The Impact of Wildfire Smoke on Rising Hospital Admissions: Michael Goulet, DO

An increased in emergency department presentations and hospital admissions for various cardiovascular and pulmonary conditions suggests that wildfire smoke can increase health care utilization, even in regions not typically affected by wildfires, says Michael Goulet, DO, pulmonary and critical care fellow, Temple University Hospital.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

What prompted your team to investigate the health impact of the 2023 wildfire smoke events in Philadelphia?

In 2023, eastern Canada had significant wildfires, and due to the weather pattern at that time, a large amount of wildfire smoke, particularly particulate matter, 2.5 microns or less, small particulate matter, was blown into the Northeast of the United States. This was a pretty unique event for the Northeast of the United States. We don't typically deal with wildfires in our region, at least to that degree. We thought this was a very unique event. We wanted to see what impact it had on our patients at Temple.

Your findings show an increase in cardiovascular and respiratory-related encounters during the wildfire periods. Can you elaborate on which specific diagnoses or patient characteristics you suspect contributed most to this spike?

We wanted to cast a pretty broad net, so we did a retrospective chart review looking for any cardiovascular or pulmonary diagnoses by ICD-10 [International Classification of Diseases, 10th Revision] codes. That was everything from cough and dyspnea to acute hypoxemic respiratory failure; so, a very broad net. We found that ED [emergency department] presentations were significantly increased from the prior years, and also the admissions of the hospital for these diagnoses were increased. When we did a deeper dive, we didn't really come up with any particular diagnoses that drove this effect. It seemed to be a little bit of everything, from, like I said, minor cough, dyspnea, to more serious events that required admission of the hospital, mechanical ventilation, that type of thing. That's consistent with prior data, we know that wildfire smoke does tend to increase ED admissions [and] hospital admissions for all sorts of cardiovascular and pulmonary events. A number of diagnoses really drove the findings.

How might these findings influence public health preparedness or hospital resource planning for future wildfire-related air quality events, especially in urban centers like Philadelphia?

The climate scientists tell us that wildfires are going to become more common even in our region of the Northeast United States. I think it's important that hospitals are aware of this, because I do think we're going to see seasonal increases in hospital utilization due to wildfires, even in regions of the country [and] in the world where wildfires are not historically prevalent. I think it's important to know that cardiovascular and pulmonary diagnoses and admissions to the hospital and ED presentations are likely going to increase in the warmer months, even in our part of the world.

Looking ahead to your future analyses, what types of disease processes or patient demographics are you most interested in exploring to better understand the drivers of increased health care utilization?

I think as we increase our future studies, we're going to get a little more information on who is most susceptible to these effects. We're looking at things like type 2 inflammation in the coming studies to see if there is a difference between the patient phenotypes for people who come to the hospital during these events. We're looking at markers of severity. We're going to look at whether some of these effects can be attenuated by different medications. We have a number of investigations to do still.