Two products that are almost certainly important are formaldehyde and acrolein. Both appear to occur in all smoke. The toxicology of both is well studied; in particular both are powerful mucosal irritants. Estimates of exposure suggest strongly that concentrations are high enough in smoke to contribute some or all of the irritant activity. There seems to be a reasonable prospect that free radical precursors with half-lives in the tens of minutes are produced when cellulosic materials burn. If so, they will reach the respiratory tract, and liberate free radicals that react immediately on or in pulmonary cells. Ozone is not produced in the fire, but the various hydrocarbons of smoke are substrates for reactions that eventually produce ozone, and that production may continue for miles down-plume. Some measured plume concentrations approach the threshold for human health effects. The effects of the best known component, the particulate material, are unknown in isolation from all of the other substances in smoke. In spite of that ignorance, particulate loading is the principal index of smoke pollution for regulatory purposes, and sometimes is incorrectly used to represent smoke emissions regardless of source. The need to understand health impacts of these components of smoke seems obvious. Perhaps less obvious is the need to use such knowledge in management of both prescribed burning and wildfire. To some extent, it is possible to either manage fire itself to alter emission patterns, or control exposures in certain situations. Whether that should be done to protect worker health can only be judged if enough is known about health effects to direct the management decisions

52: Am J Ind Med. 2007 May;50(5):377-82.

Floodwater exposure and the related health symptoms among firefighters in New Orleans, Louisiana 2005.

Tak S, Bernard BP, Driscoll RJ, Dowell CH.

BACKGROUND: Concerns over increased reports of physical health symptoms thought

to be related to floodwater exposure among New Orleans firefighters prompted a

health hazard evaluation of firefighters following Hurricane Katrina. METHODS: A

questionnaire assessing health symptoms possibly related to the response to

Hurricane Katrina was administered to all New Orleans Fire Department (NOFD)

personnel within 3 months of the disaster. Descriptive statistics were compiled

and prevalence ratios (PR) were estimated for covariates using generalized linear

models with Log link and Poisson distribution.
61: Eur Respir J. 2008 Feb 6 [Epub ahead of print]

Wood Smoke exposure induces a Pulmonary and Systemic Inflammatory Response in fire fighters.

Swiston JR, Davidson W, Attridge S, Li GT, Brauer M, van Eeden SF.

Epidemiological studies report an association between exposure to biomass smoke and cardiopulmonary morbidity. The mechanism(s) for this association are unclear.To characterize the acute pulmonary and systemic inflammatory effects of exposure to forest fire smoke.Seasonal forest firefighters (N=52) were recruited before and/or after a day of firefighting. Exposure was assessed by questionnaires and measurement of carbon monoxide levels (used to estimate respirable particulate matter [RPM] exposure). The pulmonary response was assessed by questionnaires, spirometry, and sputum induction. Peripheral blood cell counts and inflammatory cytokines were measured to define the systemic response.Estimate RPM exposure was high (peak levels >2mg.m(-3)) during firefighting activities. Respiratory symptoms were reported by 65% of firefighters. The percentage sputum granulocytes increased from 6.5% to 10.9% (p<0.02) following firefighting shifts with concurrent increases in circulating white blood cells (5.55x10(9) to 7.06x10(9) cells.L(-1), p<0.0001) and band cells (0.11x10(9) to 0.16x10(9) cells.L(-1), p<0.01). Serum IL-6, IL-8 and MCP-1 levels increased following firefighting (p<0.05). There were no changes in band cells, IL-6, and IL-8 following strenuous physical exertion without fire fighting. There was an association between changes in sputum macrophages containing phagocytosed particles and circulating band cells (p<0.05).Acute exposure to air pollution from forest fire smoke elicits inflammation within the lungs as well as a systemic inflammatory response.

70: Aust Fam Physician. 2007 Dec;36(12):994-7.

Fighting with fire--how bushfire suppression can impact on fire fighters' health.

Aisbett B, Phillips M, Sargeant M, Gilbert B, Nichols D.

BACKGROUND: Each year bushfire threatens Australia's rural, forest, and urban-rural areas. Australia's rural fire fighters work to curtail this threat in hot, smoky conditions, often at risk to their physical health. General practitioners, especially in rural areas, can help preserve the health of fire fighters during the fire season by understanding the stressors they face on the fireground. OBJECTIVE: This article outlines how the key fireground stressors of work intensity and duration, heat (from the weather, the fire, and the fire

fighter's own exertion) and smoke impact on the health of fire fighters. Practical advice for GPs treating Australia's rural fire fighters is also included. DISCUSSION: General practitioners can help preserve fire fighters' health during bushfire suppression in a number of ways, including: identifying fire fighters at risk of cardiac distress during physical labour and educating them about the early warning signs; advocating regular exercise; discouraging smoking; and promoting the benefits of maintaining fluid, carbohydrate, and

electrolyte levels during a shift.

73: J Air Waste Manag Assoc. 2006 Jan;56(1):56-67.

An analysis of effects of San Diego wildfire on ambient air quality.

Viswanathan S, Eria L, Diunugala N, Johnson J, McClean C.

The impact of major gaseous and particulate pollutants emitted by the wildfire of October 2003 on ambient air quality and health of San Diego residents before, during, and after the fire are analyzed using data available from the San Diego County Air Pollution Control District and California Air Resources Board. It was found that fine particulate matter (PM) levels exceeded the federal daily 24-hr average standard during the fire. There was a slight increase in some of the gaseous pollutants, such as carbon monoxide, which exceeded federal standards. Ozone (O3) precursors, such as total hydrocarbons and methane gases, experienced elevated concentration during the fire. Fortunately, the absence of sunlight because of the cloud of thick smoke that covered most of the county during the fire appears to have prevented the photochemical conversion of the precursor gases to harmful concentrations of O3. Statistical analysis of the compiled medical surveillance data has been used to establish correlations between pollutant levels in the region and the resultant health problems experienced by the county citizens. The study shows that the increased PM concentration above the federal standard resulted in a significant increase in hospital emergency room visits for asthma, respiratory problems, eye irritation, and smoke inhalation. On the basis of the findings, it is recommended that hospitals and emergency medical facilities engage in pre-event planning that would ensure a rapid response to an impact on the healthcare system as a result of a large wildfire and appropriate agencies engage in the use of all available meteorological forecasting resources, including real-time satellite imaging assets, to accurately forecast air quality and assist firefighting efforts.

76: Int J Hyg Environ Health. 2005;208(1-2):75-85.

Cardiorespiratory hospitalizations associated with smoke exposure during the 1997, Southeast Asian forest fires.

Mott JA, Mannino DM, Alverson CJ, Kiyu A, Hashim J, Lee T, Falter K, Redd SC.

We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates established from a historical baseline period of January 1, 1995 to July 31, 1997. We also identified age-specific cohorts of persons whose members were admitted for specific cardiorespiratory problems during January 1 to July 31 of each year (1995--1997). We compared Kaplan-Meier survival curves of time to first readmission for the 1997 cohorts (exposed to the forest fire smoke) with the survival curves for the 1995 and 1996 cohorts (not exposed, pre-fire cohorts). The time-series analyses indicated that statistically significant fire-related increases were observed in respiratory hospitalizations, specifically those for chronic obstructive pulmonary disease (COPD) and asthma. The survival analyses indicated that persons over age 65 years with previous hospital admissions for any cause (chi2(1df) = 5.98, p = 0.015), any cardiorespiratory disease (chi2(1df) = 5.3, p = .02), any respiratory disease (chi2(1df) = 7.8, p = 0.005), or COPD (chi2(1df) = 3.9, p =0.047), were significantly more likely to be rehospitalized during the follow-up period in 1997 than during the follow-up periods in the pre-fire years of 1995 or 1996. The survival functions of the exposed cohorts resumed similar trajectories to unexposed cohorts during the post-fire period of November 1, 1997 to December 31, 1998. Communities exposed to forest fire smoke during the Southeast Asian forest fires of 1997 experienced short-term increases in cardiorespiratory hospitalizations. When an air quality emergency is anticipated, persons over age 65 with histories of respiratory hospitalizations should be preidentified from existing hospitalization records and given priority access to interventions.

86: Respirology. 2000 Jun;5(2):175-82.

Impact to lung health of haze from forest fires: the Singapore experience.

Emmanuel SC.

OBJECTIVE: From late July to the beginning of October 1997, countries of Southeast Asia experienced severe smoke haze pollution from uncontrolled forest fires mainly in the Indonesian states of Kalimantan and Sumatra. In Singapore, the impact of the 1997 haze was felt in the period from the end of August to the first week of November 1997 as a result of prevailing winds. METHODOLOGY: The Ministry of the Environment monitors ambient air quality by a country-wide telemetric air quality monitoring and management network, with 15 stations located throughout the island, linked via a public telephone network to a central control station at the Environment Building. The monitoring methods used are the United States Environmental Protection Agency (USEPA) reference methods. The Pollutant Standards Index (PSI) developed by the USEPA is used for the reporting of daily air pollution concentrations. Intervals on the PSI scale are related to the potential health effects of the daily measured concentrations of the five major air pollutants: sulfur dioxide, particulate matter (PM10), nitrogen dioxide, ozone and carbon monoxide. Public sector health facilities which come under the Ministry of Health, have computerized patient care systems which enable the routine ongoing surveillance of disease conditions for the period of the haze. Attention during the period of the haze was focused on conditions related to health effects of the haze. Data sources for the monitoring of the lung health effects of the haze included morbidity from public sector outpatient care facilities, accidents and emergency departments, public sector inpatient care facilities and national mortality data. RESULTS: Findings from the health impact of the haze showed that there was a 30% increase in outpatient attendance for haze-related conditions. An increase in PM10 levels from 50 microg/m3 to 150 microg/m3 was significantly associated with increases of 12% of upper respiratory tract illness, 19% asthma and 26% rhinitis. Supplementary findings from scanning the electron microscopic sizing of the haze particles showed that 94% of the particles in the haze were below 2.5 microm in diameter. This was consistent with

emissions from combustion sources originating over 500 km from Singapore. This has been of some concern because particles smaller than 2.5 microm in diameter can easily bypass normal body defence metabolism and penetrate deeply into the alveoli of the lungs. During the same period, there was also an increase in accident and emergency attendance for haze-related conditions. There was no

significant increase in hospital admissions or in mortality. CONCLUSION: The present study found that the health effects from the 1997 smoke haze in Singaporewere generally mild.

114: J Aerosol Med. 2002 Winter;15(4):387-99.

Respiratory tract deposition efficiencies: evaluation of effects from smoke released in the Cerro Grande forest fire.

Schöllnberger H, Aden J, Scott BR.

Forest-fire smoke inhaled by humans can cause various health effects. This smoke contains toxic chemicals and naturally occurring radionuclides. In northern New Mexico, a large wildfire occurred in May 2000. Known as the Cerro Grande Fire, it devastated the town of Los Alamos and damaged Los Alamos National Laboratory (LANL). Residents were concerned about the possible dissemination of radionuclides from LANL via smoke from the fire. To evaluate potential health effects of inhaling radionuclides contained in the smoke from the Cerro Grande Fire, it was first necessary to evaluate how much smoke would deposit in the

human respiratory tract. The purpose of this study was to evaluate respiratory-tract deposition efficiencies of airborne forest-fire smoke for persons of different ages exposed while inside their homes. Potential non-radiological health effects of a forest fire are reviewed. The deposition efficiencies presented can be used to evaluate in-home smoke deposition in the respiratory tract and expected radionuclide intake related to forest fires. Theimpact of smoke exposure on firemen fighting a forest fire is quantitatively

discussed and compared. They primarily inhaled forest-fire smoke while outdoors where the smoke concentration was much higher than inside. Radionuclides released at the LANL site via the Cerro Grande Fire were restricted to naturally occurring radionuclides from burning trees and vegetation. Radiation doses from inhaled airborne radionuclides to individuals inside and outside the Los Alamos area were likely very small.

137: Med J Aust. 1989 Dec 4-18;151(11-12):719-20.

Carbon monoxide unlikely to be a hazard to bushfire fighters.

Brotherhood JR, Budd GM, Hendrie AL, Jeffery SE, Beasley FA, Costin BP, Zhien W.

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