THERMAL INJURY

In thermal inhalation, the airway is injured by the introduction of superheated air or steam. Such injuries almost always occur in an enclosed environment, although occasional mishaps occur in association with wildland fires (see page). Because water conducts heat approximately 30 times as efficiently as air, the risk of injury is far greater with steam than with dry superheated air.

The heat injures the inside of the mouth and nose, throat, vocal cords, trachea, bronchi, and occasionally lungs. External signs of an inhalation injury include burns of the face and mouth, singed nasal hairs, and soot in the mouth and nose. Symptoms include shortness of breath; wheezing; coughing (particularly of carbonaceous black sputum); raspy, coarse breathing (stridor) noted most often during inspiration, with a barking quality that seems to originate in the neck; muffled voice; drooling; difficulty swallowing; swollen tongue; and agitation.

Once the burn injury has occurred, there is no effective way to limit its progress, so the victim should be transported as rapidly as possible to an emergency facility. If oxygen (see page 431) is available, it should be administered at a flow rate of 5 to 10 liters per minute by face mask. If the victim’s condition deteriorates rapidly because the airway becomes swollen and obstructed, the only hope for survival is the placement of a tube directly through the vocal cords and into the trachea, or the creation of an air passage through the neck (tracheotomy).

SMOKE (CHEMICAL) INJURY

Most smoke is composed of soot and various chemicals. Although each specific substance causes its own variation on the basic lung injury, the immediate first-aid approach is the same: Remove the victim from the offending agent, and immediately administer oxygen at a flow rate of 5 to 10 liters per minute (see page 431) by face mask. If the victim is having difficulty breathing or is without respirations, he should be supported with mouth-to-mouth breathing (see page 29). Difficulty in breathing may be delayed for a few hours after smoke inhalation, so a victim should seek immediate medical attention even if he feels fine initially.

The utmost caution must be exercised when removing a victim from the source of suspected toxic gases, so as not to create additional victims. Rescuers should wear gas masks if they are available. Carbon monoxide intoxication is discussed on page 334.

Smoke from wildland fires can affect your health. A person does not acclimate to smoke in any way, and repeated exposures can diminish lung function. So, avoidance is very important.

Intense exposure to heat and smoke when in the immediate proximity of a raging forest fire causes burns, asphyxiation from lack of oxygen, carbon monoxide poisoning, and injury by other severe, acute causations.

Smoke exposure of a degree to create a hazy horizon, where you can see, smell, and taste the smoke, may also cause health problems. Healthy persons are usually not at a major risk from such smoke. But of course, it’s always a good idea to avoid breathing smoke if you can help it. Smoke is not good for you.

Smoke is a mixture of gases and fine particles produced when wood and other organic matter burn. It reflects the fuel, so can contain products of combustion from rubber, plastics, and any other material consumed in the blaze. Firefighters have the greatest exposures to smoke, and they are often affected. It has been estimated that nearly 40% to 50% of medical encounters by wildland firefighters are for respiratory problems. Whether or not this statistic can be perfectly extrapolated to a nonfirefighter population passively exposed to wildfire-generated smoke is not known, but it is highly likely that respiratory ailments and diminished lung function would be a logical result of exposure to smoke.

What’s in the smoke? Some of the combustion products of concern include these classes of materials: particulate matter (organic and inorganic), carbon monoxide, ozone, organic acids, polynuclear aromatic hydrocarbons, volatile and semivolatile organic compounds, and free radicals. These are present or absent in varying degrees depending on the fuel burned, temperature of the fire, suppression method(s) used, and other factors. Therefore, the toxicity of the smoke may vary, but for the purposes of this discussion, all smoke from wildland fires should be considered comparable.

Because particulate matter dominates in proportion within wildland fire smoke, the greatest health threat from smoke comes from the fine particles, which are often microscopic. The particles easily get into the eyes and respiratory system, where they can cause health problems such as burning eyes (conjunctivitis), irritated throat, runny nose (sometimes associated with an allergic response), and illnesses such as bronchitis (cough). Fine particles also can worsen chronic heart and lung diseases. Because death rates from these conditions have been noted to rise in a smoky environment, the smoke has been linked to premature deaths in people with these conditions, in a fashion analogous to increased mortality rates during heat waves.

Persons who are more susceptible to ill effects at lower smoke levels are those with heart disease (congestive heart failure, symptomatic angina, cardiomyopathy), lung disease (asthma, reactive airway disease, chronic obstructive pulmonary disease [COPD]), and any medical condition in which oxygen delivery and heart and lung function are essential for health and wellness.

Older adults appear to be at increased risk of being affected by smoke, as do children with high activity levels. Firefighters, athletes, soldiers, and others who exercise in smoky conditions often report feeling poorly, sometimes up to the point of incapacitation.

It is not difficult to know if smoke is affecting you, if you develop symptoms. It is less easy to know if you are being affected if the impact is subtle. Obvious symptoms are irritated and reddened eyes; painful throat; fatigue; decreased exercise tolerance; palpitations; chest pain; shortness of breath or inability to draw a deep breath; coughing; wheezing; sinus irritation; headache; or worsening of preexisting conditions that manifest any of these symptoms.

Prevention is key. One must know how to limit exposure to smoke:

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