Poor air quality as a result of wildfires was once an occasional inconvenience, but it is becoming an annual consideration in managing the start of fall sports for schools across the western United States. Even in the absence of local fires, wind and weather systems can affect air quality hundreds of miles from the nearest fire. Such adverse conditions are often unpredictable and can last for days to weeks without relief.
In the day-to-day management of poor air quality, sound policy and communication may somewhat ease a difficult situation. As a follow-up to the article in the September 2018 issue of High School Today, we will focus on policy development, newer research on the effects of polluted air and the role of various monitoring systems.
The Air Quality Index (AQI) is a system developed by the U.S. Environmental Protection Agency to help the public to determine air quality levels in a specific location. The AQI describes the general health effects associated with different pollution levels, as well as whatever precautionary steps may need to be taken if air pollution levels rise into the unhealthful range. During times of suspected high air pollution, the AQI should be checked prior to all practices and contests. A general location’s AQI can be found here.
The AQI measures five separate air pollutants (particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide and ozone), and converts the measured pollutant concentrations in a community’s air to a number on a scale of 0 to 500. The most important number on this scale is 100, as this number corresponds to the National Ambient Air Quality Standard established under the Clean Air Act. An AQI level greater than 100 indicates that a pollutant is in the unhealthful range.
There are two main concerns for wildfire smoke exposure in athletes. First, the smoke particles are smaller than typical urban pollution, thus the smaller particles can be inhaled deeper into lung tissue. Second, the increased respiratory rate during exercise increases the total volume of polluted air being inhaled over the duration of a practice or contest.
Research suggests there are short- and long-term consequences of exposure. Studies show increased visits to emergency departments by people with asthma during wildfire events and there is voluminous anecdotal evidence of people with pre-existing respiratory conditions experiencing a worsening of symptoms with smoke exposure. The long-term effects are more speculative at this point. The concern is that more frequent exposure to smoke particles results in an inflammatory response in the lung tissue, which will then lead to long-term scarring and effect pulmonary function through disruption of air and blood flow. Only continued observation and research will answer these questions over the coming years.
Creating policy regarding air quality is difficult at both the state and local levels. We do not have “evidence-based best practices” at this point in time. While sports medicine professionals have been involved in policy creation for athletics, most guidelines have been driven by public health and environmental health professionals. Ideally, we will see experts in many fields coming together to develop evidence-informed best practices in the next few years.
At the school district level, policy development should focus on the following considerations:
1. Coaches must be aware of the air quality policy and athletic administrators must be very clear on who decides if a practice or contest is to be postponed, relocated or cancelled, and when that decision is to be made.
2. One individual should be responsible for all “Go/No Go” decisions on contests. Given the long distances often traveled between opponents in the western United States, this means that a decision on cancelling an event must be made several hours in advance. Administrators should engage with the appropriate state agencies prior to the beginning of the school year as “smoke forecasters” may be available when needed to discuss changing conditions in the coming hours to make better informed decisions.
3. While state association policy in several states determines the specific AQI above which a contest cannot be played, local guidance may direct when contests should be modified or canceled in other states. Bear in mind that there may be differing cut-off points for local youth, collegiate and professional sports. This may lead to confusion and frustration among parents and coaches. Such variations must be understood prior to policy being enacted to limit misunderstanding. Ideally, youth sports, club sports and high school guidelines should be very similar, so reaching out to state and local stakeholders to align policy is advised.
4. The source of the AQI measurement should also be specified in policy, if possible. While this measurement is best determined in agreement with state or local public and environmental health experts, the NowCast is available online and in most cases is the ideal tool. The NowCast is computed from the most recent 12 hours of smoke particle monitoring data, but importantly, it weighs the most recent hours of data more heavily than an ordinary 12-hour average when pollutant levels are changing.
This 12-hour averaging may lead to some confusion in a few instances. If conditions worsen suddenly, the 12-hour average, even though weighted more heavily toward more recent changes, may not reflect the situation at hand. In this case, the 5-3-1 Visibility Chart (see below) should be used. Of course, the location of the monitor is the most important variable and the reported reading may offer no guidance if it is at a distance from athletic fields.
The increasing use of at-home PurpleAir monitors has improved the likelihood of a monitor being near an athletic facility, but these monitors can have some drawbacks. They use a laser sensor that averages particle size and the monitors can be prone to overestimating the AQI depending upon conditions. The “LRAPA” feature, available as a dropdown on the website, should be enabled during wildfires to provide a more accurate reading. It provides a conversion factor for a more accurate reading.
The PurpleAir monitors are often networked with the more sophisticated AirNow sensors and conversion factors to increase the accuracy will likely continue to be developed. In addition to offering “averaged” measurements in a drop-down box, PurpleAir also allows for “real-time” monitoring. Clearly, those “real-time” measurements will be higher as smoke concentrations begin to build. Again, if there is a discrepancy between monitor reporting and conditions on the field, the 5-3-1 Visibility Chart should be utilized.
5. In addition to the health and safety of students participating in athletics, administrators must also consider the potential health affects upon coaches, athletic trainers and other school personnel involved in outdoor practices and contests. Some state Occupational Safety and Health Administrations (such as Oregon and California) have put guidelines in place for employers. These guidelines may include directives to move workers indoors when feasible as a well as providing personal protective equipment if the AQI exceeds a certain level. School administrators should be familiar with any such state laws.
Air quality policy is a difficult topic, as the long-term effects of smoke exposure are not well known and the cancellation of practices and games, particularly at the beginning of the season, can be emotional for coaches, athletes and parents. Also, conditions may change rapidly, which often leads to second-guessing a decision that was made with the best available information hours earlier. Educating all involved about the policies in place, and why they exist will help lessen miscommunication and misunderstanding, hopefully easing what is an inherently difficult situation.
The graphic – “Public Health Guidance: School Outdoor Activities During Wildfire Events” – was produced by the Oregon Health Authority and reprinted with permission of the OHA.
Michael Koester, M.D., is the current chair of the Oregon School Activities Association Sports Medicine Advisory Committee (SMAC) and the former chair of the NFHS SMAC. He practices pediatric and adult sports medicine at the Slocum Center in Eugene, Oregon.