Tracking Health Effects of Wildfires: The Oregon ESSENCE Wildfire Pilot Project

ObjectiveTo build capacity to conduct syndromic surveillance at the locallevel by leveraging a health surveillance need.IntroductionWildfires occur annually in Oregon, and the health risks of wildfiresmoke are well documented1. Before implementing syndromicsurveillance through Oregon ESSENCE, assessing the health effectsof wildfires in real time was very challenging. Summer 2015 markedthe first wildfire season with 60 of 60 eligible Oregon emergencydepartments (EDs) reporting to ESSENCE. The Oregon ESSENCEteam developed a wildfire surveillance pilot project with two localpublic health authorities (LPHAs) to determine their surveillanceneeds and practices and developed a training program to increasecapacity to conduct surveillance at the local level. Following thetraining, one of the LPHAs integrated syndromic surveillance intoits routine surveillance practices. Oregon ESSENCE also integratedthe evaluation findings into the summer 2016 statewide wildfiresurveillance plan.MethodsOregon ESSENCE staff recruited two LPHA preparednesscoordinators whose jurisdictions are regularly affected by wildfiresmoke to participate in the pilot project. A state public healthemergency preparedness liaison served as facilitator in order toincrease syndromic surveillance capacity among state preparednessstaff.A pre-season interview assessed data and surveillance needs,risk communication practices, and typical response activities duringwildfires. Initial project calls focused on determining specific queriesthat would meet local needs. Participants wanted total ED visitnumbers and health outcomes including asthma, chest pain or heartproblems. Both LPHAs were interested in using the data to assesshealth effects on vulnerable populations, including elderly, children,and migrant workers. Oregon ESSENCE staff also recommendedqueries that would be used if large numbers of people were displaced(e.g., medication refills, dialysis).Before the onset of wildfire season, Oregon ESSENCEepidemiologists created queries and a MyESSENCE page for eachparticipant. LPHA staff practiced running the queries, modifyingthem, and discussed interpretation and data-sharing best practices.During wildfire season, brief weekly webinars enabled participantsto ask questions and learn additional techniques including displayingtime series as proportions and adjusting geographic parameters tofocus on areas with poor air quality.Results2015 was a severe wildfire season in Oregon, with over 685,000acres burned2. For the first time, local and state public health were ableto monitor and share near real-time health information on interagencysmoke calls. In the post project evaluation, participants reportedincreased knowledge of syndromic surveillance, interpretation,and risk communications. There were no marked increases in totalemergency department visits, or visits for asthma, heart palpitations,or other heart complaints. The public may have adhered to warningsand effectively protected themselves against exposure to wildfiresmoke, or health effects may have been less severe and not reflectedin emergency department data. Over the next several years, OregonESSENCE will integrate select urgent care data, which may bettercapture morbidity due to wildfire smoke.ConclusionsFraming syndromic surveillance training around a healthsurveillance need was effective because participants were engagedaround a high-priority health hazard. In summer 2016, OregonESSENCE integrated wildfire health surveillance into a biweeklyESSENCE seasonal hazard surveillance report and invited wildfireresponse partners to subscribe. Local ESSENCE users can use ormodify the queries. In 2017, Oregon ESSENCE will incorporate airquality data from the Environmental Protection Agency so partnerscan monitor air quality and health effects simultaneously.