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Fire and fear: Immediate and long-term health aspects 

Fire and fear: Immediate and long-term health aspects
Fire and fear: Immediate and long-term health aspects

Laura Mitchem

, Henrietta Harrison

, and Alex G. Stewart

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date: 15 December 2018


After reading this chapter the reader will be familiar with:

  • the potential impacts of fires on health,

  • the multi-agency response to a major incident,

  • the factors to consider during the response to a fire, and

  • community concerns associated with fires.


Air Quality Cell (AQC) Multi-agency group convened for major chemical incidents such as fires, explosions, and major chemical releases, which brings together experts in assessing air pollution for chemical incident response.

Controlled burn A restricted or controlled use of water/foam on fires to reduce potential environmental impacts of chemical or contaminated fire-water run-off.

Geographic Information System (GIS) Visualization tools that allow users to create interactive queries, analyse spatial information, edit data in maps, and visually present relationships, patterns, and trends.

Recovery coordinating group (RCG) Multi-agency group which manages return to normality after incident.

Receptors People potentially affected by the incident.

(See further list of terms in the Glossary.)

14.1 Background facts: fire and health

  • Fires can cause significant health concerns within local communities affected by any associated smoke plume.

  • In recent years, there has been an increase in the number of long-burning fires. Fires at waste-processing and recycling facilities, involving a variety of household and commercial waste, can be difficult to control and extinguish and have the capacity to burn for many weeks, generating significant media and public concern and fear associated with their potential to affect public health.

  • The impact of the plume on the health of the community depends on the properties of the chemical species within the plume (e.g. concentration and solubility), plume dispersion (meteorological conditions, topography, etc.), and the duration of exposure of vulnerable people (sensitive receptors; e.g. the elderly, those with pre-existing respiratory and cardiac conditions, children). Smoke will be diluted in the air due to atmospheric dispersion, reducing the concentration of substances within the plume.

  • The composition of the plume is dependent on a number of factors including the materials involved, and the nature of the fire (temperature, oxygen availability, etc.), making it difficult to predict accurately the substances local sensitive receptors may be exposed to.

  • A smoke plume typically consists of a mixture of gases, liquid droplets, and solid particles (complex mixture of particle size and type). Irritants and particulate matter are the main health concern.

  • An overview of common types of fires and resulting products of combustion is detailed below (see Wakefield 2010 for further details).

    • Waste fires: stored waste includes refuse derived fuel, wood chips, and composting materials. Products of combustion are complex, due to the varied nature of the materials involved. A wide range of pollutants can be produced including particulate matter (PM10 and PM2.5), and organic and inorganic irritant gases (e.g. hydrogen cyanide, nitrogen oxides, ammonia, hydrogen chloride).

    • Tyre fires: ground/chopped tyres can result in a fire that is difficult to extinguish. Products of combustion include large quantities of sulphur dioxide, organic and inorganic irritants, and PM10 and PM2.5.

    • Warehouse fires: it can be difficult to identify materials involved in a warehouse fire, limiting the ability to provide tailored advice. There may be real concerns about the fibre release from asbestos-containing materials (e.g. roofing tiles and sheets).

    • Moorland/forest/bush fire/health lands: these long-burning fires, which often cover a large area, have caused air quality problems in many countries, often leading to respiratory effects in those exposed. Products of combustion include PM10 and PM2.5, and respiratory irritants including formaldehyde.

  • Irritant gases, present in most fires, can cause irritation to the eyes, nose, throat, and lungs, coughing and wheezing, breathlessness, phlegm production, and chest pain. Inorganic irritants include oxides of sulphur and nitrogen, hydrogen chloride, hydrogen bromide.

  • Fires have the potential to generate high levels of PM10 and PM2.5, resulting in local, short lived peaks of pollution. Elevated levels of particulate matter are associated with short- and long-term effects on mortality, and increased hospital admissions relating to cardiovascular and pulmonary disease. For susceptible individuals with pre-existing respiratory conditions, particulate air pollution can exacerbate their conditions.

14.2 What’s the story?

  • A large fire has broken out at a waste management centre. A plume of thick black smoke is visible at a distance of 10 km, generating significant media interest. Local health protection/public health team have been informed.

  • There are schools, nursing homes, and residential properties close to the site.

14.2.1 Key scenario information

  • Fires at waste-processing and recycling facilities present many challenges for the fire and rescue service (FRS). Waste is often tightly packed on the site or stored within buildings, making aggressive fire fighting difficult due to limited space between stockpiles and poor access. Water availability and management of large volumes of fire-water run-off can also affect fire-fighting activities, often resulting in the decision to undertake a controlled burn, which may not be in the best interest for public health.

  • Plumes can be large, visible over long distances, resulting in concern to those living close to the fire, and further afield, generating local and national media attention.

  • Fires can cause significant health concerns within local communities affected by the smoke plume. Concerns can be associated with:

    • impacts on local air quality and health,

    • presence of hazardous substances, or

    • impacts of fire-water run-off on the environment (e.g. controlled waters) and public health (e.g. water supplies, recreational water use).

  • Materials involved, predicted duration, plume behaviour, meteorological conditions and locations of sensitive receptors are key information for the initial stage of the response.

14.2.2 Top tips

  • Any smoke can irritate; therefore, individuals are advised to avoid exposure to the plume.

  • Symptoms of exposure include eye irritation, coughing, wheezing, breathlessness, phlegm production, and chest pain. Smoke can exacerbate existing conditions, and individuals with pre-existing underlying respiratory or heart conditions (e.g. asthma, cardiovascular conditions, chronic obstructive pulmonary disease), children, and the elderly are particularly susceptible.

  • Most healthy individuals only suffer transient and reversible effects after exposure to low levels of smoke. It is very unlikely that any long-term effects will occur as a result of acute exposure to smoke.

  • Those with pre-existing conditions should use their inhalers as normal.

  • Individuals who develop symptoms should seek medical advice.

  • Coordinated multi-agency communication is key to ensuring those with the potential to be affected are aware of protective actions to minimize their exposure.

14.2.3 Tools of the trade

  • Meteorological Office modelling (CHEMET) to predict area potentially affected by plume,

  • use of GIS/maps to determine local population and locations of sensitive receptors, and

  • local knowledge with feedback from the incident.

14.2.4 What immediate action(s) would you take and what further information do you need?

  • Obtain information to undertake the risk assessment (Box 14.1).

  • Identify those at risk from plume.

  • Confirm agencies involved and whether a major incident has been declared.

  • Review contents of media messages issued.

14.2.5 Key scenario information

Sheltering indoors significantly reduces exposure to smoke, and is considered appropriate for short-lived fires. Shelter messages are usually issued initially by the emergency services.

Go In—Stay In—Tune In!

  • Go indoors.

  • Close all windows.

  • Turn off any mechanical ventilation including air conditioning.

  • Tune in to local radio/TV.

  • Check the Internet and social media for news.

  • Stay in until advised.

14.3 Scenario update # 1

  • The FRS has advised that the warehouse contains 100,000 tonnes of baled waste, including paper and plastics. They are struggling to access the fire due to the large quantities stored within the building, and predict the fire is likely to burn for a number of days, potentially weeks. There are concerns about access to water supplies, and possible contamination of a nearby waterbody. A major incident has been declared.

  • A Strategic Coordinating Group (SCG) has been established, and Public Health attendance has been requested at a Scientific and Technical Advice Cell (STAC) (Figure 14.1).

Fig. 14.1 The relationships of the local multi-agency groups convened in an emergency to coordinate the response (see text for abbreviations)

Fig. 14.1 The relationships of the local multi-agency groups convened in an emergency to coordinate the response (see text for abbreviations)

14.3.1 Key scenario information Strategic Coordinating Group (SCG)

The SCG maintains a strategic overview of the operation, and leads the incident response. It focuses on the overall picture rather than detailed tactical or operational decisions, and determines long-term and wider impacts or risks with strategic implications.

Aims include:

  • agree strategic aims, objectives and priorities,

  • determine policy, for implementation by the Tactical Coordinating Group (TCG),

  • act as an interface with local and National Government,

  • liaise with neighbouring agencies/authorities,

  • coordinate communication to the public or allocate appropriate agency to lead on communications,

  • ensure regular meetings and availability of situational reports (SitReps), and

  • ensure transition from the operational stage to recovery.

Membership varies according to the scale and nature of the incident and should be reviewed throughout. Representatives must have the knowledge, expertise, and authority to identify and commit resources on behalf of their organization. Tactical Coordinating Group (TCG)

The TCG ensures the actions taken at an operational level are coordinated, coherent, and integrated to achieve maximum effectiveness and efficiency.

Aims include:

  • direct tactical operations to ensure a coordinated response,

  • determine priorities for allocating available resources,

  • plan and coordinate how and when tasks will be undertaken,

  • obtain additional resources if required,

  • assess significant risks and organize appropriate actions, and

  • ensure health and safety of the public and personnel.

Membership varies according to the scale and nature of the incident and normally comprises the most senior operational member of each organization.

14.3.2 Key scenario information Scientific and Technical Advice Cell (STAC)

STAC ensures provision of timely, coordinated scientific and technical advice to the SCG and Recovery Coordinating Group (RCG), often when there are wide health and environmental consequences of the emergency.

Aims include:

  • bring together technical and scientific experts from agencies involved in the response,

  • provide a single point of advice to the SCG on scientific, technical, environmental, and public health consequences of the incident, and

  • develop public health advice and formulate actions to protect the public and environment.

Membership will depend upon the nature of the emergency and the scientific and technical advice required.

14.3.3 What further action(s) would you take?

  • Attend multi-agency meetings as appropriate to your agency’s involvement.

  • Contribute to ongoing multi-agency communications addressing the concerns of the local community. Perceived fears arising from incidents such as a fire should not be underestimated and need a strong, proportionate, and appropriate response.

  • Consider the potential impact of the plume (dispersion modelling predictions and visual observations from the scene are invaluable in supporting the risk assessment).

  • Undertake ongoing risk assessment with available environmental monitoring data.

14.3.4 Key scenario information

Air quality monitoring undertaken at sensitive receptor locations during a fire can support the public health risk assessment, public health advice, and shelter/evacuation decisions. An indication of the level of pollutants at specific locations may be available from the local Automatic Urban and Rural Network (AURN), through an Air Quality Cell (AQC), or following the decision made by the local authority (LA) to provide reassurance to the local community. Air Quality Cell (AQC)

An AQC (England and Wales) may be convened during the response phase for major chemical incidents, where there is the potential to affect the public’s health. The AQC gives interpreted air quality information to a multi-agency group to assist with decisions regarding the impact of air pollution on health throughout the acute phase of the fire.

14.4 Scenario update # 2

  • The LA has called regarding a nursing home located within the plume. Residents have been advised to shelter. However, there are concerns because it is a hot day and windows are usually open for ventilation. They are considering evacuation of the residents, as the elderly with underlying health conditions are particularly at risk of heart and respiratory problems in very hot conditions.

14.4.1 What further action(s) would you take?

  • Consider the vulnerability of and risk to residents: some individuals may experience greater harm by being moved.

  • Provide:

    • advice to keep residents cool (e.g. how to cool properties, drink plenty of cool fluids, wear loose clothing (PHE 2014)),

    • tailored sheltering messages for residents, and

    • health advice for symptomatic individuals.

  • Interpret monitoring data to predict potential impact of the plume on residents’ health—consider locating any air quality monitoring equipment at property.

  • Consider the use of existing syndromic surveillance to identify unusual local health effects.

14.4.2 Key scenario information

Syndromic surveillance (SyS) is the (near) real-time collection, analysis, interpretation, and dissemination of health-related data to enable the early identification of the impact, or absence of impact, of potential threats. SyS systems can identify unusual patterns in healthcare presentation. SyS data from the affected areas can be compared with data from the same period in previous years, and unaffected areas, to identify statistically significant increases in relevant indicators. During a large fire, compare GP consultations for asthma and wheeze, and NHS 111 calls for difficulty in breathing with data from previous years. If levels observed are no different from those expected (using historical data for the time of year), reassurance can be provided to the public that there are no major local health impacts (see Chapter 21, section

14.4.3 Top tips

  • Tailor communications to the public as the incident progresses.

  • Address local fears and concerns in all communications to the public.

  • Give detailed protective actions to minimize exposure to smoke and in relation to when the property is no longer located in the plume (e.g. open windows and ventilate the property).

  • Advise those suffering persistent health effects to seek medical attention.

14.5 Scenario update # 3

  • The FRS has reported that the asbestos sheeting of the roof of the warehouse has broken up into fragments and been deposited downwind on the neighbouring housing estate and primary school. Locals are concerned regarding the risks to health. STAC has been asked for advice.

14.5.1 Key scenario information

Material which contains a proportion of asbestos (e.g. corrugated asbestos cement roofing panels, insulating board) is usually described as asbestos-containing material (ACM). Fires involving ACMs are relatively common and can cause significant public concern if debris is carried in the smoke plume and deposited in residential areas.

Unless ACM is weathered/friable, the majority of fibres in ACMs are held tightly within the material, even when an ACM is damaged. Respirable fibres are a small fraction of the total particles released. Atmospheric dispersion and dilution further reduce the concentration of airborne fibres. During an acute incident when sheltering advice is issued, the public exposure will be very low, minimizing the health risk. Available epidemiological evidence shows that long-term health effects from fires involving ACM are negligible (Smith and Saunders 2007). If appropriate clean-up procedures are followed, there is no significant public health risk.

14.5.2 What further action(s) would you take?

  • Support the LA in producing a strategy to identify areas requiring decontamination.

  • Maintain multi-agency communication with the local community throughout clean-up, providing clean-up advice, responding to queries to alleviate anxiety and input into press releases if required.

  • Confirm with the LA that clean-up has been completed.

14.5.3 Top tips

  • Appropriate clean-up of deposited ACM debris is paramount, as is prevention of further off-site recontamination (e.g. appropriate containment of incident site and off-site debris).

  • Previous air sampling after fires involving ACM has not revealed significant levels of asbestos fibres. While it may be considered for public reassurance, in most cases air sampling for asbestos is not necessary.

14.6 Scenario update # 4

  • Recovery: four days later the fire is out. In the transition from acute to recovery phase the incident has been handed over to the LA.

14.6.1 What do you need to consider in terms of recovery?

  • whether an RCG has been established,

  • site clean-up, including clean-up expectations and waste disposal (e.g. waste remaining on site, water run-off, waste materials involved in fire),

  • off-site clean-up of contamination (e.g. residential properties, agricultural land, allotments) including ash and waste materials,

  • ongoing multi-agency communication regarding recovery decisions and actions, residual waste on site, materials deposited off-site and clean-up advice,

  • any further public health advice (e.g. regarding fears around residual waste), and

  • ask if there is a need for a public health risk register of those exposed? Alternatively, consider with epidemiologists the need for a population cohort for further study.

14.6.2 Key scenario information

Public health issues can be associated with waste remaining on site following the fire, if clean-up is inadequate. During recovery, waste not dealt with promptly has the potential to decompose and become odorous, posing nuisance concerns (dust, pests). Migration of pests off site can be a potential public health risk (zoonotic infections). Ensure there is a strategy in place to address these issues, produced as part of the RCG.

14.7 What if … ?

The fire continued for a number of weeks?

  • What is the likely impact on the local community and how will you address the resulting concerns and fears?

  • How is the incident response likely to change?

  • What are the potential impacts on your organization?

  • What is the likely media response to the ongoing incident?

14.7.1 Key scenario information

Certain fires, such as waste fires, have the potential to smoulder for weeks to months due to the volume and types of material involved. Long-burning fires can cause significant concern in the local community due to ongoing exposure to the plume, odour from smouldering waste, and the potential impact on local air quality. The response to long-running fires can be very resource-intensive for all agencies involved.

The incomplete combustion of waste materials at lower temperatures and poor oxygen availability can result in the production of complex molecules such as polycyclic aromatic hydrocarbons (PAHs) and dioxins, with production dependent on the materials involved and conditions of the fire. While the risk from a single acute exposure is considered likely to be very low, there can be significant concern in the local community. Continuing communication is key to address these concerns.

All public communication should be multi-agency, coordinated, and be consistent, timely, clear, and accurate to ensure community fears, which can be exacerbated during a protracted incident, are allayed. Perceived risk can affect the community as much as the actual risk (Stewart et al. 2010).

Public advice should continue to include protective actions for individuals to take throughout the incident and health advice for those suffering symptoms following exposure to smoke. Use of multiple communication channels ensures public health messages reach a wide population. The Internet and social media can be invaluable; however, they have potential to cause concern if multi-agency messages are not consistent and clear.

14.8 Lessons learned

  • Fires, in particular long-burning fires, with the potential to smoulder for weeks to months, can cause significant health concerns within local communities.

  • Any smoke can be an irritant. Smoke can cause symptoms including eye irritation, coughing and wheezing, and breathlessness, and can exacerbate existing conditions. Individuals with pre-existing underlying respiratory or heart conditions, children, and the elderly are particularly susceptible.

  • A coordinated, multi-agency response is key to addressing the concerns of the local community. This ensures awareness of protective actions to minimize exposure to the smoke plume and actions to undertake if individuals experience health effects thought to be associated with the plume.

14.9 Further thinking

  • What can be done to capture any potential health effects that may arise from fires (and other incidents) through routine data collection systems?

  • What should be the response to media, public, and political pressure to assess perceived adverse health effects from low-level and short-term exposure (hours/day) to smoke or other pollutants?

  • What further actions could be taken to improve the understanding of non-health protection professionals and the public around risks to health that may arise from fires?

  • How can the challenges in multi-agency communications be identified better and addressed more effectively, given the variety, complexity, and paucity of significant incidents and responses?


Public Health England and NHS England. 2014. Heatwave Plan for England 2014, Protecting Health and Reducing Harm from Severe Heat and Heatwaves. (accessed 8 March 2016).

Smith KR, PJ Saunders. 2007. The Public Health Significance of Asbestos Exposures from Large Scale Fires. HPA-CHaPD-003. Didcot: Health Protection Agency. (accessed 8 March 2016).Find this resource:

Stewart AG, P Luria, R Reid, et al. 2010. Real or illusory? Case studies on the public perception of environmental health risks in the North West of England. International Journal of Environmental Research and Public Health, 7(3): 1153–73.Find this resource:

Wakefied JC. 2010. A Toxicological Review of Products of Combustion. HPA-CHaPD-004. Chilton, Didcot: Health Protection Agency. (accessed 8 March 2016).Find this resource:

Further reading

Barker H. 2010. Air quality in major incidents, Chemical Hazards and Poisons Report, 18: 4–5. (accessed 8 March 2016).

Cabinet Office. 2007. Guidance on the Establishment of a Science and Technical Advice Cell (STAC) within the Multiagency Strategic Co-ordination Centre (SCC). (accessed 8 March 2016).

Cabinet Office. 2013. Emergency Response and Recovery. (accessed 8 March 2016).

Kibble A. 2010. Health Protection Agency experience on the public health aspects of fires involving waste materials. Chemical Hazards and Poisons Report, 18: 6–8. (accessed 8 March 2016).Find this resource:

NHS England. 2014. Emergency Preparedness, Resilience and Response (EPRR). Planning for the Shelter and Evacuation of People in Healthcare Settings. (accessed 8 March 2016).

Public Health England. 2013. UK Recovery Handbook for Chemical Incidents. (accessed 28 April 2016).

Stewart-Evans J, N Brooke, J Isaac, et al. 2013. Conference Paper. Protective Actions during Chemical Incidents and Fires: Evacuate or Shelter in Place? Didcot: Public Health England. (accessed 28 April 2016).Find this resource:

Wakefield JC. 2010. Combustion Products: A Toxicological Review. HPA-CHaPD-004. (accessed 8 March 2016).

Waste Industry Safety and Health Forum (WISH). 2014. WASTE 28 Reducing Fire Risk at Waste Management Sites. (accessed 8 March 2016).

World Health Organization. 2013. Health and Environment: Communicating the Risks. (accessed 8 March 2016).