The Health and Environmental Toll of the LA Wildfires

The historic Los Angeles wildfires have had a profound environmental and human impact on the nation’s second-largest city. Thousands of homes, businesses, schools, and health centers have been destroyed. Tens of thousands of acres have burned, covering the entire region in smoke and ash. Hundreds of thousands of residents have been evacuated, and the number of lives lost remains uncertain. 

Beyond the immediate devastation, the wildfires have far-reaching implications for the health and well-being of residents and first responders, both in the short and long term. Understanding and addressing these impacts is critical to mitigating harm and improving recovery efforts.

Immediate Health Impacts

Wildfire smoke poses a significant threat to respiratory and cardiovascular health. Millions of people in the Los Angeles area are experiencing exacerbations of chronic lung conditions such as asthma and chronic obstructive pulmonary disease. 

Particulate matter from wildfire smoke (PM2.5) may trigger lung inflammation even in healthy individuals and has been associated with increased risk for strokes and heart attacks in at-risk populations. 

The rise in acute illnesses has placed additional strain on already compromised healthcare system. Emergency department visits and hospital admissions have surged, while older adults and chronically ill individuals face displacement due to the destruction of care facilities. Skilled nursing facilities, many of which are already understaffed, are struggling to accommodate the influx of patients. 

Long-Term Health Risks

The long-term health consequences of wildfire exposure are concerning. The large-scale burning of urban structures has released a wide range of toxic substances into the air, soil, and water. These include:

• Airborne toxins: Plastics, paints, electronics, asbestos, insulation, and heavy metals release chemicals such as hydrochloric acid, ammonia, benzene, formaldehyde, and polycyclic aromatic hydrocarbons.
• Contaminated water supply: Reservoirs exposed to airborne toxins may pose risks to drinking water quality.
• Soil contamination: Toxic residues from burned materials can leach into the soil, requiring extensive cleanup efforts.

The health effects of these toxins can persist for years, leading to conditions such as asthma, bronchitis, interstitial lung diseases, cancers, and other systemic illnesses. Lessons from 9/11 underscore the potential for delayed onset of health conditions, including lung diseases and cancers, among those exposed to similar toxins. 

Additionally, the widespread use of lithium in electronics and batteries may pose a unique risk. When released into the environment, lithium contamination can have toxic effects on the nervous system, kidneys, and gastrointestinal system, though more research is needed to fully understand these risks.

Psychological and Social Impacts

The psychological toll of the wildfires cannot be overstated. Thousands of residents have lost their homes, possessions, and community infrastructure, including schools and places of worship. Children are particularly vulnerable to the psychological effects of such disasters. The loss of homes, schools, and friendships can lead to long-lasting trauma. 

Posttraumatic stress disorder (PTSD), depression, anxiety, sleep disorders, substance abuse. and even suicide are likely to rise significantly among affected populations. Estimates of PTSD prevalence following 9/11 ranged from 7.5% to 20%; the rate in California may be higher due to the scale of displacement and destruction. 

Recommendations and Call to Action

To mitigate the health impacts of the wildfires, immediate and long-term actions are needed.

Short-Term Measures 

• Provide personal protective equipment: Distribute N95 masks with filters to reduce exposure to PM2.5 and airborne toxins.
• Health screenings: Offer early screenings for respiratory illnesses and other acute conditions.
• Mental health support: Deploy counselors and mental health professionals to provide trauma-informed care for affected residents and first responders.
• Emergency prescriptions: Ensure access to replacement medications for displaced individuals.

Long-Term Initiatives 

• Environmental monitoring: Conduct extensive testing of air, soil, and water for contamination. Initiate large-scale cleanup efforts, including the creation of safe landfill areas for toxic debris.
• Health surveillance: Establish a robust system to monitor the health of exposed populations over the coming decades.
• Community education: Inform residents about the risks of exposure to ash and debris and provide guidance on protective measures.
• Infrastructure rebuilding: Rebuild healthcare facilities, schools, and housing with an emphasis on resilience to future disasters.

Learning From History

The tragedy of 9/11 offers invaluable lessons for addressing the health impacts of the Los Angeles wildfires. Proactive measures — from health screenings to environmental remediation — must be prioritized to prevent long-term harm. Early intervention in mental health care and community support is essential to rebuilding lives and fostering resilience.

By relying on history and acting decisively, we can help affected communities recover and safeguard their future health and well-being.

Robert D. Glatter, MD, is an assistant professor of emergency medicine at Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He is a medical advisor for Medscape and hosts the  Hot Topics in EM series.

Peter J. Papadakos, MD, is a professor of anesthesiology, surgery, neurology, and neurosurgery at the University of Rochester. He is also the director of critical care in the anesthesiology department at the University of Rochester Medical Center in Rochester, New York.