Apocalypse Now: Climate Change, Cardiac Arrest, And The Price Of Inaction

It seems impossible that 2020 could have brought another existential challenge to life as a lung and ICU doctor. As COVID-19 broke out earlier this year, I found myself on phone calls with physicians practicing in far-flung areas, helping host regular calls and webinar to keep doctors in my state updated on the rapidly changing science, working on triage protocols for decisions nobody should ever have to make, all trying to adjust rapidly to this deadly viral pandemic. I later found myself having to research and share the health effects of the tear gas being used in my home city of Portland, Oregon, particularly after a patient of mine had it enter her house, and now I find myself with deadly particulate matter levels outside from fires raging throughout the West Coast, brought on by our inability to effectively address climate change.

I am privileged to enjoy a safe home with a robust and expensive air filtration system that was very important to me as a lung doctor trying to protect my family from particulate matter. However, while driving back from a vacation by the river, that was cut short due to wind and fire, I saw multiple tents pitched not in a beautiful natural scene, but by the side of the road from those suffering from a chronic lack of housing. I could not help thinking about all the people living in them, not only breathing traffic-related particulate matter on a daily basis, but now also breathing very deadly air from wildfires raging in our state, carried on deadly and swift winds.



The science tells us that within days, people breathing this air are going to start to suffer bad health effects, from asthma and bronchitis attacks, to strokes, heart attacks, and more. Children will have breathing problems. People will die, and human psychology will attribute this to random events. Maybe it was just their time. Maybe this was just when their heart attack or asthma exacerbation hit. Or maybe it’s because they were breathing air filled with particulate matter. We know that particulate matter kills. Unfortunately, it has no political or partisan agenda. Whether the particulate matter is coming out the end of a cigarette butt, coming from the exhaust of a diesel engine, or coming from a wildfire due to high temperatures, dry conditions, and wind conditions worsened by climate change, the end result of death and disability is the same.

Multiple studies have demonstrated this association. I simplify it all by saying, “Don’t light things on fire and breathe them into your lungs.”

There are too many studies to cover, but one I’ll focus on is an analysis done of one of the most dramatic ways of dying, out-of-hospital cardiac arrest. An out-of-hospital cardiac arrest is when suddenly someone just drops dead from their heart being unable to pump correctly. These things can be measured with emergency medicine databases, and a group of researchers looked at the levels of particulate matter, and air pollution following the wildfires in California from 2015 to 2017, and they were able to see that as exposure to wildfire particulate matter increased, so did the rates of cardiac arrest.

The costs of this are obviously astronomical. The most immediate cost is the loss of life or disability from suffering an out-of-hospital cardiac arrest. If you’re lucky, and you’re able to be resuscitated and taken to a hospital where we can save your life, maybe you go back to your family, but not until after racking up significant health care costs, including the trip to the cardiac cath lab, your new stent and the very expensive medications required to keep it open, your ICU stay, the doctor fees, the post-hospitalization rehab facility, etc. Maybe your brain is now damaged from its time without oxygen, and you lose your job. If you’re even less fortunate, and you die, your family loses a loved one, a caregiver, a breadwinner, and an essential element of the family sense of identity and safety. Either way, that’s a massive personal and economic loss for a family and a community. These costs are in addition to the loss of homes and property, loss of affordable home insurance policies, not to mention the economic hit borne by areas that depend on tourism and outdoor activities for their economic stability or the farms that have lost a harvest.

We have to start understanding these as the real costs of climate change. We are paying these costs now. In my state of Oregon, people are going to start getting sick and dying in the next few days of the wildfire smoke choking the air. When they show up to the hospital with a severe heart attack, or stroke, or respiratory exacerbation, maybe it will be attributed to the wildfires, but probably everyone will just be focusing on getting through their shift, and the context of this one death, this one illness, will be missed. But make no mistake, the coming wave of hospitalizations, ER visits, and deaths is not random; it is due to climate change.

It is up to us when we want to do something about this. We need to speak up about this loudly and clearly, and invest our money wisely to transition away from a high carbon economy. We need to plan for climate resiliency by decreasing other particulate matter burden, whether from traffic-related air pollution or tobacco smoke, so that when these events hit, more people are healthy enough to survive them and thrive afterwards. I think of my young kids playing in the air that is still contaminated despite our expensive home air filter’s best efforts, and I hope that we all decide to act so they have better and healthier futures.

Erika Maria Moseson is a pulmonary and critical care physician.

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