Wildfires (for Health Professionals)

If your patients live in an area that is prone to wildfires, it’s recommended they have a wildfire response plan, including having a disaster kit (with N95 masks) so that they’re ready to leave home urgently if needed. If your patient has chronic health conditions, discuss plans for wildfires. Families can prepare for wildfire by knowing how to check their air quality and sign up for air quality resources. They can also protect their indoor air quality by talking with a HVAC or furnace professional about upgrading to a filter rated “MERV” 13 or higher or buy a portable air cleaner to have on hand. Sign up for emergency alerts from FEMA or your local public health department and always follow evacuation guidelines.

Symptoms of wildfire smoke inhalation can include: coughing, wheezing, difficulty breathing and chest tightness, respiratory tract and eye burning, chest pain, dizziness or lightheadedness. Air pollution from wildfires can exacerbate asthma symptoms and trigger attacks. Children with asthma, allergies, or other chronic health conditions may have more trouble breathing when smoke or ash is present. Even children without asthma could experience respiratory symptoms, resulting in school absences and other limitations of normal childhood activities. Fires may leave large amounts of ash and dust contaminated with harmful chemicals such as asbestos, arsenic, and/or lead. Wildfire smoke can persist for days or even months, depending on the extent of the wildfire.  

When advising patients, health care professionals should remember key requirements for children to return to an area impacted by wildfires include restored drinking water and sewage removal, safe road conditions, removal of ash and debris, and structurally sound homes. Schools and outdoor play areas should be cleaned, cleared of hazards and made ready for use. Persisting hazards should be isolated and made inaccessible to children. Children, and whenever possible, teens, should only be permitted to return after affected areas have been cleaned up. Children should be the last group to return. These recommendations also apply to pregnant women.

The best way to protect patients from indoor air pollution is to prevent or minimize the release of pollutants in the first place. Patients should: 

• Switch from indoor appliances that run on gas to those that run on electricity. This may reduce indoor air pollution up to 50% (Stanford, 2022).  
• Avoid burning candles and incense indoors and get rid of scented air fresheners. 
• Quit smoking! If they can’t keep cigarette smoking, vaping, and marijuana smoking to outdoor areas and away from doors and windows. Wash hands after use. 
• Use unscented EPA Certified Safer Choice cleaning products. Or, make their own DIY products!  
• Avoid using pesticide sprays or “pesticide bombs”, use gels or traps instead. The best approach is to eliminate leaking water and unsealed foods that attract pests and use integrated pest management practices (see Additional Resources section). 
• Reduce existing indoor pollution: 
  • On good air days, advise that they open windows and doors as weather permits, especially if using products that may generate pollutants. 
  • Recommend extra precautions if patients live near heavy industry or busy shipping routes like train tracks, warehouses or near seaports.   
  • If patients have a central heating and cooling system, “HVAC”, use high efficiency filters:  
  • Filters rated as MERV 13 or higher are best for reducing small particles that may impact health. Change air filters more often when there’s more smoke or pollen in the air (see Additional Resources section).  
  • Consider recommending portable indoor air purifier/filter with a HEPA filters in the rooms patients spend the most time in, especially if they live near heavy industry. Avoid those with “ionizers” as these can create more pollutants. Patients can also make fairly effective low cost filters by taping a MERV13 filter onto a box fan (see Additional Resource section). For safety reasons, make sure the box fans used are from 2015 or later.  
  • Encourage patients to advocate for similar actions at their children’s schools.  

• Patients can look up average annual air quality levels in their neighborhoods using the UCSF Health Atlas mapping tool (see Additional Resources section). If levels are at or above the 40-60 range near the home, consider adding air pollution to their asthma action plan. Consider recommending extra precautions, such as the actions below.  
• Patients can look up the air quality forecast each day by using AirNow.gov to see if it’s a good air day. If the AQI is around 50-90, advise avoiding or significantly reducing heavy outdoor exercise for their child that day. If AQI is around or above 100, patients should avoid heavy outdoor exercise altogether and limit time outdoors. If outdoors during high pollution days, and/or wildfires, have patients use a N95 mask, for child patients, make sure it’s fitted for kids (see Additional Resources section).