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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Implications of the California Wildfires for Health, Communities, and Preparedness PROCEEDINGS OF A WORKSHOP Steve Olson, Rapporteur Forum on Medical and Public Health Preparedness for Disasters and Emergencies Roundtable on Population Heath Improvement Roundtable on the Promotion of Health Equity Roundtable on Environmental Health Services, Research, and Medicine Board on Health Sciences Policy Board on Population Health and Public Health Practice Health and Medicine Division PREPUBLICATION COPY: UNCORRECTED PROOFS

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation, Administration for Children and Families Department of Health and Human Services (HHS), American Burn Association, American College of Emergency Physicians, American College of Surgeons – Committee on Trauma, American Hospital Association, American Red Cross, Association of Public Health Laboratories, Association of State and Territorial Health Officials, Blue Cross and Blue Shield of North Carolina, The California Endowment, California Wellness Foundation, Centers for Disease Control and Prevention, Colgate-Palmolive Company, The Colorado Trust, Council of State and Territorial Epidemiologists, Dartmouth-Hitchcock Medical Center, Department of Defense, Department of Homeland Security, Department of Transportation, East West Protection, LLC, Emergency Nurses Association, ExxonMobil Foundation, Geisinger, Gordon and Betty Moore Foundation, Health Resources and Services Administration Office of Health Equity, Healthcare Ready, HHS Office of the Assistant Secretary for Health, Hogg Foundation, Infectious Diseases Society of America, Kaiser Permanente, The Kresge Foundation, Merck & Co, Inc., National Association of Chain Drug Stores, National Association of County & City Health Officials, National Association of Emergency Medical Technicians, National Fire Protection Association, National Highway Traffic Safety Administration, National Institute of Allergy and Infectious Diseases, National Institute of Environmental Health Sciences, National Library of Medicine, Nemours, New York State Health Foundation, New York University School of Medicine Department of Population Health, Office of the Assistant Secretary for Preparedness and Response, The Rippel Foundation, Robert Wood Johnson Foundation, Samueli Institute, Trauma Center Association of America, Uniformed Services University of the Health Sciences, The University of Texas, U.S. Food and Drug Administration, U.S. Environmental Protection Agency, Veterans Affairs Office of Health Equity, and Wake Forest Baptist Medical Center – Stakeholder Health. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25622 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California wildfires for health, communities, and preparedness: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25622. PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

PLANNING COMMITTEE ON IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS1 KENNETH KIZER (Chair), Director of the Institute for Population Health Improvement, UC Davis Health JULIE BALDWIN, Director, Center for Health Equity Research, Northern Arizona University MICHELLE BELL, Mary E. Pinchot Professor of Environmental Health, Yale University School of Forestry and Environmental Studies WAYNE E. CASCIO, Director, Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency DAVID EISENMAN, Professor in Residence, David Geffen School of Medicine and the Fielding School of Public Health, University of California, Los Angeles RICHARD J. JACKSON, Former Professor and Chair, Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles WAYNE B. JONAS, President and Chief Executive Officer, Samueli Institute SUZET M. MCKINNEY, Executive Director, Illinois Medical District Commission WINSTON WONG, Medical Director, Community Benefit; Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente Health and Medicine Division Staff KAREN M. ANDERSON, Senior Program Officer ALINA BACIU, Senior Program Officer KATHLEEN STRATTON, Scholar SCOTT WOLLEK, Senior Program Officer CAROLINE M. CILIO, Associate Program Officer AIMEE MEAD, Associate Program Officer PAMELA RAMEY-McCRAY, Senior Program Assistant KIMBERLY SUTTON, Senior Program Assistant ROSE MARIE MARTINEZ, Senior Board Director ANDREW M. POPE, Senior Board Director Consultant STEVE OLSON, Science Writer 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS v

Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: Julie Baldwin, Northern Arizona University Linda McCauley, Emory University Colleen Ryan, Harvard Medical School Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Martín-J. Sepúlveda, Claraluzz, LLC. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. PREPUBLICATION COPY: UNCORRECTED PROOFS vii

Contents 1 INTRODUCTION AND OVERVIEW 1-1 Organization of the Workshop, 1-5 2 CALIFORNIA WILDFIRES: PAST AND FUTURE 2-1 The Role of Climate Change in California Wildfires, 2-1 Health and Medical Responses to the California Wildfires, 2-4 Lessons from Colorado Discussion, 2-6 Discussion, 2-8 3 POPULATIONS IMPACTED BY WILDFIRES 3-1 Meeting the Needs of Vulnerable Populations, 3-1 A Native American Perspective on Wildfires, 3-3 Getting Services to Vulnerable Populations, 3-5 The Effects on Surrounding Communities, 3-7 Discussion, 3-9 4 EFFECTS OF WILDFIRES ON HUMAN HEALTH 4-1 The Health Effects of Wildfire Smoke, 4-1 Challenges and Limitations of Wildfire Smoke Exposure Research, 4-3 Occupational Exposure to Wildfire Smoke Among Agricultural Workers, 4-6 Health Effects for Wildland Firefighters, 4-8 Responding to and Recovering from Wildfire-Caused Drinking-Water System Contamination, 4-10 Time-Sensitive Studies of Wildfire Effects, 4-13 The Effects of Wildfire Smoke on Rhesus Macaques, 4-16 Discussion, 4-18 5 THE TRIALS OF RECOVERY 5-1 Connecting Emergency Management with Human Services, 5-2 Recovery and Adaptation in North-Central Washington State, 5-3 Accessing the Resources of a Local University, 5-6 Discussion, 5-8 6 ENHANCING OPERATIONAL RESPONSE 6-1 Enhancing Operational Response to Protect Cardiopulmonary Health, 6-1 Evidence-Based and Trauma-Informed Psychological Response to Disasters, 6-4 Burn-Disaster Response, 6-6 Los Angeles County Public Health Emergency Operational Response, 6-8 Discussion, 6-10 PREPUBLICATION COPY: UNCORRECTED PROOFS ix

7 THE IMPACT OF MITIGATION AND PREPAREDNESS 7-1 Engaging Washington Communities to Build Resilience to Wildfire Smoke, 7-1 Structure Ignition Issues in Wildfire Prevention, 7-5 Improving Society’s Relationship with Fire, 7-6 Creating Climate and Health Adaptations, 7-8 Leveraging Citizen Science for Research and Environmental Public Health, 7-10 Discussion, 7-13 8 REFLECTIONS ON THE WORKSHOP 8-1 Wildfire and Inequities, 8-1 Health Effects, 8-2 Response and Recovery, 8-3 Preparedness and Living with Fire, 8-4 Research Needs, 8-5 A Multidisciplinary Approach, 8-6 REFERENCES R-1 APPENDIXES A Workshop Statement of Task A-1 B Workshop Agenda B-1 C Speaker and Planning Committee Biosketches B-2 PREPUBLICATION COPY: UNCORRECTED PROOFS x

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California and other wildfire-prone western states have experienced a substantial increase in the number and intensity of wildfires in recent years. Wildlands and climate experts expect these trends to continue and quite likely to worsen in coming years. Wildfires and other disasters can be particularly devastating for vulnerable communities. Members of these communities tend to experience worse health outcomes from disasters, have fewer resources for responding and rebuilding, and receive less assistance from state, local, and federal agencies. Because burning wood releases particulate matter and other toxicants, the health effects of wildfires extend well beyond burns. In addition, deposition of toxicants in soil and water can result in chronic as well as acute exposures.

On June 4-5, 2019, four different entities within the National Academies of Sciences, Engineering, and Medicine held a workshop titled Implications of the California Wildfires for Health, Communities, and Preparedness at the Betty Irene Moore School of Nursing at the University of California, Davis. The workshop explored the population health, environmental health, emergency preparedness, and health equity consequences of increasingly strong and numerous wildfires, particularly in California. This publication is a summary of the presentations and discussion of the workshop.

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