SANTA ROSA, Calif. -- As the deadliest fires in California history swept through leafy neighborhoods here, Kathleen Sarmento fled her home in the dark, drove to an evacuation center and began setting up a medical triage unit. Patients with burns and other severe injuries were dispatched to hospitals. She set about treating many people whose symptoms resulted from exposure to polluted air and heavy smoke.
"People were coming in with headaches. I had one. My eyes were burning," said Sarmento, the director of nursing at Santa Rosa Community Health, which provides health care for those who cannot afford it. But respiratory problems -- coughs and shortness of breath -- were among the biggest risks. "We made sure everyone had a mask."
More than half of the evacuees at the shelter that October night were elderly, some from nursing homes who needed oxygen 24/7. Sarmento scrambled to find regulators for oxygen tanks that were otherwise useless. It was a chaotic night -- but what came to worry her most were the weeks and months ahead.
"It looked like it was snowing for days," Sarmento said of the falling ash. "People really need to take the smoke seriously. You've got cars exploding, tires burning. There has to be some long-term effect" on people's health.
From Puget Sound to Disneyland and east over the Rockies, Americans have coughed and wheezed, rushed to emergency rooms and shut themselves indoors this year as pollution from wildfires darkened skies and rained soot across the landscape. Even for healthy people, it can make breathing a miserable, chest-heaving experience. For the elderly, the young and the frail, the pollution can be disabling or deadly.
Even though the nation has greatly improved air quality over the past 40 years through environmental regulations and technological improvements, the increasing frequency of large wildfires now undermines that progress, releasing copious pollutants that spread far and wide through the air and linger long after the fires are extinguished.
Scientists say climate change, degraded ecosystems and the fickleness of the weather have been amplifying fires in forests, grasslands and neighborhoods throughout the West. Nine times more western forestland is burning in large fires each year on average now than 30 years ago, according to calculations by two leading scientists.
The blazes create smoke waves -- pulses of pollution containing everything from charred plastic residue to soot to other small particles that lodge deep in the lungs. They can trigger short-term ailments, such as coughing; worsen chronic diseases, such as asthma; and lead to long-term damage, including cancer.
The effect of the fires in Northern California's wine country, which destroyed thousands of homes and killed 43 people, went well beyond the burn zone. The smoke choked the San Francisco Bay Area, home to 7 million people in nine counties, for days.
Colette Hatch, 75, of Santa Rosa, who suffers from lung disease and uses a nebulizer daily, evacuated to her daughter's home in Sunnyvale, in Silicon Valley, when the fires came. But even nearly 100 miles away, Hatch said she struggled to breathe, coughing so hard she couldn't sleep.