Abstract
Wildfires are increasing in frequency and intensity, which increases outdoor workers’ risk of breathing smoke for sustained periods. Occupational health nurses have multiple roles to play to protect outdoor workers from the new “smoke season.”
Forest fires in the western United States are nearly 5 times as frequent as they were 50 years ago with increased prevalence and severity expected due to climate change and land management policies (Balmes, 2018). Wildfire smoke affects more people than those endangered by wildfire. Short-term exposures to fine particulate matter (PM2.5) in wildfire smoke increase risk of adverse respiratory and cardiovascular outcomes, such as exacerbations of asthma and chronic obstructive pulmonary disease, to name a few (Atkinson, Mills, Walton, & Anderson, 2015).
Outdoor workers, such as agricultural workers, grounds maintenance workers, and construction laborers, masons, painters, and roofers, spend most of their working hours outside, and therefore are at increased risk for breathing wildfire smoke (U.S. Department of Labor & Bureau of Labor Statistics, 2019). Those with underlying lung disease are most at risk.
In 2019, the California Division of Occupational Safety and Health (Cal/OSHA) issued Assembly Bill 1124 proposing that employers use the local air quality index (AQI) or a direct-reading PM monitor to determine smoke levels and offer respirators to workers expecting exposure to harmful levels of smoke (California Legislature, 2019-2020). The bill provides a temporary exemption from the medical evaluation and fit testing requirements for respirators due to the unpredictable nature of wildfire smoke. Having passed in the Assembly, it awaits Senate action.
The AQI reflects federal health standards of five air pollutants identified in the Clean Air Act, including PM2.5. The AQI ranges from 0 to 500, with values related to a level of health concern: good (0-50), moderate (51-100), unhealthy for sensitive groups (101-150), unhealthy (151-200), very unhealthy (201-250), and hazardous (251-500; Environmental Protection Agency [EPA], 2019). The EPA’s “Air Now” website (https://airnow.gov) gives a 24-hour forecast of the AQI.
Occupational health nurses, employers, and employees should use the AQI to inform work activities and prevention efforts. A “smoke season” is predicted annually for the American West, and occupational health nurses must advocate for longer term protections for outdoor workers such as engineering (e.g., vehicle cabs with filtered air) and administrative controls (e.g., reduction in work intensity, additional rest periods; Steiger, Parker, & Katten, 2018).
Multiple AAOHN and NIOSH research priorities relate to wildfire smoke hazards, such as control of hazards and exposures, influences of the built environment, and organization of work. To promote evidence-based practice in our changing environment, occupational health nurses can take the training titled, “Particle Pollution and Your Patient’s Health,” geared toward health care professionals (EPA, 2017). Applying course content (e.g., the health effects of particulate exposure, using the AQI, and methods to reduce exposure) to the workplace will help ensure adoption of best practices.
In summary, as wildfire intensity and frequency increases, outdoor workers are at risk of breathing wildfire smoke for sustained periods. Occupational health nurses have multiple roles to play to protect these workers during future “smoke seasons.”
