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Driving north on the 405 freeway this past Friday night, I witnessed an eerie scene: the usually congested freeway was surprisingly empty. The smoke plumes from the Palisades fire created a Dali-esque skyscape, their amorphous shapes zigzagging from west to east in utter disarray, as if nature was pointing the blame for the chaos at us mortals below.
As I made my way through the Sepulveda Pass, I could see the embers of ash enveloping my car in a cocoon of particulates. The distant sounds of helicopters and military planes created a pulsating rhythm of unease, their propellers echoing the collective heartbeat of a city on edge. I then crossed into the San Fernando Valley onto the 101 Freeway. I could see in the distant hills an explosion of red hues, like a volcano spewing its inner contents out in a constant flow of ethereal lava.
As the City of Angels grapples with an unprecedented environmental crisis, the once-familiar landscape has transformed into a surreal canvas of smoldering masses. These wildfires have painted our skies with an otherworldly palette, oscillating between the celestial and the infernal.
This wildfire is not like previous ones. It is affecting hundreds of thousands of people at the urban-wildland interface. It involves many man-made buildings which, as a result of the scale of the burning, are releasing a slew of toxic chemicals into the air. These include particulates like PM2.5 as well as the byproducts of plastic, fire retardant materials, and asbestos, among a host of thousands of chemicals found in commercial and residential properties. Given the large amounts of chemicals circulating right now in the greater atmosphere, this puts first responders and the broader community at significant risk for inhalational injuries. Moreover, with the inconsistent use of personal protective equipment in the community, we are already seeing an uptick in the number of people seeking emergent medical attention.
The long-term effects of the mass release of these chemicals will more likely than not lead to broad chronic health effects as part of the “afterburn” of surviving the fire. There will also be increased concerns about cancer risks, as well as the immunological impacts on first responders and those in direct proximity to the wildfires, similar to the World Trade Center aftermath.
Nor can we forget the psychological toll these wildfires will have, particularly amongst those who lost their homes. Young and old people alike will be struggling with their mental health, with many suffering from anxiety and post-traumatic stress.
Managing Environmental Disasters
As an occupational and environmental medicine physician, I’ve dedicated my career to understanding the intricacies of how our environment impacts our health. The current wildfire crisis in Los Angeles has crystallized the urgency of our mission. Occupational and environmental medicine physicians are equipped to deal with natural disasters of this magnitude. We have the knowledge to understand the fundamental environmental hazards plaguing our cities and how to mobilize clinicians, public health professionals, government agencies, the private sector, and the greater community to get in sync to combat these epic challenges.
And we have dealt with emergencies of this magnitude before. After the 9/11 attacks, my colleagues and peers were instrumental in developing the World Trade Center program to monitor first responders over time, ensuring they were being screened appropriately and referred to specialty care if they were symptomatic. During the COVID pandemic, many of us helped employers develop standard operating procedures to keep workers working safely.
We are experts at medical surveillance. As part of our training, we are skilled at developing medical surveillance programming for firefighters and first responders to ensure they are physically and mentally fit to perform the essential functions of the job.
During the current crisis and to prepare for future climate-related crises, we must accelerate our efforts to create real-time environmental monitoring systems, bringing together data on air quality, pollutant levels, traffic routes, food resources, and healthcare access points into a single, actionable dashboard that our citizens can access at a moment’s notice.
Our agenda for the coming years includes:
- Developing research frameworks to assess the impacts of environmental hazards on urban, rural, veteran, and other vulnerable populations in the U.S. and globally;
- Enhancing existing emergency preparedness operations within healthcare systems to create a comprehensive approach to delivering exposure-informed care effectively and compassionately;
- Forging new partnerships with colleagues in the technology sector (including entrepreneurs in informatics and the AI space) to create cutting-edge environmental monitoring tools that can be widely deployed;
- Designing personalized guidance systems that adapt to individuals’ current environmental conditions and health states.
A Call for More Support
But we need more occupational and environmental medicine physicians. As of 2020, there were just 25 accredited occupational and environmental residency programs left in the U.S., with at least 18 programs having closed since 2000. These training programs have received inadequate investment for decades and we are beginning to see the ripple effects. We need these physicians now more than ever to develop resiliency strategies and implement them at scale, directing the charge toward environmental independence.
As Los Angeles faces this environmental juggernaut, we must emerge stronger and more resilient. The challenges we face today are not just local concerns but harbingers of a global environmental shift. By harnessing the power of data, technology, and medical prowess, we can build a future where our cities are not just surviving environmental crises but thriving in harmony with our planet. Occupational and environmental medicine physicians are at the critical nexus of these worlds. We can deploy our model of care to not only deliver medical services rapidly but also create preventive protocols to minimize exposures using the hierarchy of controls, the fundamentals of our practice.
The skies may be smoky, but our vision for a healthier, more resilient future has never been clearer. It’s time for Los Angeles and the rest of the country to lead the way in environmental innovation, adaptation, and ultimately, mitigation. Our city can become a beacon of hope in the fight against climate change, showing the world that even in the face of environmental adversity, human ingenuity and determination can prevail.
Manijeh Berenji, MD, MPH, is a double board-certified physician specializing in occupational and environmental medicine as well as preventive medicine. She is currently chief of occupational health at VA Long Beach Healthcare System, and leads the Environmental Health Clinic at VA Long Beach Healthcare System in California. She is also a clinical assistant professor in the Department of Occupational and Environmental Medicine at UC Irvine School of Medicine. She is chair of the Environmental Health and Health Informatics Sections of the American College of Occupational and Environmental Medicine. She is a member of the Medical Society Consortium on Climate and Health via the American Medical Informatics Association, where she serves as the chair-elect of the Climate Health and Informatics Working Group as well as the secretary of the Public Health Informatics Working Group.
The views of the author do not necessarily reflect those of the Medical Society Consortium on Climate and Health, the American College of Occupational and Environmental Medicine, the American Medical Informatics Association, the Veterans Administration, or the University of California or its staff/faculty/members.