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San Mateo County, California Creates Novel Approach to Monitoring Emergency Room Visits Related to Wildfire Smoke Events

Posted By Alesha Thompson, MPH, Friday, May 15, 2020
Updated: Thursday, May 14, 2020

In 2019, wildfires burned an estimated 259,823 acres of land in the state of California. 

The impact of climate change on health is receiving increasing attention at the national level, especially when extreme weather events such as hurricanes and wildfires are affecting communities across the country. The Council of State and Territorial Epidemiologists (CSTE) provides a forum through its Climate, Health, and Equity Subcommittee for epidemiologists who work in the climate and health field at state, tribal, local, and territorial levels. The subcommittee was formed in 2004 to create the State Environmental Health Indicators Collaborative (SEHIC) and has continued to allow members to collaborate and share best practices.
The subcommittee is supported by funds from the CDC Climate and Health Program. In 2018, CSTE was awarded funds for pilot projects to address wildfire events and respiratory health outcomes. San Mateo County Health was one of two sites selected to receive this funding. San Mateo County, which is located in the San Francisco Bay Area, has a very high fire hazard severity zone designation in eight of its cities. Additionally, the San Mateo Medical Center had the highest daily average percentage of emergency room visits for all respiratory health syndromes among the emergency departments participating in the county's BioSense system, during the deadly Camp Fire in Butte County that occurred in 2018.
Karen Pfister is the supervising epidemiologist in the San Mateo County Health’s Office of Epidemiology and Evaluation. In addition to Karen, epidemiologists Edwina Williams, Aracely Tamayo, and Tiffany Tsukuda, and epi intern Morgan Rousch, worked on a project to assess asthma burden in the county’s vulnerable populations. They also used epidemiologic methods to build surveillance capacity for asthma-related emergency room visits following wildfire-smoke events. The team named their project the 2019 Climatic Exposures and Respiratory Health Outcomes Pilot (CERHOP).
The CERHOP team developed a modified vulnerability/risk index and surveillance plan for sensitive populations in the county and developed working relationships with key partners. When creating the modified vulnerability index, they combined data from local, state, and federal surveillance levels into the index. When finished, users will be able to select indicators and decision support layers to visualize the impact of wildfire events. They also used modified ESSENCE syndromic surveillance methods for acute and intermediate respiratory health effects during wildfire events. The team is currently finalizing a public dashboard to share this risk index and syndromic surveillance data. Lastly, they initiated the development of an asthma and respiratory disease registry of San Mateo County Health patients.
San Mateo County plans to finalize the project and share it with the public health community this year. CSTE was also awarded funds to work with the National Syndromic Surveillance Program Community of Practice (NSSP CoP) to develop a wildfire syndromic surveillance guidance document for state and local health jurisdictions to use when planning for and responding to wildfire events.
Projects such as the San Mateo County Climatic Exposures and Respiratory Health Outcomes Pilot allow for continued sharing of lessons learned and best strategies for preparing for wildfire events.


Alesha Thompson, MPH, is a CSTE program analyst focused on Environmental Health, Climate, and Disaster Epidemiology activities.


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