Nevada Nurses Association

NNA Wildfire Smoke Information Dashboard

Resources for Nurses and their Patients

Overview

The "smoke season" is lengthening as forest fires across the Western United States are more frequent, last longer, and have higher intensities. Wildfire smoke is produced by the combustion of vegetation, or biomass. It is composed of multiple pollutants that include carbon dioxide (CO₂), carbon monoxide (CO), water vapor, particulate matter (PM), hydrocarbons, together with thousands of other organic chemical compounds such as acrolein, benzenes, and aldehydes. If buildings or homes are consumed by the fire, even more toxic pollutants are added to the smoke.

The link between fine PM air pollution and cardiorespiratory effects in populations has become clearer. Research has found associations between wildfire smoke events and clinical presentations for dyspnea, cough, wheezing, SOB, chest pain, and eye irritation. Hospital admissions correlate with PM levels for respiratory diseases (asthma with acute exacerbation, acute bronchitis, COPD exacerbation, pneumonia, upper respiratory infections), as well as cardiovascular diseases (ischemic heart disease, cardiac dysrhythmias, congestive heart failure, cerebrovascular disease, and stroke).

Everyone is affected at some level, but some of our patients are at higher risk to adverse health effects from exposure to the smoke. These patients may be children, pregnant women, outdoor workers, elderly, or have obesity, a cardiorespiratory disease, or low socio-economic status without resources to reduce smoke exposure in their residences or to seek health care. Therefore, as nurses we need to reach out and provide education and free tools for all our patients. These actions can help reduce disparities and the inequities experienced from environmental health hazards.

What Interventions Should I Offer My Patients?

1. Guidance on Knowing the Air Quality: Knowledge of air quality will help your patients make the best decisions for their health.
   Have your patients:
   • Use the Air Quality Index (AQI) developed by the EPA. The AQI is a tool that uses color-coded categories about real-time air quality in the area, advising which groups of people may be affected and steps to take to reduce exposure to air pollution. There are also "AQI forecasts" that can help a patient plan ahead for the day.
   • Make AirNow for their residence as a "favorite" or quick link on their computer, and get the AirNow App installed on their iPhone or Android.
   • Sign up for AQI text alerts: go to EnviroFlash; it's easy to set this up for one or more locations like home and work.
   • Personal Exposure Monitoring: there are new small, low-cost, highly portable air quality sensors that patients can wear while doing their normal activities. This may be appropriate for patients with means who live in highly polluted urban areas – not just for wildfire smoke events. Most measure PM and ozone levels. More information is in the EPA's Air Sensor Toolbox.
2. Use the AirNow's Fire and Smoke Map: this map shows levels of fine particle pollution (PM_2.5) from permanent monitors (EPA), temporary monitors deployed for smoke events, and low-cost sensors made by PurpleAir. The map shows air monitors in colors that reflect the air quality (e.g., green is good), along with large fire incidents as fire icons, satellite fire detections as small glowing points, and smoke plume locations as grey polygons.
3. Behavioral Actions: there are handouts and fact sheets that you can give your patients for actions to take while indoors and outdoors. Advise your patients on behavioral actions based on their individual health status. For example, a patient with asthma in Nevada should have wildfire smoke events as part of their Asthma Action Plan.
   Interventions may include:
   • Taking it easy during smoky times to reduce their smoke exposure. If it looks or smells smoky outside, they should limit time outdoors and certainly avoid strenuous activities such as mowing the lawn or going for a run or bike ride.
   • Wearing NIOSH N95 or P100 respirators when going outdoors. Demonstrate how to use these masks properly. Offer a supply if possible. Do not rely on dust masks, surgical masks, or bandanas.
   • Reducing smoke in their vehicle by closing the windows and vents and running the air conditioner in recirculate mode. Slow down when they drive in smoky conditions.
   • Staying inside with the doors and windows closed. Whether your patient has a central air conditioning system or a room unit, they should use high efficiency filters to capture the smoke particles.
   • Seeking shelter elsewhere if they do not have an air conditioner and it is too warm to stay inside with the windows closed.
   • Not adding to indoor air pollution. They should not burn candles or use gas, propane, wood-burning stoves, fireplaces, or aerosol sprays. Do not fry or broil meat, smoke tobacco products, or vacuum.
   • Using a portable air cleaner to reduce indoor air pollution. Make sure it is sized for the room and that it does not make ozone, which is a harmful air pollutant. Portable air cleaners can be used along with central air systems to maximize the reduction of indoor particles.
   • Creating a "clean room" in their home. Choose a room with no fireplace and as few windows and doors as possible, such as a bedroom. Use a portable air cleaner in the room.
   • Refreshing the air in the home. Long-term smoke events usually have periods when the air is better. When air quality improves, even temporarily, air out the home to reduce indoor air pollution.
   • Having enough food and medication on hand to last several days so they don't have to go out for supplies. If they must go out, they should avoid the smokiest times of day. Check the AQI and the Air Now's Fire and Smoke Map !
   • Having a family plan in case of evacuation. Patients should know how to get alerts and health warnings, public service announcements (PSAs). Public advisories can provide important information such as changing smoke conditions and evacuation notices. They should know the evacuation routes, organize important items ahead of time, and know where to go in case they must evacuate.
   • Keeping pets safe. Resources from the CDC are available for small pets and livestock.
4. Monitoring their Health Status: Encourage your patients to check their health status and seek medical care as needed. They may take their blood pressure more often. Remind them to carry any rescue medications (check that they have a working inhaler – have them show it to you). Emphasize the importance of taking their heart and BP medicines as prescribed. Keep communication open with your outpatient clinic's team (RNs, doctor, or nurse practitioner).