ADVANCEMENT OF THE PRACTICE
The New York State Department of Envi- ronmental Conservation also conducted a more regional analysis of emergency depart- ment visits during a 2-week period in June where the air quality for particulate matter reached “unhealthy” and “very unhealthy” levels across the state. Their findings were that particulate matter in New York was high- est on June 7, 2023, representing 590% to 1,229% increases across the state (except for the Adirondacks) and that emergency depart- ment visits associated with asthma increased statewide by 81.9% (Meek et al., 2023). Per- haps these high rates of asthma, particularly in the 18- to 64-year-old cohort, relate to the lack of personal experience with wildfire smoke in this population and the lack of knowledge of options available to reduce exposure. The results from these emergency depart- ment analyses can help guide emergency response planning and public health commu- nication strategies, especially in U.S. regions where wildfire smoke exposure was previ- ously uncommon. These findings also sug- gest that clinicians can consider counseling patients about protective measures, includ- ing awareness of current and predicted air quality conditions, staying indoors, using air filtration, and using properly fitted N95 respirators when outdoors, especially among persons with asthma, COPD, heart and vas- cular disease, or children, older adults, and pregnant persons. Having partnerships formally established and relevant resources available and commu- nicated in advance of an environmental health crisis is essential to ensuring clinicians have the available information at their fingertips when needed. After the Canadian wildfires, U.S. EPA analyzed website traffic on specific sites that offered training and resources to public health professionals on exposure to wildfire smoke. It was found that access to the Wildfire Smoke and Your Patients’ Health course rose from 4,863 visits in May 2023 to 49,535 visits in June 2023, with approximately 18,000 views in one day when most of the wildfire smoke was impacting major U.S. cities. Furthermore, the Particle Pollution and Your Patients’ Health course rose from 6,884 visits in May 2023 to 46,136 visits in June 2023. Similarly, daily access to websites and informational materials rose substantially in June 2023, such as access to the U.S. EPA Smoke Ready Toolbox and the DIY air cleaner information documents,
FIGURE 3
Trends in Emergency Department Visits Associated With Asthma Compared to Concentrations of Fine Particulate Matter Indicative of Wildfire From April 30–August 4, 2023
Note. Fine particulate matter = ≤2.5 μm in aerodynamic diameter. Source: McArdle et al., 2023.
which rose from approximately 150 views per day to over 1,500 views per day and 100 views per day to over 2,750 views per day, respec- tively. These data suggest that the availability of resources prior to an emerging event can enable clinicians to quickly access environ- mental information they were previously not well versed in and provide health-protective information to their patients. Future Opportunities While environmental public health practitio- ners continue to study the effects of environ- mental hazards adversely impacting human health and identifying the most at-risk popu- lations, few at-risk patients are counseled by their healthcare professionals about the risks of short- and long-term exposure to ambient particulate matter (Mirabelli et al., 2018). Many reasons might explain the low rate of engagement between clinical provid- ers and patients on the topic of environmen- tal health risks. Inadequate time to counsel patients during brief encounters is a common explanation, even when a clinician knows an environmental risk. Another reason is the uncertainty of a benefit from an intervention, which is in part due to physicians depending on clinical data to inform disease prevention and exposure interventions. While well-designed clinical studies have confirmed that personal interventions to
reduce exposure to ambient particulate mat- ter improve surrogate biomarkers of cardio- vascular risk, there is as yet no randomized clinical trial testing an intervention to lower long-term reductions in ambient particulate matter and measure clinical cardiovascular endpoints, such as the reduction in the rate of heart attack, stroke, arrhythmia, or heart failure (Rajagopalan et al., 2020). Random- ized controlled trials of individual-level inter- ventions to reduce particulate matter expo- sure are essential to establish evidence-based recommendations for approaches to improve health outcomes, especially among those individuals with a higher risk from exposure (Cascio & Ward-Caviness, 2023). Until then, environmental health profes- sionals can continue to develop, engage, and foster relationships with clinicians and allied healthcare professionals. They can also learn how their colleagues in the healthcare pro- fessions process information and relay inter- ventions to their patients. Furthermore, environmental health professionals can pro- actively develop and communicate resources and tools that clinicians and patients can use during emerging environmental events that place many people at higher risk for adverse health outcomes.
Acknowledgements: The authors acknowl- edge Bruce Rodan, Kacee Deener, Kelly Wid-
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Volume 86 • Number 5
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