Fire Resource Guide for Health Officials Susan Aitkens Consultant Emergency Preparedness Office California Department of Public Health susan.aitkens@cdph.ca.gov

Fire Resource Guide Major challenges identified by Health Officers Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Fire Resource Guide Major challenges identified by Health Officers 3 Main topics Air Quality during Smoke Events Debris Management Medical Needs of Shelter Occupants Want concise, usable information based on latest research and expert agency recommendations

Air Quality – Sources of Information Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Air Quality – Sources of Information Published Research Agency Expertise California Department of Public Health (CDPH) California Air Resources Board (CARB) Cal EPA’s Office of Environmental Health Hazard Assessment (OEHHA) Cal OSHA CDC, US EPA, FDA, NIOSH, WHO…

Local Planning / Response Partners Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Local Planning / Response Partners Local Health Departments Environmental Health Offices/Departments Air Quality Management Districts/Air Pollution Control Districts (collectively, “Air Districts”) – some have Health Officers School Districts, etc.

Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 InterAgency Efforts California Smoke Blog http://californiasmokeinfo.blogspot.com/ CARPA – California Air Response Planning Alliance Wildfire Smoke Guide for Public Health Officials (undergoing revision) Air and Waste Management Association (planning “Wildfire and Air Quality” conference in CA)

Key Issues What are the adverse health impacts of smoky air? Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Key Issues What are the adverse health impacts of smoky air? Which population groups may be particularly sensitive to smoky air? Can we reach consensus on protective health recommendations? How do we achieve coordinated messaging to public?

Monitoring Air Quality Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Monitoring Air Quality Local, regional, state and federal agencies monitor major air pollutants AirNow.Gov website – Computes Air Quality Index (AQI) for PM2.5 and ozone Particulate Matter (PM2.5): fine inhalable particles with diameters < 2.5 micrometers

Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 AQI on July 28, 2018 - Yosemite

Real-Time Air Quality Information Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Real-Time Air Quality Information Purple Air https://www.purpleair.com/

Who may be sensitive to high PM2.5? Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Who may be sensitive to high PM2.5? People with lung disease People with heart disease Children (to age 18) > 65 yrs Obesity People with metabolic disease, e.g., diabetes People with mental health issues Kidney disease

Protective Health Actions Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Protective Health Actions Who? When? Can we achieve consistency?

Protective Health Actions Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Protective Health Actions “Take precautions” and “use common sense” Reduce or avoid activity while outdoors Remain indoors Wear N95 respirator if outdoors Upgrade home HVAC (high MERV filtration) Create “clean air” room in home Leave area

Are recommended protective actions on point? Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Are recommended protective actions on point?

Schools and Athletic Events Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Schools and Athletic Events NCAA guidance, updated Sept 2018: “At AQIs of 200 or above, serious consideration should be given to rescheduling the activity or moving it indoors.” “At AQIs of 300 or above, outdoor activities should be moved indoors or canceled if indoor activity is not an option.” Recommendations for Schools???

Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018

N95 Respirators May Help Filter Particulate Matter Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 N95 Respirators May Help Filter Particulate Matter May Present an Unintentional Hazard

Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 N95 Respirators “Filtering face-piece respirators and masks can make the work of breathing more difficult and can lead to increased breathing rates and heart rates. They can also contribute to heat stress. Because of this, respirator use by those with heart and respiratory diseases can be dangerous, and should only be done under a doctor’s supervision.”

Voluntary Use of N95 by Staff Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Voluntary Use of N95 by Staff Q: What are the employer's obligations when respiratory protection is not required but employees wear respirators on their own accord? A: The employer must implement those elements of the written respiratory protection program necessary to ensure that any employee using a respirator voluntarily is medically able to use that respirator…

Goals Identify consensus recommendations for California regarding: Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Goals Identify consensus recommendations for California regarding: Protective health actions in response to smoke events (public, schools, deployed staff, etc.) Decision-making considerations Coordination between involved agencies Informing the public

Debris Management Summary of potential health hazards in debris Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Debris Management Summary of potential health hazards in debris Explanation of the public assistance clean-up process Examples of private clean-up process List of agencies and their roles

Private Property Debris Removal Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Private Property Debris Removal Debris removal on private property is not typically eligible for cost recovery For state or federal support, applicant must demonstrate “immediate threat to public health and safety” One way to achieve this by proclamation of a local health emergency

Thank you! Susan Aitkens Emergency Preparedness Office Radioactive Material Production, Transportation, Use, and Possible Misuse 11/28/2018 Thank you! Susan Aitkens Emergency Preparedness Office California Department of Public Health susan.aitkens@cdph.ca.gov