Oregon's Active Fire Season Brings Smoke-Related Challenges

Poor air quality from the wildfires near Portland, Oregon, posed unusual challenges for area hospitals — including the compounding operation at Legacy Meridian Park Medical Center in Tualatin.

Director of Pharmacy Services Doug Meyer said the hospital’s air-handling system normally pulls about 30% of its air from outside the facility. But with high levels of smoke in the area, the hospital switched to “zero percent” outside air for about a week in late September, Meyer said.

That change caused differential air pressure in the cleanroom to fall outside of specifications, and the pharmacy had to shorten beyond-use dates for compounded products made during the smoke event.

“We were not able to do batching” during this time, Meyer said. He added that the problem persisted long enough that the cleanroom required a deep cleaning after the smoke abated.

Despite changing the air circulation, closing some entry doors, and even installing a carbon filter on the rooftop air handler, smoky air from outside continued to seep into the hospital.

“It was certainly a noticeable and at times uncomfortable smell,” Meyer said.

Meyer said he’s been in Oregon for nearly a decade and has never seen a fire season like this year’s, with smoke and fire encroaching on urban areas. He said the hospital staff huddled daily for about a week just to manage the evolving situation.

“We have seven hospitals in our system, and one of them was relatively close to the actual fires such that we ... relocated our inpatients there to one of our other hospitals,” Meyer noted. “We kept the emergency department open for walkups. But otherwise, that hospital essentially closed.”

Fire activity in nearby states also affected medication delivery to the health system.

“We had some delays with our high-dose flu vaccine coming up to us through California,” Meyer explained. “We had an order of 700 boxes of the high-dose vaccine, and were able to get 50 of those 700 for all the hospitals and clinics. ... It hit right during the week of starting our flu clinics for employees as well as patients. That didn’t impact us with patients being able to get vaccine, we just had to shift things around to manage that.”

In the two months since Sept. 7, wildfires killed nine people in Oregon, destroyed more than 4,000 homes, and burned nearly a million acres, according to the Oregon Office of Emergency Management (OEM).

A Sept. 20 report from the Oregon Department of Environmental Quality states that wildfire seasons have lengthened over the past decade in the Western United States and Canada, and fires are burning larger areas than in the past. This trend includes an increase in days with air quality rated unhealthy in parts of Oregon because of wildfire smoke.

According to the report, Portland had no wildfire-related “unhealthy” or “unhealthy for sensitive groups” air quality days from 1985 through 2014, but the city recorded 14 such days from 2015 through 2019. The report doesn’t include data from the 2020 fire season.

Meyer said some of his hospital colleagues were unable to make it into work during the smoke emergency. Others were working while also monitoring the evacuation status in their neighborhood.

Some of the health system’s 13,000 employees were evacuated from their homes during the fires — an added stress on top of the COVID-19 pandemic that staff have been coping with for months, Meyer said.

“We did have some employees that did lose their homes,” he said. “Some people lost everything.”

Erin Wu, fourth-year student at Oregon State University College of Pharmacy in Corvallis, said smoke from nearby wildfires became an issue during the first week of her intensive care unit rotation at Oregon Health and Science University Hospital.

“It was pretty bad here,” she said. “They actually didn’t let us come into the hospital during ... part of the rotation.”

Wu said her community was under an OEM Level 2 evacuation alert. The warning indicates there is “significant danger,” and everyone in the area must prepare to leave at a moment’s notice.

“My apartment building actually sent an email out telling us to get our backpacks and be ready to go,” Wu said. “I didn’t evacuate, but I had my bags ready. And I was a little stressed because I don’t have any family here, so it would be stressful for me to find a place to stay.”

Meyer said that although the immediate local fire threat waned in early October, other areas in the state remained at risk.

“The fires are not out,” he said. “So the fact that Portland doesn’t feel them anymore doesn’t mean they’re not still burning.”

[This news story will appear in an upcoming issue of AJHP.]