The Maui Fires: Where do our First Responders go From Here?


By Manijeh Berenji MD and Marc Wilkenfeld MD

The Maui fires that occurred in Lahaina and surrounding areas on Aug. 8, 2023, have had a devastating impact on the island’s environment. The fires burned over 100,000 acres of land, killed at least 97 people, and destroyed/damaged up to 3,000 structures. As of a September 18, 31 people were still missing.

The environmental impacts of the Maui fires are still being assessed, but scientists believe that the fires will have a lasting impact on the island’s ecosystem. The fires destroyed large swaths of forest, which will take decades to recover. The fires also killed or displaced many animals, including endangered species. The loss of vegetation and wildlife will disrupt the island’s food chain and could have a cascading impact on other species.

The fires released harmful pollutants into the air, including smoke, ash, and carbon monoxide. These pollutants (including PM10 and PM2.5) could have long-term health consequences for residents and visitors. These pollutants can potentially cause respiratory problems, heart disease, and cancer down the line.

The fires had a significant impact on the first responders (including firefighters, police, and first aid workers among others). These first responders were on the front lines of the battle against the fires, working long hours and risking their lives to protect the island and its residents. Many first responders also lost their own homes in the fires.

These first responders will face many challenges in the coming months and years. These challenges include post-traumatic stress disorder, financial hardship, grief and loss. Many first responders lost friends, family members, and/or neighbors in the fires and continue to suffer from these losses.

Medical surveillance of first responders is important after such fires. Medical surveillance can help to identify first responders who are at risk of developing health problems after working in these hazardous conditions. Such surveillance can ensure that they receive the appropriate medical care and monitoring.

There are several ways to conduct medical surveillance of first responders after a catastrophic event such as what has occurred on Maui. One way is to conduct physical exams and spirometry tests. Spirometry tests measure the amount of air that can be inhaled and exhaled. This can help to identify firefighters who have respiratory problems.

Another way to conduct medical surveillance is to collect blood samples and test them for biomarkers of exposure to smoke and other pollutants. Biomarkers are substances that can be measured in the blood and that indicate exposure to a particular substance.

Medical surveillance is typically conducted by a physician or other healthcare professional. It is important to start medical surveillance as soon as possible after such events, as this can help to identify health problems early on.

By taking these steps, we can help to protect the health of these first responders and ensure they can continue to lead healthy, productive lives and serve their communities to their fullest capacity.

Manijeh Berenji MD MPH; is a double board certified occupational and environmental medicine and preventive medicine specialist with over 10 years of clinical and public health experience currently serving as clinical assistant professor of occupational and environmental medicine at University of California Irvine Schools of Medicine and Public Health. Marc Wilkenfeld MD;, associate professor of occupational and environmental medicine at New York University Langone School of Medicine, has been practicing for over 20 years. He managed the World Trade Center Program for first responders and is a world-renowned expert on occupational and environmental medical surveillance programming.