Fires can leave behind more than visible damage. The lingering smoke and airborne contaminants from the recent warehouse fire in the Boyle Heights neighborhood in Los Angeles may continue to affect air quality for weeks or even months. Exposure to pollutants released during the fire and after it was extinguished can significantly increase the risk of developing respiratory problems and other health issues. 

While some people experience only temporary irritation, others, especially children, older adults, and those with underlying medical conditions or breathing issues, may face more serious or long-term health effects.

The Cedars-Sinai Newsroom recently spoke with Irina Dralyuk, MD, director of Pediatric Pulmonology at Cedars-Sinai Guerin Children's, about the health risks associated with fire and smoke exposure, who is most vulnerable and what people can do to protect themselves.

What are the health dangers following a fire like the warehouse fire in Boyle Heights?

Following a fire, air quality can be affected for an extended period of time. Fires release a variety of chemicals and fine particles into the air, and many of those substances may not be immediately identified as materials continue to burn and break down.

The first few weeks after a fire are generally the most concerning, but people should remain cautious for at least two to three months. For individuals with respiratory diseases, weakened immune systems or heightened sensitivity to environmental pollutants, the health effects can last much longer, potentially up to a year.

Who should be especially cautious following a fire?

Several groups are at higher risk, including infants and young children, especially babies born prematurely, older adults, people with weakened immune systems, and those with chronic lung conditions such as asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis.

However, even people with healthy lungs should take smoke exposure seriously. Environmental hazards from a fire can trigger inflammation or respiratory problems in otherwise healthy individuals, so everyone should take steps to protect themselves when air quality is poor.

What precautions can people take after a fire?

One of the most effective ways to reduce exposure indoors is by using air purifiers. It's important to choose a purifier that's appropriately sized for the room and to replace filters regularly. Home HVAC [heating, ventilation and air conditioning] filters should also be changed according to manufacturer recommendations.

If possible, limit activities that bring smoky outdoor air into the home. During periods of poor air quality, consider using fans instead of air conditioning, as it typically draws outside air into your living space. When spending time outdoors, wear a well-fitting mask on days when air quality is poor, especially during the weeks and months following a fire.

When should people seek medical attention?

Even mild symptoms such as an itchy or scratchy throat, irritated eyes, or persistent coughing are signs that smoke may be affecting your body and should not be ignored.

People experiencing coughing, wheezing, shortness of breath or difficulty breathing should see a doctor or head to an urgent care. Depending on the symptoms, a doctor may recommend diagnostic tests such as a chest X-ray or lung function tests. Your doctor might also listen to the lungs and determine whether medications, including inhalers, nebulizer treatments or oral medications, are needed to reduce inflammation, open the airways and improve breathing.

Read more from Cedars-Sinai Stories and Insights: What Parents Should Know About Teen Vaping

At home, Hedrick tends to at least 60 more.

“I’m not listening to audiobooks, I’m not talking to family, I’m not thinking about work when I’m gardening,” Hedrick said. “I’m in the present moment, fully focused on my plants.”

For Hedrick, gardening is a form of mindfulness meditation. She initially turned to meditation to help manage stress after an autoimmune condition caused flare-ups that led to vision loss. Over time, meditation helped lessen both the frequency and intensity of those flare-ups.

Today, Hedrick incorporates mindfulness-based stress reduction into her work as a psychiatrist and encourages similar mind-body interventions as healthy, science-backed ways to help alleviate anxiety.

In a widely cited clinical trial published in JAMA Psychiatry, an eight-week mindfulness-based stress reduction program was found to work as well as a commonly prescribed first-line medication for anxiety in reducing symptoms of anxiety disorders.

“Meditation doesn’t just calm you down in the moment,” Hedrick said. “It changes how the brain is wired, helping the thinking part of the brain get better at dialing down the fear response.”

Hedrick said mindfulness meditation strengthens the connection between the prefrontal cortex—the area of the brain responsible for planning, higher-level thinking and information processing—and the amygdala, the brain’s danger center.

“Meditation is a bicep curl for your brain,” she said, noting that neuroimaging studies show meditation can produce measurable structural and functional changes in the brain. “The brain actually gets bigger in the areas that control attention regulation.”

One common meditation misconception, Hedrick said, is that meditating requires sitting perfectly still and emptying the mind. Instead, it’s paying attention to the present moment without judgment.

“Many people find movement—gardening, running, practicing tai chi or yoga, playing the guitar—to be a more accessible form of meditation than sitting still,” she said. “There are infinite ways to bring your mind into the present moment.”

Distraction during meditation is not failure, Hedrick added, but part of the exercise. Redirecting attention strengthens brain circuits involved in emotional regulation and self-awareness.

As with any form of training, the benefits build gradually over time.

“Stick with it,” she said. “The benefits come with practice. That’s why we call it a practice—you have to keep doing it.”

Hedrick cautions, however, that meditation should not be used to suppress difficult emotions.

“Meditation works best when you stop trying to use it to feel better and instead, use it to get better at feeling,” Hedrick said. “Mindfulness is most powerful when integrated with therapy. If unresolved trauma, grief or depression are driving these emotions, you still need the therapeutic work of understanding and processing them.”

Hedrick emphasized that meditation is not always calming or appropriate for everyone, particularly people with trauma histories, severe anxiety or certain psychiatric conditions. In those cases, treatment decisions should be guided by a healthcare professional.

“Meditation isn’t a one-size-fits-all solution or a cure-all,” Hedrick said. “Consider it one part of a tool kit. Mindfulness works alongside therapy, physical activity, social connection—and, when appropriate, medication.”

For those interested in beginning a mindfulness practice, Hedrick recommends joining a guided meditation group, exploring a digital app, or incorporating breath work—slow, focused breathing that helps calm the body and anchor attention in the present moment.

Music to Calm and Heal

Meditation and mindfulness are not the only therapeutic tools that can help people cope with stress and anxiety. Music also can bring comfort, connection and emotional relief.

Bronwen Jones, MTheol, BCC, an interfaith chaplain in the Spiritual Care Department who works with the Patient and Family Support Program at Cedars-Sinai Cancer, coordinates live, virtual concerts by professional musicians for patients receiving chemotherapy and other treatments.

In infusion areas, music—from Gershwin to Beatles classics—acts as a salve.

“Hearing live music completely changes the atmosphere of the room,” Jones said. “It’s extraordinary and powerful when a professional musician plays for one of our patients. It’s a uniquely personal and often emotional experience—a magical moment where people transform.”

Jones coordinates the performances with musicians through the Project: Music Heals Us “Vital Sounds Initiative.” Sessions are tailored to each person’s musical preferences, with musicians often taking requests and building rapport along the way.

Patients frequently describe the music as the highlight of their day, Jones said, helping them relax and reconnect with joy during the often-isolating experience of cancer treatment.

She recalled one patient whose blood pressure was dangerously high before chemotherapy. After watching a live cello performance, the patient’s blood pressure decreased so dramatically that she was able to proceed with treatment.

Jones, a former professional musician, said music can reach people emotionally in ways other interventions sometimes cannot.

“If you appreciate listening to music, you can use it to help shape your mood—whether you’re seeking tranquility or a sense of renewal,” she said. “I also encourage people to learn or relearn an instrument because engaging in learning is a wonderful coping skill when dealing with anxiety.”

The Power of Awe

Like meditation and music, awe—experiencing wonder, admiration and reverence when encountering something vast, powerful or beautiful—can allow for conceptual reframing by reconnecting people to meaning, gratitude and perspective.

Postdoctoral scientist Rebecca Benhaghnazar, PhD, founder and co-chair of the Scientific, Spiritual and Interfaith Community at Cedars-Sinai, said awe can emerge through music, prayer, mindfulness, nature or art—anything that helps people feel connected to something larger than themselves.

“Whatever allows a person to transcend themselves can create a very powerful shift in cognitive retraining,” Benhaghnazar said. “For some, that’s taking in a sunset or listening to beautiful music. For others, it’s prayer.”

Benhaghnazar, whose research focuses on therapeutic design and cell biology, finds those moments of awe in her own work.

“I get to take a look at nature on a microscopic level,” she said. “When I see inside a single cell, it’s wondrous.”

In a culture dominated by nonstop stimulation, Benhaghnazar emphasized the mental reset that even a few reflective moments can provide.

“A daily awe practice is a must,” she said. “Go outside for a few minutes and look at the leaves on a tree, look up at the sky. Awe, connection, spirituality, gratitude—they’re all grounding.”

Read more from Cedars-Sinai Stories and Insights: Sound Advice—Do Sound Therapy and Binaural Beats Work?

One year after wildfires tore through Pacific Palisades and Altadena, upending hundreds of thousands of lives across Los Angeles, many residents are still navigating recovery—rebuilding homes, reestablishing routines and managing the emotional aftershocks of disaster.

As communities mark the anniversary, questions about resilience feel especially relevant: What does it mean to be resilient? Do resilient people share common traits? Can resilience be strengthened over time?

The answers, said Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, are layered and complex.

“The notion that resilience is just pulling yourself up by your bootstraps is an oversimplification,” Danovitch said. “When we think about resilience, we must avoid applying our own framework to somebody else’s situation. Rather, we need to recognize that there may be different conditions shaping their response.”

The Cedars-Sinai Newsroom recently spoke with Danovitch about the science of resilience, the role of meaning and social connection, and what the past year reveals about resilience as Angelenos continue to recover and adapt.

What is resilience?

Resilience is often misunderstood. In reality, it is the capacity to adapt—to focus on what can be brought under your control so you can better cope with what you cannot control. At its core, resilience involves flexibility: adjusting expectations, behaviors and coping strategies in response to changing circumstances.

Do resilient people share common traits?

There isn’t a single profile for resilience because people differ widely in their skills, resources and circumstances. An artist, a professional athlete and a surgeon may each rely on very different strategies to navigate stress and adversity. Some people have a more positive outlook, and others are more cautious and skeptical. Both approaches can be valuable. Faith and spirituality can serve as anchors for some people, while others find different ways to ground them in challenging times. There are multiple ways to respond to the world around us, and resilience is less about having the “right” traits and more about being able to use the tools available to us in ways that fit our lives.

Are there shared building blocks?

While resilience looks different across individuals, a related area of research focuses on meaning-making, a concept closely associated with psychiatrist and Holocaust survivor Viktor Frankl, author of Man’s Search for Meaning. Frankl argued that even in the face of profound suffering, the ability to find purpose can help preserve one’s sense of self. If you can make or find meaning, you can adapt, and if you can adapt, you can survive.

What else shapes resilience?

Like most psychological characteristics, resilience is shaped by biology, psychology and social environment. Early life experiences matter. Stability, love and support can strengthen coping skills, while trauma also can leave lasting imprints. But resilience cannot be predicted by childhood experiences alone. Developmental experiences interact with biological predispositions in ways that aren’t always linear or predictable.

Can resilience be improved?

Yes. There is substantial research on how to recover from adversity; I’ll simplify it into four broad categories.  The first is improving emotional awareness—learning to recognize, name and express feelings. This awareness makes emotional regulation possible, whether through taking a timeout during emotional distress or practicing mindfulness or breathing exercises. The time to manage a highly charged conflict is not when you’re overwhelmed, but when your mind and body are calm enough to access your own wisdom. Frankl’s insight is relevant here: While you can’t always control your circumstances or feelings, you can control your attitude and response. The second category involves setting boundaries and expectations, which allows people to express agency and protect themselves emotionally or physically. The third is self-care—including adequate sleep, proper nutrition, physical activity and stress management. The fourth is meaning-making and social connection—cultivating relationships, community and experiences that provide a sense of purpose.  One important note: It’s easy to talk about strengthening resilience. It’s much harder to practice it consistently. 

What can the L.A. wildfires reveal about community resilience?

The story is still unfolding. Recovery isn’t cut and dry, and it doesn’t end just because it’s been a year. Disaster research shows emotional responses often emerge in phases. There’s the initial crisis and response people must navigate, and then there are phases of the psychological effects that tend to surface later. The continued impact on families and communities remains profound. We’ll continue to see regrowth and rebuilding as people navigate new challenges and curveballs. The bottom line is that it’s important to remember that flexibility—both in how resilience is defined and how it’s practiced—is central to understanding recovery from adversity.

Read more on the Cedars-Sinai Blog: The Power of Healthy Stress

“Wildfires that spread into urban areas have proven to be extremely dangerous because of how quickly they move and what they burn and release into the environment,” said Susan Cheng, MD, MPH, vice chair of Research Affairs in the Department of Cardiology in the Smidt Heart Institute and senior author of the study, published in JACC. “Our research suggests the Eaton and Pacific Palisades fires had an immediate effect on people’s health.”

The Cedars-Sinai Emergency Department is located on the academic medical center’s main campus, about 10 miles from Pacific Palisades and about 20 miles from Altadena, the locations where the largest L.A. fires ignited in January 2025. Investigators collected data on emergency department visits during the 90 days after the fires started, from Jan. 7 to April 7, 2025. They compared this data with emergency visit data collected during the same calendar period in the years 2018 through 2024. 

Although there wasn’t a significant difference in total emergency department visits during the first 90 days following the start of the wildfires in 2025 as compared with other years, there was a drastic increase in emergency department visits for certain conditions. Investigators found a 118% increase in visits for general illness, 46% increase in the number of visits for heart attack, and a 24% increase in visits for pulmonary illness when compared to the average rate of these conditions diagnosed during the same time window in the past seven years. 

“Fine particles released by wildfires can enter the body and cause injury, particularly to the heart and lungs,” said Cheng, who is also the Erika J. Glazer Chair in Cardiovascular Health and Population Science in the Smidt Heart Institute at Cedars-Sinai. “Stress related to the fires may also contribute to a broad range of health issues.” 

The investigators found that abnormal blood test results related to general illness more than doubled in the 90-day period in 2025 as compared with that period in previous years. This is a finding not previously reported after major wildfires, according to the investigators.

“Abnormal blood test results could indicate that the body is responding to an external stressor such as toxins in the air,” said Joseph Ebinger, MD, MS, associate professor in the Department of Cardiology and first author of the study. “This study is an important step toward understanding how the Eaton and Palisades fires may have affected Angelenos’ health. We need more research to determine what we can do to mitigate any remaining risks and protect people from fire harm in the future.” 

This study is part of the larger LA Fire HEALTH Study, a research collaboration that seeks to determine the health effects of the fires that ignited in January 2025 in L.A. County. Investigators with Cedars-Sinai; the Harvard T.H. Chan School of Public Health; the Keck School of Medicine of the University of Southern California (USC); Stanford University; UCLA; the University of California, Davis (UCD); the University of California, Irvine (UCI); the University of Texas at Austin; and Yale University plan to study the impacts of the fires for the next 10 years. 

Additional Cedars-Sinai authors include Tzu Yu Huang, MS; Sandy Joung, MSHS, MBA; Juliane Kwong, BS; Wasay Warsi, MS, BS; Nancy Sun, MPS; Jesse Navarrette, MPA; Patrick Botting, DHSc; Zaldy S. Tan, MD, MPH; and Alan C. Kwan, MD.

Other authors include Brian L. Claggett, PhD, of Brigham and Women’s Hospital in Boston.

Funding: This work was partially supported by the Spiegel Family Fund, the Smidt Heart Foundation, and the Erika J. Glazer Family Foundation. 

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

More than a quarter of U.S. adults say they are estranged from at least one close relative, and “going no-contact” with family members is a phrase heard more often these days. Whether more people are distancing themselves from family—or simply more comfortable talking about it—is unclear.

What is clear, said Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, is that loneliness is a growing health problem, and the holidays can intensify feelings of depression and isolation.

“There are many causes of loneliness, but certainly one of the most significant emerging causes is our physical disconnection and increasing reliance on technology to communicate with each other,” Danovitch said. “We evolved to be a highly social species with the capacity to form personal relationships, families, tribes and communities. Some of the most remarkable distinctions of the human brain are those that help us understand one another, imagine another person’s perspective, and empathically share their feelings.

“But we’ve seen an unraveling of the social structures that have always anchored us, and particularly during times of need, that has left many of us feeling alone and disconnected.”

These dynamics create a host of challenges and difficult emotions that commonly surface during the holidays, when relationships, family and community are front and center.

The Cedars-Sinai Newsroom spoke with Danovitch about ways to cope with loneliness and estrangement during the holiday season, as well as how to build meaningful and healthy connections.

Why do people feel lonelier or depressed during the holidays? 

There are several reasons. Loneliness and isolation are amplified during the holidays if people are already experiencing a sense of separation from their families of origin or the social pain of loneliness. Even people who are not estranged from their families—but who may not live close by or aren’t accustomed to spending time together—can suddenly feel overwhelmed by dynamics that resurface as if no time has passed, although one person is now an adult and another a grandparent. Another contributor to holiday depression or loneliness is expectations. People bring personal ideas about what the holidays should look like, and those expectations often carry emotional weight—and often don’t align with reality.

How can people cope when there is family estrangement or spending time together is difficult?

When it comes to family dynamics, relationships are messy. Families are messy. It’s valuable to be aware of challenging dynamics and to bring patience and grace to any interactions. Take a deep breath and feel compassion and forgiveness if you feel like you're not being your best self. If you suddenly slip back into the 13-year-old version of yourself, give yourself a break. Give your family a break. Also, know that you can't solve everything over one holiday. Developing better or more fulfilling relationships with family takes effort and time. Lean into relationships and approach engagement and connecting in a way that feels appropriate for the situation and the individuals.

For mental wellbeing, is it OK to maintain boundaries with family during the holidays?

There's no right or wrong answer. Boundaries are individualized, and I wouldn’t judge the reason somebody does or doesn't want to spend time with their family—or whether they remain estranged. That's for them to decide. But I think it's helpful to be honest and accepting of our decisions on how to handle the tradeoffs we make. Self-acceptance and self-compassion are an important foundation for everything else.

How can people cope if they don’t have family to spend the holidays with?

Foster connections within the community and the people around you—friends, neighbors, or groups who share an interest that’s important to you. Think about participating in a food kitchen or a beach cleanup, or volunteer with an animal shelter or in supportive services for kids. Spend time outdoors or reach out to your neighbors. Consider what interests you, what moves you, and how you can find others who share those interests. These connections are crucial for mental health. 

What are healthy ways to manage holiday stress—say, social anxiety or discomfort during holiday gatherings?

Social anxiety is one of the most common types of anxiety, and meeting new people is one of the most stressful things people do. Part of what makes us anxious is the feeling that we're being judged, so we're prone to worrying about coming across the right way. When you're in a group and somebody is new, be gracious and include them. It goes a long way. For people worried about falling into old habits with their family, consider intentional activities. Some families come together and talk, and then conversation drifts toward points of conflict—like politics or religion. Redirect with a board game, a movie or a group hike. It’s time together that matters.

Read more on the Cedars-Sinai Blog: Social Anxiety—How to Navigate the Holiday Season

“I noticed it most when I lay down to sleep,” said Scott, whose family has lived in Altadena for three generations. “I could hear wheezing, I could hear a lot of wheezing, which I had never experienced before.”

Scott is not the only one. Since the wildfires ravaged the area, residents have been seeking help for symptoms that indicate difficulty breathing, such as coughing, wheezing, chest tightness and fatigue.

“We know that heavy exposure to wildfire smoke can have a delayed and long-term impact on lung function,” said Talar Kavafyan, MD, medical director of the ambulatory care center at Huntington Health, an affiliate of Cedars-Sinai. “Following the devastating fires our community experienced in January, providing enhanced pulmonary care is an important step in recovery—and an important example of how Huntington is dedicated to improving community wellbeing.”

So dedicated that, in response to the potential health impact in the wake of the fires, Huntington Health recently expanded pulmonary medicine for the community at the Huntington Ambulatory Care Center (HACC).  

The expansion came just in time for Scott, who continued to have difficulty breathing months after the flames were extinguished. “I began to talk to my primary physician about it,” Scott said, “and I kept telling her I don't feel like I'm getting a good capacity of air.”

That is a symptom that Raj Dasgupta, MD, has heard from dozens of patients who lived through the wildfires.

“It's understandable to be concerned when someone is having difficulty breathing [dyspnea], which is the sensation of not being able to get enough air, tightness in the chest, or working harder to breathe,” said Dasgupta, associate professor of Clinical Medicine and associate program director of Huntington Health’s Internal Medicine Residency Program. “By offering a wider range of tests in an outpatient setting, we can potentially detect pulmonary issues earlier and initiate treatment more quickly, which can lead to better outcomes and help bring some peace of mind to our patients who might be experiencing pulmonary issues right here in our community.”

Conditions frequently treated by the center’s physicians include asthma; chronic bronchitis and bronchiectasis; persistent cough; chronic obstructive pulmonary disease (COPD); lung scarring, or fibrosis; and sarcoidosis, an autoimmune disease that causes growths on the lungs.

“When you arrive at HACC, the first step of treatment is to collect information about your lungs and their function,” Dasgupta said. “We do this by conducting a breathing test in our office called spirometry, which is a valuable tool for diagnosing, monitoring and evaluating lung function. It provides essential information for managing lung conditions and improving respiratory health. After additional tests and evaluations, we then discuss the next steps to best support your lung health. Remember,  difficulty breathing and coughing can have various causes, and it's essential to seek medical evaluation for a proper diagnosis and treatment.” 

The pulmonary clinic is open every second and fourth Tuesday of the month from 1–5 p.m. For an appointment, call (626) 397-5711.

Read more from the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

The tone was urgent: “Please pick up your child now.” Moments later, Kim, director of the Division of Pediatric Surgery, learned his Pacific Palisades community was on the brink of a wildfire evacuation order. He raced home to help his family pack, but he felt certain, based on past experience, they’d be back soon.

The Kim family is now marking four months in a Santa Monica apartment: The L.A. wildfires, which began Jan. 7, 2025, and also devastated the Altadena community, destroyed their home.

Kim’s daughters, 13 and 16, were uprooted from their home, school and community. In a flash, they were separated from friends and unable to participate in local activities. And now, with summer break approaching, they and many other affected students could experience more disruption in their daily routines.

Connections and Consistency

Suzanne Silverstein, MA, ATR, founding director of Cedars-Sinai’s Share & Care, a program at 30 L.A.-area schools helping at-risk children through trauma, said parents should be prepared to guide children—many of whom are still grieving—through that disruption.

“The Pacific Palisades and Altadena communities were very tight-knit, and they are still suffering,” Silverstein said. “Children and parents have had to deal with losing homes as well as their community connections. It’s a double whammy, and it’s normal to still be grieving.”

Silverstein said children in the Share & Care program have received donated items, and she often hears them say, “I had this in my house that burned down.”

She added, “They’re also struggling because they’ve changed schools—their family moved, or their original school is no longer there—and their friends are at different schools. They’ve had to start over.”

Silverstein emphasized the importance of maintaining connections, especially during the summer break. She encourages parents to set up playdates with friends who have moved to different areas, saying, “Whole families can reconnect, which can be a gift to have everyone together for some positive experiences, and to see that everyone is OK.”

Consistency also is key, Silverstein said. If children have always attended summer camp and their camp is taking place this summer, it could be healing for them to go again, “if it’s something that’s familiar to them and something they can connect to, from before the fire.”

An art therapist, Silverstein also encourages children to express themselves in the ways they are most comfortable.

“Is it writing, is it drawing, is it through poetry or acting? Give them more of those experiences this summer,” she tells parents.

Art is a healing tool in Share & Care—younger children are encouraged to draw what they’re experiencing, while older ones are encouraged to write or draw in a journal, and then share if they’d like.

Also taught are mindfulness, calming breathing techniques, and how to sit quietly together and listen to what others in the group are sharing.

These are activities parents can continue with their children during summer recess, Silverstein said.

“We’ve been teaching parents the breathing techniques we’ve used with their children,” she said. “Parents also can benefit, as this continues to be a stressful and overwhelming time for them, too.”

Silverstein noted that the healing process is different for every child, and a strong parent-child connection can lead the way in best addressing the needs of each individual.

Leaning on Each Other

In the weeks following the fire, Kim’s family stayed in Orange County with relatives. He remembers kindness on full display when his daughters—competitive swimmers—were invited to swim with the local team. His older daughter took them up on the team’s offer.

“That was a huge part of maintaining some semblance of connection, and it helped her recovery,” he said, because she could participate in a routine activity she enjoys while also making new friends.

Kim said both daughters, as well as he and his wife, have benefited from social time with former neighbors and friends who are recovering from the fires.

“Talking about the complete loss we’ve experienced with people who’ve also been through it is a huge help,” he said.

Kim said he hopes to create a “normal” summer experience for his daughters, even though the family is living in a different place—filling it with swim meets and a vacation to the East Coast, a family tradition. His older daughter also will volunteer at Cedars-Sinai, an activity she finds fulfilling.

For the Kim family, time together may prove to have been the most healing.

“My wife and I were quite concerned about the stress of this trauma on the girls,” he said. “Earlier on, there were teary days and sleepless nights, but it’s been a while since we’ve seen emotions bubble up. We continue to watch them closely and make sure they know we’re here for them. I’m in awe of their resilience—it gives me strength to see them get up every morning, go to school and carry on to the next day.”

As the school year ends, these moments are more important than ever.

“We can’t get back the things we lost,” Kim said, “but we can help each other write the next chapter.”

Read more on the Cedars-Sinai Blog: Five Deep Breathing Exercises for Kids and Teens

The multi-institutional study was published in the peer-reviewed journal JAMA Internal Medicine.

The addiction consultation service, called the Substance Use Treatment and Recovery Team (START), pairs experts in addiction treatment: a physician with a social worker or case manager. The team provides each patient with diagnostic assessments, recommendations for treatments, psychosocial support, connections to post-hospital medical care and follow-up telephone calls for one month.

“Our program addresses a major challenge across hospitals,” said Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai and senior author of the study. “Even though effective medications exist for opioid use disorders, only a small percentage of hospitalized patients begin treatment during their stay or connect with services after discharge.”

Danovitch, START lead principal investigator, said the service offers a supportive, patient-centered intervention that reduces stigma, promotes engagement and increases access to both treatment and follow-up services.

The co-led study was done in collaboration with RAND and conducted from 2021 through 2023 at three geographically distinct U.S. hospitals: Cedars-Sinai in Los Angeles; University of New Mexico Hospital in Albuquerque, New Mexico; and Baystate Medical Center in Springfield, Massachusetts.

The study included 325 hospitalized patients 18 or older who had a probable diagnosis of opioid use disorder. Of the patients enrolled,164 were randomly assigned to the START program while 161 received the usual hospital care.

The data shows that 57.3% of the START patients began medication treatment for opioid use disorder while in the hospital compared with 26.7% of the patients in the usual care group. Additionally, the study showed that 72% of the START patients accessed follow-up care within 30 days after discharge from the hospital compared with 48.1% of the control group.

Prior studies have shown that addiction consultation services are associated with improvements in care and outcomes, but this new study was the first multisite, randomized, controlled trial to compare the effects of such services to usual care, Danovitch said.

Opioid use disorder is a persistent problem. Nearly 80,000 people died from opioid overdoses in the U.S. in 2023, according to the U.S. Centers for Disease Control and Prevention. Between 2002 and 2018, hospital admissions for opioid use disorder rose significantly—from nearly 302,000 to nearly 942,000.

“Hospitalization provides a crucial window to involve patients in addiction treatment when they might be most open to it, particularly after experiencing health-related consequences of their substance use,” said Jeffrey A. Golden, MD,  director of the Burns and Allen Research Institute and executive vice dean for Research and Education at Cedars-Sinai. “These important findings show how the medical community can significantly boost this engagement and help find solutions for the national opioid epidemic.”

Other Cedars-Sinai authors include: Mia W. Mazer, BSc; Teryl Nuckols, MD, MSHS; and Waguih William IsHak, MD.

Other authors include: Allison J. Ober, PhD; Cristina Murray-Krezan, PhD; Kimberly Page, PhD; Peter D. Friedmann, MD, MPH; Jess Anderson, MS; Karen Chan Osilla, PhD; Stephen Ryzewicz, MD; Sergio Huerta, MD: Randall A. Hoskinson, MA; Richard Garvey, MA; Alexandra Peltz, BA; Katherine E. Watkins, MD, MSHS; and Louis T. Mariano, PhD.

Funding: Support for the study was provided by the National Center for Advancing Translational Sciences and National Institute on Drug Abuse, both parts of the National Institutes of Health, under grant award number U01TR002756-01A1. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“For very young children, use simple explanations when answering their questions,” Hedrick said. “With older children, you want to be honest and open, directly answering questions and using as simple language as possible.”

Playtime can help children express themselves and feel a sense of control. One example, Hedrick said, is focusing on the positive aspects of knowing fire safety.

“For children who haven’t lost their homes but are affected by the fires, involve them in age-appropriate fire drills,” she said. “Or allow other types of play to be related to the fire, because a lot of times it’s easier for kids to express their feelings through play than by outwardly saying, ‘I'm feeling scared.’”

Building simple forts with pillows, blankets and sheets can be a beneficial play activity for children of all ages—even some middle schoolers, Hedrick said.

“The parent can get inside the fort with them and talk about feelings, as the child may feel safer there,” she said.

It also can be helpful for parents to model how to express feelings.

“A parent could say something like, ‘I noticed I was feeling a little scared today; are you feeling scared?’ This gives their child a chance to talk about feelings of fear, anger, sadness,” she said.

Alternatively, when the child says they’re angry, sad or scared, parents should acknowledge those emotions.

“It’s important not to say, ‘You don't have to feel sad or scared or angry,’” Hedrick said. “It's better to say, ‘Of course, that’s how you’re feeling and it’s perfectly normal. At the same time, there are things we can be grateful for—let’s talk about some of those.’”

Tweens and teens especially may find journaling helpful, as well as art, physical activities and supportive connections with their peers.

“Reminders that there is hope, and that the family will get through this together, are important,” Hedrick said.

Read more on the Cedars-Sinai Blog: Art Therapy Helps Children Cope With Trauma

That’s true for people experiencing the trauma of devastation and loss firsthand, as well as those following the news from a distance, said Rabbi Jason Weiner, PhD, senior rabbi at Cedars-Sinai and director of the Spiritual Care Department.

“This tragedy reminds us all of our vulnerability,” he said.

Itai Danovitch, MD, chair of the medical center’s Department of Psychiatry and Behavioral Neurosciences, said feeling distress and anxiety right now is normal, as is feeling numb or disconnected from emotions.

“There is no one-size-fits-all response to the challenges we’re facing, and adapting to stress can take time, but it helps to pinpoint specific sources of worry,” Danovitch said. “Is there nervousness about the safety of loved ones or a home? Is it the long-term impact on the community or uncertainty about air quality? Knowing this can help manage anxiety in a constructive way.”

Among anxiety management tactics are maintaining daily routines and self-care while staying connected with supportive people, getting adequate rest and exercise, and practicing relaxation or meditation exercises.  

“It also can help to make sure you’re getting information from trustworthy sources to help avoid unnecessary fear,” Danovitch said. “Plan ahead for potential future evacuations and manage exposure to news and social media.”

Is It Post-Traumatic Stress Disorder?

Negative thoughts, sleep or concentration problems, social withdrawal or intensified and persistent symptoms of despair that interfere with daily functioning could signal post-traumatic stress disorder (PTSD).

“A therapist who specializes in trauma treatment, along with medications and participating in support groups and psychotherapy, can be beneficial,” Danovitch said. “Some people may develop PTSD and others won't, but all emotional responses deserve care and attention.”

The National Center for PTSD can provide guidance for immediate coping strategies and long-term recovery.

Feeling Seen and Heard

Cedars-Sinai Cancer Center Chaplain Carrie Kohler, MPhil, BCC, can personally relate to hospital patients and staff struggling with grief and uncertainty. She navigated those same complex emotions after evacuating her home during the wildfires.

“Some people are grappling with survivor’s guilt or a sense of helplessness as they try to support loved ones,” Kohler said. “For others, there are practical and logistical questions—how to file an insurance claim or get transportation to a Disaster Recovery Center. Social disparities, such as language barriers, physical disabilities or compromised health, can make already difficult tasks more challenging. It can all feel very overwhelming.”

Kohler said listening and validating experiences is critical in providing support.

“Comfort and hope are created when people feel seen and heard, and that can be simply sitting with someone in their pain without rushing to fix it,” she said. “Hope isn’t about erasing pain or pretending everything will be fine; it’s about making space for all emotions and respecting individual experiences.”

Empathy From Afar

Those who live miles away may also feel distraught. Danovitch said that’s human nature—and it may be especially true for people who once lived in Los Angeles, because the fires conjure nostalgia as well as loss.

“Former Angelenos often have deep relationships, memories and connections to the area,” he said. “Seeing those threatened can heighten feelings of longing and attachment.”

Kohler agreed. “It might even reignite memories of your own past challenges in L.A., blending past and present grief,” she said. “For people without a direct connection, the fires may evoke a generalized empathy or compassion. These are normal emotions and feelings.”

Helping Children

For parents of kids who have experienced the fires, listening is key, said Suzanne Silverstein, MA, founding director of Cedars-Sinai Share & Care and a registered art therapist.

“Hear what they’re saying,” Silverstein said. “Instead of talking at them, validate their feelings by acknowledging that it’s scary, hard or sad. Reassure them that they are OK as a family and will get through this together.”

Art for young children can be a beneficial coping mechanism: Children can draw things they miss, or items they would have gotten out of their home if they’d had the chance. Very young children may be better able to express feelings through play—using dolls or stuffed animals to act out scenarios and discuss emotions, or building forts with sheets and pillows to create a “safe space.”

“When adults can provide a safe emotional space for the child to take the lead in creative play, children will naturally work through difficult emotions without having to verbalize their feelings directly,” said Rebecca Hedrick, MD, child and adolescent psychiatrist at Cedars-Sinai. “It helps them feel some control and be able to process grief.

“Older kids may benefit from a daily ritual of saying five things that they’re sad about, five things they’re worried or angry about, five things they’re grateful for, and five things they’re looking forward to.”

The Path Forward

Patience, compassion, and faith in a better future are values to uphold in this time of crisis, the experts agreed.

“Take time to stop and mourn, and then address things one day at a time, one minute at a time,” Weiner said. “We shouldn’t try to do it all on our own—we need community now more than ever. I’ve been very moved by our community’s resilience.”

Cedars-Sinai Christian Chaplain the Rev. Peggy Kelley said she often has witnessed that “out of chaos comes creation,” and added, “This moment in time will bring healing restoration, new depths of compassion, profound lessons and growth.”

Kohler noted that spirituality can serve as an anchor to help make sense of what can feel senseless.

“Faith doesn’t erase pain,” Kohler said, “but it can provide a way to hold that pain while moving toward healing. We’re all in this together, and whether it’s in shared grief, acts of kindness, or the effort to rebuild, this experience has deepened my appreciation for community. By holding space for grief and recovery, we transform collective trauma into collective renewal.”

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.

As Southern California grapples with a third week of devastating wildfires, Cedars-Sinai continues to actively support our patients, employees and the community at large.

Cedars-Sinai continues to proceed with a full surgical schedule. Our Medical Network has reopened most outpatient offices and surgery centers that had been temporarily closed, including locations in Los Feliz, Pasadena and Santa Monica. Some of our Altadena locations remain closed as we work to reopen them. Healthcare professionals in our Brentwood/West LA office are caring for patients virtually for the time being. To make an appointment with a Cedars-Sinai physician call 1-800-CEDARS-1 (1-800-233-2771).

Cedars-Sinai Connect continues to offer 24/7 access to virtual care to all residents, including children 3-17 years old, during the current natural disaster. Our healthcare professionals are available around the clock to address a wide range of medical concerns and support the community. Visit csconnect.cedars-sinai.org or click here for step-by-step instructions to start a virtual visit.

This week, the medical center’s Community Benefit Giving Office is issuing more than $250,000 in grants to nonprofit organizations supporting wildfire relief and recovery efforts. 

We will share further updates as we navigate this challenging time in our community together. In the interim, the Cedars-Sinai Newsroom team has compiled advice from our experts—in both English and Spanish—on the following subjects:

• Managing medications
• Masking recommendations
• Respiratory safety tips
• First aid

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here. 

The medical center has issued more than $250,000 in emergency grants to nonprofit organizations assisting residents, workers and business owners affected by the disaster, as well as supporting first responders on the front lines.

Nine organizations so far have received grants, with amounts ranging from $15,000 to $50,000, to help address the community’s relief and recovery efforts.

“Whether it’s direct aid or volunteer efforts, Cedars-Sinai will continue to leverage all of its resources to help rebuild and strengthen our community,” said Erin Jackson-Ward, DrPH, executive director of Grantmaking and Social Impact at Cedars-Sinai. “So many of our community members are facing tremendous loss and uncertainty, and we feel a deep responsibility to support our beloved city during this challenging time." 

Among the causes receiving grants are the Los Angeles Fire Department Wildfire Emergency Fund, United Way of Greater Los Angeles Wildfire Response Fund, the California Community Foundation Wildfire Recovery Fund, and the Pasadena Community Foundation’s Eaton Canyon Fire Relief and Recovery Fund.

The Jewish Federation Los Angeles, Food Access Los Angeles, Inclusive Action for the City, the Institute of Popular Education of Southern California Essential Workers Fund and the YMCA of Metropolitan Los Angeles Community Response Fund also received grants to help pay for immediate response needs. Funding to the YMCA, for example, will help provide free daycare for children of first responders, essential workers and displaced or evacuated families. Other grants are focused on providing mental health services to those impacted as well as direct assistance to low-income workers and those displaced by the fires.

Cedars-Sinai also is making in-kind donations, including its distribution of more than 13,000 N95 masks and the issuance of personal protective equipment, such as goggles, respirators and coveralls. Additionally, Cedars-Sinai is focused on offering resources and support to its employees across the health system through the Emergency Employee Fire Relief Fund.

“We recognize that the road to recovery will be long, but Cedars-Sinai is committed to standing shoulder-to-shoulder with the people of Los Angeles,” said Arthur J. Ochoa, JD, senior vice president of Advancement and chief advancement officer for Cedars-Sinai. “As Angelenos grapple with the aftermath of these devastating wildfires, we want the message from our institution to be clear: we are in this together, and we will emerge from this crisis stronger than before.”

Read more on the Cedars-Sinai Blog: Faces of Cedars-Sinai—Erin Jackson-Ward, Grantmaker and Community Builder

“Rather than have this hanging over us while thinking of rebuilding, I decided I wanted to be operating at an optimum physical level,” Booher, 45, said. “My husband and I looked at each other and said, ‘This is tragic, but it doesn’t change the immediate plan. We’ll move on to the next step.’”

Booher and husband, Steve, along with their three greyhounds, evacuated their home on Jan. 7. He didn’t have time to pack the collection of comic books he has written. The next day, they learned the house was gone. By Jan. 9, Booher was at the Smidt Heart Institute at Cedars-Sinai for surgery to repair one of his heart’s valves.  

A few months prior, Booher had been diagnosed with mitral valve regurgitation, a condition in which the heart’s mitral valve doesn’t close as it should. Mitral valve regurgitation can cause heart failure, strokes and even sudden death, but it often goes unnoticed because symptoms are subtle. Booher’s fatigue, which he chalked up to his active lifestyle, was one such overlooked sign.

Joanna Chikwe, MD, chair of the Department of Cardiac Surgery at Cedars-Sinai, spent last Wednesday reassuring patients who were watching the Sunset fire from the hospital’s windows that they were in the safest place to be.

“I called patients already scheduled to have open-heart surgery to see what they wanted,” she said. “When I saw David’s address I thought, ‘He’ll never want to proceed. He must be overwhelmed.’ But I was astonished and inspired by his resolve. He told me, ‘Let’s fix my heart so I can rebuild my life.’”

Chikwe repaired the faulty heart valve through a tiny incision with the help of a robot, and Booher, recuperating at a friend’s home a few days later, already feels transformed.

“It boggles my mind that they went into my heart, repaired my valve, and now I feel so healthy,” he said. “The change has been remarkable. I feel like my heart is working efficiently. I feel clearheaded.”

Booher is coming to terms with not being able to go back to a community he loves. Altadena is a special place for him, a mix of architecture, mom-and-pop shops and tight-knit neighbors. He and his husband plan to spend time at their cabin in Big Bear where he’ll continue to write.

“Emotionally, it is starting to sink in,” he said. “When I was in the hospital, I was recovering, so I didn’t have the chance to internalize what happened. I have an incredible support system as I am working through my grief of losing everything. I’m grateful our dogs are safe, we are safe and have a place to stay. And I’m grateful for a healthy heart. That’s what we have to hold on to.”

 Read more on the Cedars-Sinai Blog: Treatment Options for Heart Valve Disease

And as people in Los Angeles County spend more time indoors in the aftermath of widespread wildfires—avoiding smoke-filled air, keeping out of the way of emergency responders and sheltering in place—they should be prepared to treat some of those injuries on their own, when possible, said Gregory Jones, RN, injury prevention and outreach coordinator for the Cedars-Sinai Trauma Program.

“It’s good to have basic knowledge—and a first-aid kit—ahead of time,” Jones said. “Unfortunately, many people don’t think about it until it’s too late. You want to prevent being in a situation in which you are completely unprepared.”

When Jones—whose job is to be prepared for emergencies and trauma—was recently faced with looming evacuation orders during an approaching wildfire, he was reminded first-hand that proper planning and preparation take time, focus and even practice.

“I talk every day about the importance of being prepared, and yet, as we packed to evacuate, I still needed to pause and recenter myself,” he said. “Be as ready as you can for an emergency, and that includes at-home first-aid planning. Know what to do to help yourself or someone else.”

The Cedars-Sinai Newsroom spoke with Jones about ways to prepare for and treat injuries at home, especially when it may be difficult to leave the house for immediate care.

What is the first thing a person should do if they’ve been injured at home or are looking to help someone who has?

Assess the situation and take a deep breath. Basic knowledge of first-aid practices will help. For example, for a bad cut, you should apply pressure to stop bleeding. If someone else is injured, consider whether it’s safe for you to help, or whether there is a chance you also could get injured. Also think, “Is this bigger than what I can do at home?” If that’s the case, make every effort to seek medical help. If there’s a life-threatening emergency, call 911. But when it comes to immediate care for cuts, burns, sprains and fractures, even a little knowledge goes a long way. So does a first-aid kit.

What should be in a first-aid kit?

A basic first-aid kit should have bandages, gauze, medical tape and an antibiotic cream. To supplement that, you could include varying sizes of bandages, extra gauze and a small pair of scissors. If you have young children, add fun adhesive bandages or stickers. SpongeBob SquarePants is a very good distraction from an injury.

What is the best way to treat a bad cut?

First, if there’s glass on the floor and you’re barefoot, grab slippers. Wash the cut with soap and water and apply direct pressure to stop bleeding. Dress the wound with antibiotic cream and cover it with a sterile bandage or gauze. Cleaning and covering the wound are critical to prevent infection. If you don’t have a bandage, use a clean kitchen towel or a T-shirt. Even a sock would work; in an emergency, you may need to improvise and use whatever is handy.

In the case of an amputation—you’ve lopped off the end of a finger chopping vegetables—try not to panic. Put the amputated part in a plastic bag filled with water and ice. This ice bath may allow it to be reattached when you are able to access medical care.

A word about pets: If your pet gets a cut, clean the wound with soap and water, use antibiotic cream and try to bandage the area until you can get them to a vet.

What is the best way to care for a burn?

For a mild burn—you touched a hot pan, for example—the first thing to do is cool down the burned area. Run cool water over it, and maybe apply ice, but never put ice directly on the skin. If you do use ice, put it in a plastic bag, wrap a towel around the bag, and only use it for a minute or two at a time. You want to cool the skin, not freeze it. Cover the burn with gauze or a sterile bandage.

If the burn is more severe—there’s a blister or broken skin—clean the area with soap and water, and then apply antibiotic cream and dress it with a sterile bandage. Don’t break the blister; it provides a protective barrier and helps prevent infection.

What should a person do if there’s a sprain or fracture?

For sprains, apply ice to help reduce swelling. You may want to alternate between ice and heat. If you think you have a broken bone and you cannot get medical help right away, splint the limb to immobilize it. You can splint a leg with household items such as a broom and mop. Place one on either side of the leg to help immobilize it and use medical tape to secure the splints. To splint an arm or wrist, consider using a book on either side of the arm, and use a kitchen towel or even a sock to hold the limb in place. Remember, improvisation is key.

Is there anything else to remember when it comes to emergency planning or at-home care for injuries?

Two things: Take a basic first-aid or a Stop the Bleed class. Most communities offer them. Also, remember to give yourself grace. My career is in trauma and emergency medicine, and even still, as my family prepared to evacuate last week, it was a tense time and a little chaotic. I had to remind myself of the importance of grace.

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here. 

Read more on the Cedars-Sinai Blog:  Mental Emergency Toolkit | Strategies to Try When Panic Takes Hold

That’s because the weather data does not measure many dangerous pollutants circulating in the air from smoke and wind, said pulmonologist Jeremy Falk, MD, associate professor of Medicine at Cedars-Sinai.

“People may think, ‘Well, I don’t see or smell smoke anymore, and it looks sunny like it normally does in Southern California,’ and be lulled into thinking everything is fine,” Falk said. “But much of what can harm us in situations like this doesn’t have an odor. The Air Quality Index system was developed for everyday pollution, and not necessarily to warn us about particles that are not typically in the air because of wildfires.”

Falk, along with Irina Dralyuk, MD, a Cedars-Sinai Guerin Children’s pulmonologist, and Daryl Banta, MD, pulmonologist and medical director of Pulmonology and Critical Care at Huntington Health, an affiliate of Cedars-Sinai, said it’s best to err on the side of caution and stay as safe as possible during periods of bad air quality—which will be around as long as the fires continue to burn.

About the Air Quality Index

An Air Quality Index level of 101-150 indicates that people in sensitive groups (such as those with lung disease, severe allergies or heart disease) could experience sore throats, wheezing or difficulty breathing. A level of 151-200 means even those without chronic breathing problems could experience health effects.

Still, the Air Quality Index can be deceiving, Falk said.

“Homes and buildings are full of all kinds of materials that are toxic when burned—plastics, oil products, metals—and the Air Quality Index does not pick up on that. Another limitation is in the unpredictable, shifting winds. You don't know if the air quality data that you're viewing is up to date. What may be an ‘acceptable’ level of air pollution one minute may be a very different level half an hour later. It's the unknown that makes this situation so dangerous.”

The South Coast Air Quality Management District is a good resource to check updated air quality in your area.

Benefits of Wearing a Mask

“What makes the air pollution associated with fires so dangerous is that the particles that seem to do the most damage are much smaller than even the microscopic droplets we saw with COVID-19,” Falk said. “Because the particles are so tiny, they can fit between the fibers of a simple paper mask or cloth mask and get far down into our airways, causing damage.”

The best masks to protect the lungs from microscopic particles found in dust, smoke, smog and particulate matter are N95 masks that can filter out really small particles, down to the 2.5-micron level. However, if KN95 masks are more readily available, they also are acceptable.

Banta advised wearers to make sure that their masks fit properly. 

“If there is any leak around the mask because of a beard or incorrect size, you may be exposing yourself to unhealthy air or smoke,” he said.

Safety Outside and Inside

“The longer you're outside breathing air that we know is not safe, the more you’re putting yourself at high risk,” Falk said. “While the fires are still happening, any exercise that could be moved to an indoor space is preferable. If you really do need to be outside for any reason, wearing the N95 mask is the best approach.”

When inside, Banta said, close windows, make sure any cracks are sealed and that there’s a good air filtration system. Check that any air conditioner is recirculating air that is in the structure and not pulling in air from the outside.  

“If there is significant smoke, ash or dust inside, wear masks indoors,” he said. 

Most modern cars also have a recirculating option, although drivers should check to make sure the automobile’s air filters have been changed recently.  

Parents should keep an eye on children who have a cough, wheezing, noisy breathing, chest tightness or pain, increased rate of breathing or increased heart rate, shortness of breath, retractions, labored breathing, gasping for air, throat irritation, hoarse voice, confusion, dizziness, or mental changes.

“It’s advisable for children of all ages to wear an N95 or KN95 mask when outside,” Dralyuk said. “Also, avoid outdoor sports or events, and evacuate the area if your child is having symptoms or the air quality is very poor, or if your child has risk factors for respiratory issues.”

If children have respiratory issues, make sure they take all scheduled medications as prescribed, and have rescue inhalers at home. Also, check expiration dates and number of puffs left, and get refills as necessary.

Watch for Symptoms

Direct, prolonged smoke inhalation or exposure is very dangerous.

“If you have severe symptoms, such as severe cough, shortness of breath, chest pain, dizziness or confusion after smoke exposure, seek immediate medical attention,” Banta said.

Milder symptoms can include irritated or watery eyes, runny nose, scratchy throat, wheezing, headache, dry eyes, phlegm or irritated sinuses. Older people and very young children can be more susceptible to these effects, as well as people who have preexisting lung or heart problems.

For people with chronic medical conditions, exposure to smoke and unhealthy air could potentially increase the risk for stroke, heart attacks and lung conditions. People exposed to prolonged amounts of particulate matter also may be at increased risk for lung cancer.

“If the air outside is bad to breathe, do what you can to not breathe it,” Falk said. “There’s nothing high tech about it. Just use common sense—that’s going to be our best way out of this.”

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.  

Wildfires across Los Angeles County have forced hundreds of thousands of people to flee their homes, leaving many without critical medications.

But patients can access vital medications using a variety of resources, according to Cedars-Sinai pharmacists.

“There are options for those in need of medications during all types of natural disasters,” said Rita Shane, PharmD, vice president and chief pharmacy officer at Cedars-Sinai.

Shane, alongside Vipul Patel, PharmD, executive director of Pharmacy and Oncology Services; Douglas Malcolm, PharmD, associate director of Ambulatory Pharmacy; and Rachel Vaystub, PharmD, manager of Pharmacy Services, offered advice for navigating medication access during a disaster.  

How can patients refill medications without access to their prescriptions or their regular pharmacy?

Patients have a few options. If they use a chain pharmacy, they can go to any other location, which will be able to access their medication records and provide refills. Or they can visit a local pharmacy, explain their situation, and the pharmacy might be able to determine the patient’s medications by checking with the patient’s insurance company.

Patients can call their insurance provider to get their medication list and ask for a recommended pharmacy. Or they can contact their medical provider and get their prescriptions sent to another pharmacy. Online tools like RxOpen track which pharmacies have remained open during emergencies.

Will pharmacies refill prescriptions early?

Pharmacies can—in good faith—provide a reasonable supply of medications without a prescription during a federal, state or local emergency. Under their professional judgment, pharmacists can refill prescriptions if failing to do so could interrupt ongoing care or create a significant, adverse impact on a patient’s wellbeing. The pharmacist will need to contact the patient’s physician as soon as possible to explain what was provided.

Do patients need to find pharmacies covered by their insurance provider?

Patients can go to any pharmacy in an emergency, especially in a declared state of emergency. Out-of-network pharmacies might cost more up front, but patients might be able to submit a claim to their insurer for reimbursement. Patients should call their insurance company to determine which pharmacy they recommend and whether a reimbursement will be provided.

What should patients do if they are uninsured?

The federal government has activated the Emergency Prescription Assistance Program for specific zip codes in California to help uninsured residents replace prescription medications and certain medical equipment lost or damaged during the wildfires. Call the program’s hotline at (855) 793-7470 to find out if you are eligible and to register. Visit the program’s website to review a list of participating pharmacies. Free clinics also might be able to help with critical medications, and certain local pharmacies might be willing to waive payment during emergencies.

Can patients get controlled substances without a prescription in an emergency?

Controlled substances would be very difficult to access without any proof of prescription. Having a medication list or information from insurance companies helps pharmacies when these medications are needed during emergencies/disasters. Strict regulations require additional steps and may result in delays.

What else should patients know?

For self-administered injectables, appropriate storage, and access to supplies like needles and syringes are major considerations. Many of these medications require refrigeration, but some can remain at room temperature. It is best to consult a pharmacist about how long the medication will last outside a fridge. Local pharmacies can also provide supplies in emergency situations. 

To arrange an interview, contact:
Marni Usheroff | 323-317-0556 | marni.usheroff@cshs.org

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.  

“Los pacientes con enfermedades de las vías respiratorias, como fibrosis pulmonar, EPOC y asma, pueden experimentar un empeoramiento de los síntomas debido a la exposición a la mala calidad del aire por los contaminantes de los incendios forestales”, dijo Isabel F. Pedraza, MD, profesora asistente de Medicina y directora de la Unidad de Cuidados Intensivos Médicos en el Cedars-Sinai. “Queremos asegurarnos de que nuestros pacientes tienen acceso a la atención cuando más lo necesitan.”

Los pacientes de neumología, dijo Pedraza, deben asegurarse de tomar sus inhaladores según lo prescrito, así como cualquier otro medicamento “controlador” que contenga un esteroide inhalado.

“Tanto los inhaladores como los medicamentos de control pueden ayudar a reducir la inflamación de las vías respiratorias provocada por el humo”, dijo Pedraza.

Pedraza ofreció varios otros consejos a cualquier persona que experimenta humo y restos de fuego:

• Permanezca dentro de casa el mayor tiempo posible, manteniendo las ventanas cerradas.
• Evite las actividades extenuantes al aire libre.
• Utilice ventiladores para mantenerse fresco; si utiliza aire acondicionado, ajuste el sistema para permitir la recirculación y evitar la entrada de aire del exterior.
• Utilice mascarillas N95 cuando esté al aire libre, especialmente en zonas con humo denso.
• Mantenga subidas las ventanillas del coche y ajuste las rejillas de ventilación para que recircule el aire.
• Asegúrese de tener a mano todos los medicamentos respiratorios necesarios. Si tiene asma pero no está tomando su inhalador de esteroides de mantenimiento, considere la posibilidad de volver a utilizarlo.

Para aquellos que experimentan un empeoramiento de los síntomas respiratorios, como tos incontrolada, sibilancias o dificultad para respirar, Pedraza dijo que deben ponerse en contacto con su médico lo antes posible. Cedars-Sinai Urgent Care también está disponible para apoyar a los pacientes.

Para mas cobertura de los incendios forestales del condado de Los Ángeles por parte de la sala de prensa de Cedars-Sinai, haga clic aquí.

“Patients with airway diseases, such as pulmonary fibrosis, COPD and asthma, may experience worsening of symptoms due to exposure to poor air quality from wildfire pollutants,” said Isabel F. Pedraza, MD, an assistant professor of Medicine and director of the Medical Intensive Care Unit at Cedars-Sinai. “We want to ensure that our patients have access to care when they most need it.”

Pulmonology patients, Pedraza said, should be sure to take their inhalers as prescribed, as well as any other “controller” medications that contain an inhaled steroid.

“Both inhalers and controller medications can help reduce the airway inflammation brought on by smoke,” Pedraza said.

Pedraza offered several other tips to anyone experiencing smoke and fire debris:

• Stay indoors as much as possible, keeping windows closed.
• Avoid strenuous outdoor activities.
• Use fans to keep cool; if you are using air conditioning, adjust the system to allow for recirculation and prevent intake from outdoor air.
• Wear N95 masks when outdoors, especially in areas with dense smoke.
• Keep car windows rolled up and set vents to recirculate air.
• Ensure you have all necessary respiratory medications on hand. If you have asthma but are not currently on your maintenance steroid inhaler, consider restarting the inhaler.

For those experiencing worsening respiratory symptoms—such as an uncontrolled cough, wheezing or shortness of breath—Pedraza said patients should contact their care provider as soon as possible. Cedars-Sinai Urgent Care is also available to support patients.

To arrange an interview, contact:
Soshea Leibler | 213-215-8000 | soshea.leibler@cshs.org
Cara Martinez | 310-562-7821 | cara.martinez@cshs.org

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.  

Nuestros corazones están con todos los afectados por los devastadores incendios en el condado de Los Ángeles. Seguimos evaluando el impacto de esta catástrofe.

Cedars-Sinai ha reanudado su calendario quirúrgico normal. Nuestro Medical Network ha reabierto la mayoría de las oficinas ambulatorias y centros de cirugía que habían sido cerrados temporalmente, incluyendo lugares en Los Feliz, Pasadena y Santa Mónica. Algunos de nuestros centros de Altadena permanecen cerrados mientras trabajamos para reabrirlos. Los profesionales sanitarios de nuestra oficina de Brentwood/West LA están atendiendo a los pacientes de forma virtual por el momento.

Cedars-Sinai Connect sigue ofreciendo acceso 24/7 a la atención virtual a todos los residentes, incluidos los niños de 3 a 17 años, durante la actual catástrofe natural. Nuestros profesionales sanitarios están disponibles las 24 horas del día para atender una amplia gama de preocupaciones médicas y apoyar a la comunidad. Visite csconnect.cedars-sinai.org para obtener instrucciones para iniciar una visita virtual.

Estamos apoyando activamente a nuestro personal para garantizar su seguridad y su capacidad de seguir atendiendo a los pacientes y a la comunidad. Compartiremos más actualizaciones a medida que atravesemos juntos este difícil momento en nuestra comunidad. Hasta entonces, instamos a todos a mantenerse a salvo y fuera de peligro.

Para mas cobertura de los incendios forestales del condado de Los Ángeles por parte de la sala de prensa de Cedars-Sinai, haga clic aquí.

The catastrophic wildfires raging throughout Los Angeles County present special concerns for adults and children with respiratory illnesses. Irina Dralyuk, MD, a Cedars-Sinai Guerin Children’s pulmonologist and Isabel F. Pedraza, MD, a pulmonologist in the Department of Medicine at Cedars-Sinai, are available for interviews to discuss topics such as how smoke can damage lungs, how to recognize respiratory distress and how to keep your children and family members safe.

“Parents of children with a history of lung issues need to be especially cautious,” said Dralyuk, MD. “That means premature infants, children with asthma, cystic fibrosis and severe allergies as well as children with weak or compromised immune systems.”

Dralyuk adds that parents should track the air quality measurement on their smart phones and whenever the air quality measurement is 125 or above, they should keep their children inside. Wednesday morning’s air quality measurement was above 400.

“If parents notice their children struggling with a persistent cough, wheezing or shortness of breath, seek medical attention immediately,” Dralyuk said.

Dralyuk and Pedraza also can discuss prevention tips, including:

• Using air purifiers and humidifiers
• Keeping windows and doors closed
• Wearing air filtration masks—not the simple anti-COVID-19 masks
• Checking asthma medications to make sure they have not expired
• Washing hands frequently

To arrange an interview, contact:
Soshea Leibler | 213-215-8000 | soshea.leibler@cshs.org
Cara Martinez | 310-423-7798 | cara.martinez@cshs.org

For the Cedars-Sinai Newsroom team's complete coverage of the Los Angeles County wildfires, please click here.  

The Cedars-Sinai Newsroom sat down with Sabrina Renteria, MD, a child and adolescent psychiatrist in the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, and Romina Kim, MD, a pediatric hospitalist with Cedars-Sinai Guerin Children’s, to discuss stress and burnout symptoms and what parents can do to help.  

What are some of the main causes of stress and burnout in children and teens?

Renteria: Some of the top causes of stress and burnout for this age group stem from academic pressures with high expectations and heavy workloads. High achievers, in particular, tend to overwhelm themselves with extracurricular activities in addition to their schoolwork, leaving insufficient time for rest and relaxation, which can be exhausting both physically and mentally. Additionally, social stress is often a contributing factor, especially in the age of social media where kids are constantly online. Bullying, peer pressure and difficulties navigating social relationships can all lead to severe emotional distress.  

What do stress and burnout look like in this age group?

Renteria: Burnout and stress in children and teens can manifest in various ways. This can look like snappiness or irritability, lack of energy or tearfulness. Depression and withdrawing from friends and family can be common as well. Children might even express frustration or that they feel like giving up.

Kim: Physically, stress can show up as things like headaches, gastrointestinal issues, unintended weight loss due to loss of appetite, tics and other generalized pain. In severe cases, some patients can experience what’s known as functional neurologic disorder, which is characterized by physical symptoms that cause distress and impair function without a structural or neurologic abnormality. In these cases, while nothing seems to be physically wrong with the child, they may experience various physical manifestations, including the inability to walk, muscle weakness or even seizures. With proper treatment, along with time and patience, most of these ailments are reversible.

How do doctors determine if a child’s physical ailment is stress-related, versus physiological?

Kim: It’s our role as doctors to do our due diligence. We always start by obtaining a detailed history from the patient and their family. This subjective information is our first step to piece together the puzzle. We also obtain objective data, such as physical exams, lab work, imaging studies and more to help support a possible diagnosis. Once we narrow things down, we often bring in additional experts, such as our neurology or psychiatry teams to help us confirm the diagnosis and address the problem to get the patient firmly on a path to recovery.

What signs of stress or burnout should parents or guardians look for in their children?

Renteria: Parents know their children best and should look out for significant changes in their behavior and mood. If your child starts to have a drop in grades, is increasingly irritable or constantly in a bad mood, those could all be signs they are under too much stress. Kids may also lose interest in their previously cherished pastimes or hobbies. Another red flag may be sleep issues, like trouble falling or staying asleep, or even sleeping too much.

Kim: When kids are burned out or feeling too much stress, they tend not to be able to cope with their emotions. Often, even the smallest inconvenience can trigger a big reaction. It’s important that parents don’t automatically dismiss what may be an unusual behavior for their child as them just being a “moody teenager,” when there may be much more to it than that.

How can parents or guardians help their kids manage significant stress or burnout?

Renteria: It’s OK for kids to be active and busy, but it’s all about striking a balance. It is important to find the right amount of organized activity and free time to help promote social and emotional growth and development in your child. Parents can help children combat burnout by encouraging them to engage in physical activity, maintain a healthy diet, get enough sleep, establish a daily routine, set realistic goals, practice relaxation techniques, limit screen time and seek professional help if needed.

Kim: By building an open, communicative relationship with their children early on, parents can create a foundation in which a child feels comfortable being able to talk openly about any stress or anxiety they’re experiencing. Another important thing for parents to remember: If they are not modeling good self-care and coping skills themselves, it is that much more difficult for their children to learn these habits. By setting an example of healthy balance for yourself, you can help set your kids up for success as well.

Read more from the Cedars-Sinai Blog: Five Deep Breathing Exercises for Kids and Teens