Vive le français! (Et préparons-nous aux feux de forêt)

1. Douglas-Vail M, Jiang A, Erdelyi S, Brubacher JR, Abu-Laban RB. Association of air quality during forest fire season with respiratory emergency department visits in Vancouver, British Columbia. The Journal of Climate Change and Health. 2023 Jun 10:100255. Abstract

Background
Climate change has been deemed the biggest global health threat of the 21st century. One consequence of climate change is the increasing frequency and severity of forest fires. Smoke from wildfires has the ability to negatively impact air quality over large distances. The aim of this study was to examine the association that air quality had on emergency department visits for cardiac, respiratory and psychiatric/behavioral health chief complaints during forest fire season in Vancouver, British Columbia.

Methods
The study period was January 1, 2009 – December 31, 2019. Forest fire season was defined as April 1- September 30. Air quality (measured by PM2.5 in ug/m3) was obtained from the Vancouver International Airport (YVR) Air Quality station. Emergency department visit data (CEDIS triage complaint) was acquired from a regional emergency department database. A generalized linear mixed model with Poisson link function was used to determine the relative risk (as a percentage) for respiratory, cardiac and psychiatric/behavioral health CEDIS triage complaints associated with a 10 unit increase in PM2.5.

Results
PM2.5 during forest fire season was significantly associated with emergency department visits for respiratory chief complaints. For every 10 ug/m3 increase in PM2.5, there was a 4.61% (95% CI: 3.07, 6.17) increase in relative risk of respiratory chief complaints presenting to emergency departments. No association was found between PM2.5 and cardiac or psychiatric/behavioral health chief complaints during forest fire season or non-forest fire season. During non-forest fire season, PM2.5 was found to be negatively associated with respiratory (-3.57, 95% CI: -5.44, -1.66) and cardiac chief complaints (-2.77, 95% CI: -4.16, -1.47).

Conclusion
Our results indicate a probable association between air quality during forest fire season and emergency department visits for respiratory chief complaints. This provides further illustration of the widespread impact of climate change, and underscores the importance of efforts to address it.

2. Festa N, Heaphy NM, Throgmorton KF, Canavan M, Gill TM. Evaluating California nursing homes' emergency preparedness for wildfire exposure. Journal of the American Geriatrics Society. 2023 Mar;71(3):895-902.

Background
The relationship between the risk of exposure to environmental hazards and the emergency preparedness of nursing homes is not well-understood. This study evaluates the association between wildfire exposure risk and nursing home emergency preparedness.

Methods
From a sample of Centers for Medicare & Medicaid Services (CMS) certified nursing homes in California, we determined the prevalence of “exposed” facilities that were located within 5 km of a wildfire risk area, as informed by a field-tested model. Among the 1182 nursing homes, we identified emergency preparedness deficiencies from January 2017 to December 2019. We estimated associations between exposure and emergency preparedness deficiencies using unadjusted and adjusted generalized estimating equations with logistic and negative binomial distributions.

Results
A greater percentage of the 495 exposed facilities had at least one emergency preparedness deficiency than the 687 unexposed facilities (83.9% vs 76.9%). The mean (3.6 vs 3.2) and median (3 vs 2) numbers of emergency preparedness deficiencies were also greater for exposed facilities. In both the unadjusted and adjusted analyses, exposure to wildfire risk was significantly associated with the likelihood of at least one emergency preparedness deficiency (adjusted odds ratio 1.52, p-value 0.007). There was a positive but not statistically significant association between exposure and the number of emergency preparedness deficiencies assigned to a nursing home (adjusted rate ratio 1.12, p-value 0.062). These results were consistent in analyses that used more stringent distance- and severity-thresholds to define exposure status.

Conclusion
California nursing homes at heightened risk of exposure to wildfires have poorer emergency preparedness than unexposed facilities. These findings suggest that nursing home management and staff may be unaware of important environmental risks to which their facilities are exposed. Improved integration of nursing homes into community disaster planning may better align facility preparedness with surrounding wildfire risk.

Photo by Pixabay