1. Pocosin Lakes National Wildlife Refuge Wildfire 2008 Health Effects Study Ana G. Rappold, Statistician, Clinical Research Branch, Environmental Public Health Division, US EPA Wayne E. Cascio, MD, FACC, FAHA Director Environmental Public Health Division, US EPA Susan L. Stone Lucas M. Neas, Vasu J. Kilaru, Martha Sue Carraway, James J. Szykman, Amy Ising, William E. Cleve, John T. Meredith, Heather Vaughan- Batten, Lana Deyneka, and Robert B. Devlin

2. Cardiovascular and Respiratory Health Data Emergency Department Visits NC Disease Event Tracking and Epidemiologic Tool – NCDETECT - early event detection and public health surveillance program - 45,836 cardio-pulmonary daily visits within 41 counties over 6 week period - county of residence, gender, age, and discharge diagnostic codes Hospital Admissions East Carolina University Medical Center, Greenville, NC - full chart review by medical professional - individual level data with geo-coded address GOAL: to understand impact on community health, economy, and the environment

3. Federal and State Air Quality Monitoring Fine and Coarse PM (FRM, TEOM) Gasses: O3, NOx, CO

4. CMAQ 9 Day Run Source AMAD, NERL, US EPA

5. Martin County Fine Particulate Matter

6. Rappold AG et al. Environ. Health Perspectives 2011 Aerial maps showing counties impacted by the wildfire on June 10, 11, and 12 th as measured by satellite AOD images

7. Pocosin Lakes National Wildlife Refuge Wildfire 2008 Daily counts of asthma ED visits in the exposed counties Arrows represent the 3 day of high exposure (red) and the subsequent 5 lag days (blue) Rappold AG et al. Environ. Health Perspectives 2011

8. Percent change in cumulative RR by discharge diagnosis category for exposed and referent counties in NC during 3-day period of high exposure compared with the entire 6-week study period. Health Effects

9. Pocosin Lakes NationalWildlife Refuge Wildfire 2008 First population based health study of peat bog fire utilizing syndromic surveillance system. Statistically significant changes in asthma, COPD, pneumonia and acute bronchitis, heart failure as well as an increasing trend for acute coronary syndrome related visits. Questions Raised: - Peat vs. Forest fires; difference in burning temperature, chemical properties, organic composition, toxicity and exposure at ground level. - Susceptible population with high rates of diabetes and hypertension.

10. Mortality Rates from Cardiovascular Disease: NC and Eastern NC Total Population, 2000-2004 ECU, Center for Health Services Research and Development 2007 Five-Year Average, Age-Adjusted Rates Standardized to US 2000 SM Data Source Odum Institute UNC-Chapel Hill

11. Percent High Blood Pressure by Race/Ethnicity NC BRFSS 2007 ECU, Center for Health Services Research and Development 2007

12. Determining the Role of Health Disparities in Susceptibility to Adverse Health Outcomes We examine cardiovascular outcomes as modified by indicators of county level health disparities. Health Outcomes Mortality Morbidity Health Factors Health Behaviors Clinical Care Socioeconomic Factors Physical Environment Developed by University of Wisconsin, population Health Institute and Robert Wood Johnson Foundation Health Ranking Weights for the 2010 County Health Rankings (source www.countyhealthrankings.org accessed July 2010) www.countyhealthrankings.org

13. Health Disparities and Susceptibility to Adverse Response Estimates are based on 100µg/m3 increase in PM2.5 concentration from NOAA Hysplit Model Congestive Heart Failure Asthma

14. Current and Future Studies It is expected that the risk of peat fires is likely to increase in upcoming decades due to prolonged drought periods, population changes and land use practices. Peat covers only 2% of global land cover, but peat fires are very difficult to manage, and produce substantial ground level pollution It is necessary to understand impacts on community health, economy and environment, in order to make better informed decisions. Impacts of wildfire smoke exposure on hospital admissions. Follow up study of the impacts of 2011 Pains Bay fires. Look for collaborations to better understand events and exposure matrix during these events