About this report

Health Effects of Summer Hazards

Experiencing high summer temperatures without relief from the heat and knowledge of protective health measures can lead to illness, hospitalization and death in severe cases.^[1][2]. The heat can stop a person’s body from regulating internal temperature, increasing their risk of experiencing heat-related illness such as heat cramps, heat exhaustion, heat stress and heat strokes^[3]. Extended periods of extreme heat may also create conditions for other summer hazards. These may include poor air quality from wildfire smoke and extended allergy seasons, as well as injuries or drowning from recreational water-based activities as people try escaping the heat^[4].

Historically, Washington County’s communities had milder summer temperatures with few days over 90°F, and periods of low temperatures that gave enough relief without air conditioning. In recent years however, the average annual temperatures and number of days with temperatures over 90° F in the Pacific Northwest have increased. This summer hazards report presents Washington County resident’s data on emergency department and urgent care visits for heat-related illness, asthma-like illness, fire and smoke inhalation, seasonal allergies, recreational water exposure, non-infectious respiratory illnesses, submersion and non-fatal drowning. The goal of this report is to help communities better understand health effects of summer hazards, so we can better prepare, respond and adapt.

Key Takeaways

• The number of heat-related illness emergency department and urgent care (ED/UC) visits during summer months since 2021 has been greater than previous years.

• Although Oregon has historically had mild weather, recent years show that communities faced at least 12 days annually of moderate heat exposure during summer months.

• When compared with all-cause ED/UC visits, a larger percent of heat-related illness visits had three common factors: They were by males, people 65 years and over and people identifying as white alone.

• In each of the past four summer seasons, we have lost at least one Washington County resident to drowning, and have had at least 12 ED/UC visits due to drowning . Most of these visits have been by children.

Methods

Quantitative

Summer Exposure

We report number of days based on categories of heat risk in Washington County, from 2018 to 2025, during the summer months of May 1 to September 31.

We report the number of summer season days with different levels of the National Weather Service heat risk. This is a color-numeric-based index that provides a forecast for risk of heat-related impacts to occur over a 24-hour period. It considers:

• How usual the heat is for the time of the year

• The duration of the heat including both daytime and nighttime temperatures

• If those temperatures pose a higher risk of heat-related impacts based on data from the CDC

More information can be found on NOAA’s “Understanding Heat Risk” document

We report on the Air Quality Index (AQI). The U.S. Air Quality Index (AQI) is Environmental Protection Agency’s (EPA) tool for communicating about outdoor air quality and health. The AQI includes six color-coded categories, each corresponding to a range of index values. The higher the AQI value, the greater the level of air pollution and the greater the health concern.

• Good: AQI between 0 and 50
• Moderate: Between 51 and 100
• Unhealthy for Sensitive Groups: Between 101 and 150
• Very Unhealthy: Between 201 and 300
• Hazardous: Between 301 and 500

More information can be found on the Air Now’s Air Quality Index (AQI) Basics page

Health Outcomes

We explain how summer hazard weather conditions are related to health emergencies like heat-related illness, asthma, smoke inhalation, non-infectious respiratory illness, seasonal allergies, recreational water exposure injury, and drowning and submersion in each tab.

We describe and analyze emergency department and urgent care (ED/UC) visits from the Oregon Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) ) from 2018-2025 summer seasons (May 1- Sept. 31) by Washington County residents. For each of the queries, we present:

• Annual counts that include average count for the entire period as a reference

• Rates of ED/UC query-specific visits among all-cause visits that are ranked by zip code during all 2019-2025 seasons

• Comparison of demographic distributions (i.e., age, sex, and race/ethnicity) for ED/UC query-specific visits and all-cause visits during 2021-2025 summer seasons that include note of statistically significant differences (p < 0.05) based on chi-square and Fischer tests with a *, and sizeable differences with ^ (absolute difference of 5 percentage points).

This data was updated on July 10, 2025.

We analyzed mortality data from Oregon Vital Statistics for deaths that happened in Washington County from 2018-2025. We used that to identify andreport the number of heat-related deaths, respiratory deaths, deaths from drowning, and all-cause deaths by summer season (May 1 to Sept.31).

Qualitative

From 2023-2024, Washington County partnered with Rede Group to conduct phases one and two of a community engagement process to inform public health modernization plans^[5]. These plans include the Climate Action Plan and All Hazards Preparedness Plan.

We conducted a third phase – funded by the Department of Energy through the Energy Efficiency and Conservation Block Grant – to further inform the Climate Action Plan. In the context of climate change and health, we asked participants about climate preparedness, needs, and sources of resilience during all phases of engagement.

All phases include a total of 759 participants who took part in surveys, tabling events, knowledge exchanges, interviews and focus groups. This report shares quotes from the people participating in engagements focused on climate change and emergency preparedness. Participants included people identifying as Latino/a/x/e, Chinese American, Vietnamese, African American, Native Hawaiian, Pacific Islander, American Indian and Alaska Native, Russian, Ukrainian, Arabic-speaking, Somali-speaking, Pashto-speaking, and other immigrant and refugee communities. People and organizations also represented youth, students, older adults, individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer/Questioning and other gender identities and sexual orientations, people with disabilities, unhoused individuals, and individuals experiencing food insecurity.

Community Engagements by Phase are summarized below:

Community Engagements by Phase

Phase 1 and 2	Phase 3
Phase 1 (Aug-Oct 2023)|Phase 2 (Apr-Aug 2024)	Apr-May 2025
Five individual interviews with community partners and organizations Three knowledge exchanges with community members in partnership with Bienestar, African Youth and Community Organization, and home visitors from Washington County Public Health’s Maternal, Child, and Family program One focus group with Pacific University students Five tabling events including Juneteenth Celebration, Tauraro Fest, Tigard Pride Festival, Beaverton Pride Festival, and the Adelante Mujeres Forest Grove Farmers Market Two survey efforts at Cedar Halal Market and Islamic Social Services of Oregon State food pantry **Emergency Preparedness (180 participants)** Eight individual interviews with community partners Six knowledge exchanges with CHWs, partners who belong to Washington County’s Community Participation Organizations, and community members who identify as disabled, are BIPOC and speak Russian One tabling event with Adelante Mujeres at the Forest Grove Farmers Market Three focus groups with community members from Washington County and Pacific University students	**Climate Change (176 participants)** One Community Survey Four focus groups including:   • Members of a senior community center   • • Washington County’s Community Participation Organizations   • Advisory council on racial equity   • Native Hawaiian and Pacific Islander (NHPI) community members

Two people reviewed triage notes, chief complaints, discharge diagnosis and ICD codes sections of heat-related illness visits during 2025’s warm season (May-Sept.) to identify common exposure circumstances (i.e., outdoor exposure, ambulance use, occupational, recent trauma history before injury, exposure in a vehicle, houselessness, pregnancy, intoxication, and special event participation) and existing conditions and disability (i.e., chronic condition, disability, mental health, diabetes, and cardiovascular disease). Categories mentioned in 10 or fewer visits were consolidated into broader groups to lower their risk of being identified.

Data details

Daily data on heat risk for Washington County comes from National Weather Services. The data on Air Quality Index (AQI) comes from the EPA. Measures of AQI 24-hour averages were taken from all air monitor stations in Washington County, and results from the air monitor with the highest daily index were included in this report.

The number of emergency department and urgent care (ED/UC) visits for heat-related illness, seasonal allergies, asthma-like illness, fire and smoke inhalation, non-infectious respiratory illness, recreational water exposure, and submersion and non-fatal drowning, and all-cause visits came from Oregon’s ESSENCE database. All visits were by Washington County residents.

Data on deaths came from death certificates from Oregon Vital Statistics from 2018-2025 summer seasons. Deaths described in this report occurred in Washington County and may include non-Washington County residents.

Data in this report are for the months of May-Sept.from 2018-2025, referred to as summer months or seasons. Queries used to define health outcomes in this report are detailed in the table below.

Heat-related health indicators and sources

Health Outcomes Surveillance Data

Health Outcome	Data Source	Query Text
Heat-related illness (ED/UC Visits) among county residents	Oregon ESSENCE	Keywords in patient records that suggest heat illness, such as: 'heat stroke', 'heat exhaustion', 'too hot', 'hyperthermia', 'sunstroke', 'heat cramps' and other variations like 'hot' with 'fatigue,' 'exposure,' or 'cramps.' ICD 9 and 10 Codes: T67, 992
Seasonal Allergies (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records that suggest seasonal illness, such as any mention of 'allergy' or 'allergies'. This identifies patients who might be reacting to pollen, dust, or seasonal environmental allergens (e.g., grasses, trees, weeds).
Asthma-like illness (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records include: 'asthma' (including misspellings like 'asma,' 'asthmae,' 'asthmia'), 'bronchospasm' (tightening of the muscles around the airways), 'reactive airway disease,' 'airway disease'.
Fire and Smoke Inhalation (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records include: wild fire or wildfire, the word 'smoke,' but not when it's part of common phrases that don't indicate environmental exposure.
Non-Infectious Respiratory Illness (ED/UC visit) among county residents	Oregon ESSENCE	Keywords in patient records indicating chronic or acute lung conditions like: Asthma, COPD, Chronic bronchitis, Emphysema, Acute bronchitis (without infection), Bronchial asthma
Recreational Water Exposure (ED/UC visits) among county residents	Oregon ESSENCE	Keywords in patient records: Lake, river, boat, swim
Submersion and non-fatal drowning (ED/UC visits) among county residents	Oregon ESSENCE	Keywords in patient records includes mentions of drowning, but not feelings of drowning. This includes the word 'DROWN', but excludes phrases like: 'FEEL DROWN,' 'FELT DROWN'.
Heat-Related Deaths that occurred in the County	Oregon Vital Records	ICD 10 Codes: X30, T67, and P810
Respiratory Deaths that occurred in the County	Oregon Vital Records	ICD 10 Codes: J20, J43, J44, J45, J80, R060, R0602, R0609, J96

Acknowledgments

Land Acknowledgement (as prepared by representatives of Confederate Tribes of Grand Ronde, Nez Perce, Siletz, and Yavapai)

We want to acknowledge the people on whose land we live — the Atfalati-Kalapuyans, also known as the Tualatin Band of Kalapuyans — the first inhabitants of Washington County. We are grateful for the land we are on, Kalapuyan land.

Signers of the Willamette Valley Treaty of 1855 were removed from their homelands to the Grand Ronde Indian Reservation. Today, their descendants are tribal members of Grand Ronde and Siletz tribes, carrying on the traditions and cultures of their ancestors.

We acknowledge and express gratitude for the ancestors of this place and recognize that we are here because of the sacrifices forced upon them. In remembering these communities, we honor their legacy, their lives and their continuation in our community. Please reflect on the role government has played in the painful, colonial history and reflect as well on the resilience and healing of the Indigenous land and communities.

We would like to invite everyone to collaborate and work together with the tribes to take care of the land and water and the people who inhabit these spaces.

Community partners Acknowledgement

We would also like to acknowledge community members and partnering organizations interviewed for their dedication to communities and willingness to share experiences and stories that give critical context to how we track and respond to impacts of summer hazards on the community.

Resources

For more information on how to stay cool, go to the County’s Hot Weather page

Thank you again to our community who supported collection of information to identify heat islands in our community! This work continues to inform our County climate and health planning and is another reminder of the strength of working together as a community. View results from the heat mapping campaign

Notes

Common terms and abbreviations:

ED/UC: Emergency Department and Urgent Care Visits

ESSENCE: Electronic Surveillance System for the Early Notification of Community-Based Epidemics

Summer Seasons: In this report we refer to the months from May to September because these often are the months with the warmest weather.

AQI: Air Quailty Index

EPA: Environmental Protection Agencies

CDC: Center for Disease Control and Prevention

References

^[1] Voelkel J, Hellman D, Sakuma R, Shandas V. Assessing Vulnerability to Urban Heat: A Study of Disproportionate Heat Exposure and Access to Refuge by Socio-Demographic Status in Portland, Oregon. Int J Environ Res Public Health. 2018;15(4). ↩︎

^[2] Mahsin MD, Cabaj J, Saini V. Respiratory and cardiovascular condition-related physician visits associated with wildfire smoke exposure in Calgary, Canada, in 2015: a population-based study. Int J Epidemiol. 2022; 51(2): 166-178. ↩︎

^[3] CDC. National Institute For Occupational Safety and Health(NIOSH): Heat Stress Heat-related Illness. 2025; https://www.cdc.gov/niosh/heat-stress/about/illnesses.html. Accessed April 2025. ↩︎

^[4] Sindall R, Mecrow T, Queiroga AC, Boyer C, Koon W, Peden AE. Drowning risk and climate change: a state-of-the-art review. Inj Prev. 2022; 28(2): 185-191. ↩︎

^[5] Rede Group, on behalf of Washington County Public Health Division. Community Engagement Findings to Support Public Health Modernization. Washington County, OR; October 2024. https://www.washingtoncountyor.gov/public-health/documents/community-engagement-findings-support-public-health-modernization/download. Accessed June 12, 2026 ↩︎

Weather

Why we track this?

Exposure to extreme heat for longer periods can result in major health impacts. As stated in the 2023 Report on Climate and Health in Oregon, the likelihood of visits to the emergency department for heat-related illness during summer is greater on days that reach temperatures over 80°F and periods of time where daily temperatures do not fall below 65°F^[6].

In Washington County, we have observed that emergency department visits for heat-related illness begin to occur at lower temperatures in the earlier months of summer when people are less used to warmer temperatures. Because there are many factors at play, emergency preparedness and response teams will often base action off of the National Weather Service Heat Risk Index^[7].

In addition to heat, drought can increase risk of wildfires. Wildfire smoke in the region can linger and worsen asthma symptoms as well as other air-quality related illnesses^[8].

To better understand summer hazards in our community, this report presents annual number of days during summer months with various levels of heat and air-quality.

What are you seeing

This section has two tabs that show the number of summer season days with different heat risk levels (source: CDC) and air quality index levels (source: EPA) that often informs response^[9][10]. Key takeaways are in the titles and description of information. They are included below each tab’s image. Data are from May 1 to Sept. 30 and referred to as the warm season.

Each square represents one day during the heat season (May through September). The color of each square indicates the maximum daily heat risk level. Green indicates Little to None (minimal heat-related health risk). Yellow indicates Minor risk. Orange indicates Moderate risk, when heat may begin to affect sensitive individuals. Red indicates Major risk, when heat poses a significant health concern for the general population. Purple indicates Extreme risk, representing the highest potential for heat-related illness. Gray indicates that heat risk data are unavailable. Darker, warmer colors represent progressively greater heat-related health risk.

Since 2019, most summer days have had little to none or minor heat risk. However, a majority of warm season days in 2025 had at least moderate heat risk.

We report number of days to understand frequency of exposure, and report heat risk levels to understand severity.
Source: National Weather Service

Each square represents one day during the wildfire season (May through September). The color of each square indicates the daily air quality category based on fine particulate matter (PM₂.₅). Green indicates Good air quality, with little or no health risk. Yellow indicates Moderate air quality, which is acceptable for most people but may affect unusually sensitive individuals. Orange indicates Unhealthy for Sensitive Groups, meaning children, older adults, pregnant people, and individuals with heart or lung disease may experience health effects. Red indicates Unhealthy air quality, when everyone may begin to experience health effects and sensitive groups are more likely to be affected. Purple indicates Very Unhealthy air quality, with increased health risks for the general population. Dark burgundy indicates Hazardous air quality, representing emergency conditions in which everyone is likely to experience serious health effects. Gray indicates that air quality data are unavailable. Colors progress from lower to higher health risk as they transition from green to dark burgundy.

Most warm season days since 2019 have had good air quality, however many of the days with moderate to unhealthy air quality have coincided with regional wildfires.

We report number of days to understand frequency of exposure, and report air quality index levels to understand severity.
Source: Environmental Protection Agency (EPA)

Notes

Common terms and abbreviations:

ED/UC: Emergency Department and Urgent Care Visits

ESSENCE: Electronic Surveillance System for the Early Notification of Community-Based Epidemics

Summer Seasons: In this report we refer to the months from May to September because these often are the months with the warmest weather.

AQI: Air Quailty Index

EPA: Environmental Protection Agencies

CDC: Center for Disease Control and Prevention

References

^[6] Jesse E. Bell SCH, Lesley Jantarasami,Ch. 4: Impacts of Extreme Events on Human Health. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment.,Washington, DC: U.S. Global Change Research Program 2016. ↩︎

^[7] Center NWSWP. The Heat Index Equation. 2022. https://www.wpc.ncep.noaa.gov/html/heatindex_equation.shtml. 2025. ↩︎

^[8] Wehner MF, J.R. Arnold, T. Knutson, K.E. Kunkel, and A.N. LeGrande. Droughts, floods, and wildfires. DC, USA 2017. ↩︎

^[9] Centers for Disease Control and Prevention.How to use the HeatRisk Tool and Air Quality Index. Published September 18, 2025. https://www.cdc.gov/heat-health/hcp/clinical-guidance/how-to-use-the-heatrisk-tool-and-air-quality-index.html. Accessed June 12, 2026. ↩︎

^[10] U.S. Environmental Protection Agency. Final Updates to the Air Quality Index (AQI) for Particulate Matter: Fact Sheet. February 2024. https://www.epa.gov/system/files/documents/2024-02/pm-naaqs-air-quality-index-fact-sheet.pdf. Accessed June 12, 2026. ↩︎

This page presents health impacts of environmental hazards.

Use the tabs below to explore specific topics:

Heat Related Illness

Why we track this?

During periods of extreme heat, people with inadequate cooling can suffer from a number of different health impacts. Exposure to extreme heat can lead to excessive sweating as the body attempts to cool itself. This can lead to heat-related illnesses such as heat rash, heat cramps, heat syncope (i.e., fainting), rhabdomyolysis (i.e., breakdown of muscle tissues), heat exhaustion and heat stroke^[11]. In the most severe cases, heat exposure can result in death.

The ability to adapt to extreme heat is dependent on both social and environmental conditions. This report shares percent of visits by age, sex and race as a step towards understanding who heat impacts in Washington County. Unfortunately, existing data does not identify all groups at risk, but below we share groups most impacted by heat based on existing research (i.e., Regional Climate Health Monitoring Report 2022)^[12]:

• Adults over the age of 65
• People experiencing houselessness
• People with chronic medical conditions that reduce thermoregulation (e.g., heart disease or poor blood circulation)
• People with few social connections and limited social networks
• Children
• Pregnant people
• People living, working, or going to school in an urban heat island
• People with limited access to protective factors (e.g., homeownership, proximity to high pollution, access to affordable healthcare, access to cool spaces)
• Outdoor workers (e.g., construction, road crews, farm workers)
• People with mental, behavioral, or cognitive disorders that are exacerbated by heat, or who rely on medications that interfere with thermoregulation
• People with no access to cooling systems at home

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information included, which are detailed below each tab’s image. Data are from May 1 to Sept. 30 and referred to as the warm season.

The number of warm season heat-related illness ED/UC visits since 2021 have been greater than previous years.

The annual count tab shows the total number of emergency department and urgent care (ED/UC) visits for heat-related illness each warm season.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Zip codes in rural areas have the highest rates of heat-related illness ED/UC visits among all-cause ED/UC visits during 2018-2025 warm seasons.

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97119	146.1
97223	105.2
97078	102.1
97113	100.8
97123	95.9
97116	95.1
97124	90
97005	89.2
97225	87
97062	87
97003	82.9
97133	81.7
97106	75.5
97007	69.6
97229	69.2
97224	63.8
97006	63.2
97140	59.1
97008	58.2

The zip codes of residence tab shows the rate of heat-related illness ED/UC visits among all-cause ED/UC visits by zip code. We use rate of heat-related illness ED/UC visits among all-cause ED/UC visits to adjust for changes over time in number of facilities reporting to ESSENCE.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

The percentage of warm season heat-related illness ED/UC visits by people identifying as males, and white alone were significantly greater than the percent observed among all-cause ED/UC visits.

References

^[11] CDC. Nation Institute for Occupational and Health(NIOSH): Heat Stress. Heat-related Illness. https://www.cdc.gov/niosh/heat-stress/about/illnesses.html. Published 2024. Accessed April 2025. ↩︎

^[12] Clackamas County, Multnomah County, and Washington County, 2023: Regional Climate and Health Monitoring Report., https://www.washingtoncountyor.gov/public-health/documents/2023-regional-climate-and-health-monitoring-report/download?inline ↩︎

Seasonal Allergy

Why we track this?

With warmer temperatures, shift in seasonal patterns and more carbon dioxide in the atmosphere, the length and intensity of allergy seasons have grown^[13].

Based on a report by the nonprofit Climate Central, all regions in Oregon as of 2022 reported a greater number of freeze-free season days when compared to 1970^[14]. This means there’s a longer period of time that people can be exposed to allergens like pollen and mold.

We share the number of allergy-related ED/UC visits that are likely related to exposure to allergens, based on triage notes. The current query excludes food allergies to better capture seasonal allergies, but we’re exploring additional criteria to improve the query and identify pollen allergies in future reports.

While increased exposure to pollen can impact anyone, some people may be at risk of suffering more severe symptoms and outcomes as a result of personal characteristics as well as social and environmental conditions. We share percent of visits by age, sex and race as a step towards understanding who heat impacts in Washington County. Currently, existing data does not identify all groups at risk, but we do share groups most impacted by pollen exposure below^[15][16]:

• Individuals with pre-existing disease including asthma and hay fever
• People with chronic obstructive pulmonary disease (COPD)
• Children and adolescents with asthma

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information, which are detailed below each tab’s image. Data are from May 1 to Sept. 30 and referred to as the warm season.

The average number of seasonal allergy-related ED/UC visits by Washington County residents from 2018-2025 warm seasons was 122. From 2020-2021 annual visits decreased, likely due to changes in accessing care during the peak of COVID. The past summer visits have returned to pre-pandemic levels.

The annual count tab shows the total number of seasonal allergy-related ED/UC visits each year.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Zip codes with higher rates of seasonal allergy-related ED/UC visits among all-cause ED/UC visits during 2018-2025 warm seasons were similar across the county, but both the 97140 and 97106 zip codes had the highest rates.

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97140	160.2
97106	120.8
97006	109.9
97123	105.3
97007	99.9
97062	99.5
97124	95.1
97224	88.3
97078	86
97133	81.7
97119	81.1
97223	78.9
97229	74.8
97003	73.4
97113	68.6
97008	66
97116	63.4
97005	46.6
97225	34.8

The zip codes of residence tab shows the rate of seasonal allergy-related ED/UC visits among all-cause ED/UC visits by zip code. We use rate of seasonal allergy-related ED/UC visits among all-cause ED/UC visits to adjust for changes over time in number of facilities reporting to ESSENCE.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

The percentage of warm season seasonal-allergy related ED/UC visits by people younger adult (18-44), identifying as Hispanic, and Asian alone were significantly greater than the percent observed among all-cause ED/UC visits.

References

^[13] Stein, Zachary. Syndromic surveillance for monitoring health impacts of pollen exposure. APHA 2021 Annual Meeting and Expo, ICF, Atlanta, GA ↩︎

^[14] CDC. Climate and HealthSeasonal allergies: pollen and mold. https://www.cdc.gov/climate-health/php/effects/allergens-and-pollen.html. Published 2023. Accessed April 2025 ↩︎

^[15] Kitinoja MA, Hugg TT, Siddika N, et al.Short-term exposure to pollen and the risk of allergic and asthmatic manifestations: a systematic review and meta-analysis. BMJ Open. 2020 Jan;10(1):e029069. DOI: 10.1136/bmjopen-2019-029069. PMID: 31924628; PMCID: PMC7045159 ↩︎

^[16] Li Z, Xu X, Thompson LA, et al.Longitudinal Effect of Ambient Air Pollution and Pollen Exposure on Asthma Control: The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Study. Acad Pediatr. 2019;19(6):615-623. doi:10.1016/j.acap.2019.03.010 ↩︎

Asthma

Why we track this?

Hotter and drier conditions have led to more frequent wildfires in the Pacific Northwest, increasing air pollution levels during our summer months^[17]. . In the short term, wildfire and wildfire smoke can result in more immediate injury, and this is addressed in the Fire and Smoke injury tab. Long-term exposure can increase one’s risk of developing asthma.

During the summer of 2020, multiple wildfires across the region resulted in hazardous air quality that lasted for days and we observed increased emergency department and urgent care visits for asthma-like illness^[18]. ]. Exposure to high levels of smoke increases risk of asthma-like illness as well as other types of respiratory disease, including infectious disease^[19][20]. To improve future response to increasingly frequent wildfire and smoke events, we present data on (ED/UC) visits involving asthma-like illness as a marker of how wildfire smoke impacts asthma-like symptoms in our community.

Systemic structures, including displacement of Indigenous communities and housing and development policies have resulted in low-income groups being disproportionately exposed to air pollution due to where they live. Ongoing exposure increases their risk of illness during air pollution events, including wildfire smoke. We share percent of visits by age, sex and race as a step towards understanding who heat impacts in Washington County. Unfortunately, existing data does not identify all groups at risk, but below we share groups most impacted by air pollution based on existing research:

• Outdoor workers (e.g., construction, road crews, farm workers)
• Older adults, children and people with chronic lung conditions like asthma, or chronic obstructive pulmonary disease
• Communities that have lived in areas that have not been prioritized for public works enhancements
• Those living near high traffic areas or near industrial facilities
• Immigrants and communities that are culturally or linguistically isolated and may not have access to emergency communications warning of poor air quality

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information included are detailed below each tab’s image. Data are from May 1 to Sept. 30 and referred to as the warm season.

Warm season 2024 had the greatest number of asthma-like illness ED/UC visits since 2018. Changed interaction with hospitals during the COVID19 pandemic likely contributed to the lower than average asthma-like illness ED/UC visits from 2020 to 2021.

The annual count tab shows the total number of asthma-like illness ED/UC visits each year.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Zip codes in Northern Washington County have the highest rates of asthma-like illness visits among all-cause visits during 2018-2025 warm seasons.

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97109	3195.7
97144	2713.2
97078	2088
97133	2065.3
97006	2056.1
97113	2052.9
97008	2009.5
97003	2001.2
97124	1984.8
97106	1887.1
97005	1885.9
97123	1848.5
97116	1841.8
97007	1799.8
97229	1674.1
97223	1665.2
97119	1639.1
97224	1531.4
97140	1455.5
97225	1406.8
97062	1363.5
97117	1087

The zip codes of residence tab shows the rate of asthma-like illness ED/UC visits among all-cause ED/UC visits by zip code. We use rate of asthma-like illness visits among all-cause visits to adjust for changes over time in number of facilities reporting to ESSENCE.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

The percentage of ED/UC visits involving asthma-like illness by people identified as female were notably greater than the percentage observed among all-cause ED/UC visits.

References

^[17] Mote, P.W., J. Abatzoglou, K.D. Dello, K. Hegewisch, and D.E. Rupp, 2019: Fourth Oregon Climate Assessment Report. Oregon Climate Change Research Institute., occri.net/ocar ↩︎

^[18] Clackamas County, Multnomah County, and Washington County, 2023: Regional Climate and Health Monitoring Report., https://www.washingtoncountyor.gov/public-health/documents/2023-regional-climate-and-health-monitoring-report/download?inline ↩︎

^[19] Noah TL, Worden CP, Rebuli ME, Jaspers I, The Effects of Wildfire Smoke on Asthma and Allergy. Curr Allergy Asthma Rep.. Jul;23(7):375-387. doi: 10.1007/s11882-023-01090-1. Epub 2023 May 12. PMID: 37171670; PMCID: PMC10176316. ↩︎

^[20] Landguth EL, Holden ZA, Graham J, Stark B, Mokhtari EB, Kaleczyc E, Anderson S, Urbanski S, Jolly M, Semmens EO, Warren DA, Swanson A, Stone E, Noonan C. The delayed effect of wildfire season particulate matter on subsequent influenza season in a mountain west region of the USA.. Environ Int. 2020 Jun;159:105668. doi: 10.1016/j.envint.2020.105668. Epub 2020 Mar 31. PMID: 32244099; PMCID: PMC7275907 ↩︎

Fire and Smoke Inhalation

Why we track this?

Hotter and drier conditions have led to more frequent wildfires in the Pacific Northwest, increasing air pollution levels during our summer months^[21]. In the short term, wildfire and wildfire smoke can result in more immediate injury and care facility use. In the long term it can increase risk of developing asthma, which is addressed in the asthma tab. During the summer of 2020, multiple wildfires across the region resulted in hazardous air quality that lasted for days and we observed increased emergency department and urgent care visits for fire and smoke inhalation^[22]]. Exposure to high levels of smoke increases risk of asthma as well as other types of respiratory disease, including infectious disease^[23][24]. To improve future response to increasingly frequent wildfire and smoke events, we present data on fire and smoke inhalation-related ED/UC visits to understand how wildfire impacts our community’s health. Visits in this data capture health impacts from wildfires but can also include other types of fire such as house fires.

Systemic structures, including the displacement of Indigenous communities and housing and development policies have resulted in communities of low-income groups being more likely to live in areas with disproportionately greater exposure to air pollution. Ongoing exposure increases their risk of illness during air pollution events including wildfire smoke. We share percent of visits by age, sex, and race as a step towards understanding who is impacted by heat in Washington County. Unfortunately, existing data does not identify all groups at risk, but below we share groups whose health is most impacted by pollution based on existing research (Regional Climate Health Monitoring Report 2022:

• Outdoor workers (e.g., construction, road crews, farm workers).
• Older adults, children, and people with chronic lung conditions like asthma, or chronic obstructive pulmonary disease.
• Communities that have lived in areas that have not been prioritized for public works enhancements
• Those living near high traffic areas or near industrial facilities
• Immigrants and communities that are culturally or linguistically isolated and may not have access to emergency communications warning of poor air quality

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information, which are detailed below each tab’s image. Data are from May 1 to Sept.30 and referred to as warm season.

The number of warm season fire and smoke inhalation ED/UC visits were greatest in 2020 but there has been a gradual increase from 2021 to 2024. It is important to note that in 2020 there were multiple wildfires near to our county, but wildfire smoke has continued to regularly impact our region.

The annual count tab shows the total number of fire and smoke inhalation ED/UC visits during each warm season.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Zip codes in the more urban region of Washington County have the highest rates of warm season fire and smoke inhalation-related ED/UC visits among all-cause ED/UC visits from 2018-2025.

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97006	30.4
97008	29.1
97003	28.4
97007	26.6
97124	24.4
97005	22.3
97123	20.1
97229	20.1
97116	19.5
97223	15
97225	14.9
97078	13.4
97062	12.4
97224	9.8

The zip codes of residence tab shows the rate of fire and smoke inhalation ED/UC visits among all-cause ED/UC visits by zip code. We use rate of fire and smoke inhalation ED/UC visits among all-cause visits to adjust for changes over time in number of facilities reporting to ESSENCE.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

The percentage of fire and smoke inhalation ED/UC visits by adults (18-64 years), older seniors (75+ years), and identifying as Hispanic was notably greater that the percentage observed among all-cause ED/UC visits.

References

^[21] Mote, P.W., J. Abatzoglou, K.D. Dello, K. Hegewisch, and D.E. Rupp, 2019: Fourth Oregon Climate Assessment Report. Oregon Climate Change Research Institute., occri.net/ocar4 ↩︎

^[22] Clackamas County, Multnomah County, and Washington County, 2023: Regional Climate and Health Monitoring Report., https://www.washingtoncountyor.gov/public-health/documents/2023-regional-climate-and-health-monitoring-report/download?inline ↩︎

^[23] Noah TL, Worden CP, Rebuli ME, Jaspers I, The Effects of Wildfire Smoke on Asthma and Allergy. Curr Allergy Asthma Rep.. Jul;23(7):375-387. doi: 10.1007/s11882-023-01090-1. Epub 2023 May 12. PMID: 37171670; PMCID: PMC10176314. ↩︎

^[24] Landguth EL, Holden ZA, Graham J, Stark B, Mokhtari EB, Kaleczyc E, Anderson S, Urbanski S, Jolly M, Semmens EO, Warren DA, Swanson A, Stone E, Noonan C., The delayed effect of wildfire season particulate matter on subsequent influenza season in a mountain west region of the USA.. Environ Int. 2020 Jun;139:105668. doi: 10.1016/j.envint.2020.105668. Epub 2020 Mar 31. PMID: 32244099; PMCID: PMC7275907. ↩︎

Non-Infectious Respiratory Illness

Why we track this?

Hotter and drier conditions have led to more frequent wildfires in the Pacific Northwest, increasing air pollution levels during our summer months^[25]. Wildfire and wildfire smoke can result in fire and smoke inhalation injury and asthma that are addressed in other tabs, as well as other types of respiratory distress^[26][27]. To improve future response to increasingly frequent wildfire and smoke events, this report presents data on non-infectious respiratory illness-related ED/UC visits to understand how wildfire impacts our community’s health.

Systemic structures, including displacement of Indigenous communities and housing and development policies have resulted in communities of low-income groups being more likely to live in areas with disproportionately greater exposure to air pollution. Ongoing exposure increases their risk of illness during air pollution events, including wildfire smoke. We share percent of visits by age, sex and race as a step towards understanding who is impacted by heat in Washington County. Unfortunately, existing data does not identify all groups at risk, but the below shares groups that pollution impacts the most based on existing research (Regional Climate Health Monitoring Report 2022):

• Outdoor workers (e.g., construction, road crews, farm workers).
• Older adults, children, and people with chronic lung conditions like asthma, or chronic obstructive pulmonary disease.
• Community members that have experience race-based gaps in access to services or unlawful separation based on a protected class. Those living near high traffic areas or near industrial facilities.
• Immigrants and communities that are culturally or linguistically isolated and may not have access to emergency communications warning of poor air quality.

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information, which are included below each tab’s image. Data are from May 1 to Sept. 30 and referred to as warm season.

Summer 2024-2025 had more warm season non-infectious respiratory illness ED/UC visits than recent years.

The annual count tab shows the total number of non-infectious respiratory illness ED/UC visits each warm season.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

The rate of non-infectious respiratory ED/UC visits among all-cause ED/UC visits was highest in more rural zip codes of Washington County for 2021 to 2025 warm seasons.

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97144	13565.9
97109	9587.2
97119	9266.5
97116	9150.6
97117	8937.2
97113	8514.2
97133	8226.4
97123	7932.4
97078	7916.8
97124	7750.2
97006	7611.4
97008	7561
97125	7456.1
97106	7367.1
97005	7320.6
97003	7301.5
97224	7270.7
97223	6927.5
97229	6904
97007	6791.8
97225	6390.1
97062	6067.5
97140	5882.9

The zip codes of residence tab shows the rate of non-infectious respiratory illness-related ED/UC visits among all-cause ED/UC visits by zip code during 2021 to 2025 warm seasons. We use rate of non-infectious respiratory illness-related ED/UC visits among all-cause ED/UC visits to adjust for changes over time in number of facilities reporting to ESSENCE.Source:ESSENCE

The percentage of non-infectious respiratory illness-related ED/UC visits by people over 75 years of age, and identifying as white alone were notably greater that the percentage observed among all-cause ED/UC visits.

References

^[25] Mote, P.W., J. Abatzoglou, K.D. Dello, K. Hegewisch, and D.E. Rupp, 2019: Fourth Oregon Climate Assessment Report. Oregon Climate Change Research Institute. ↩︎

^[26] Noah TL, Worden CP, Rebuli ME, Jaspers I, The Effects of Wildfire Smoke on Asthma and Allergy. Curr Allergy Asthma Rep.. Jul;23(7):375-387. doi: 10.1007/s11882-023-01090-1. Epub 2023 May 12. PMID: 37171670; PMCID: PMC10176314 ↩︎

^[27] Landguth EL, Holden ZA, Graham J, Stark B, Mokhtari EB, Kaleczyc E, Anderson S, Urbanski S, Jolly M, Semmens EO, Warren DA, Swanson A, Stone E, Noonan C., The delayed effect of wildfire season particulate matter on subsequent influenza season in a mountain west region of the USA.. Environ Int. 2020 Jun;139:105668. doi: 10.1016/j.envint.2020.105668. Epub 2020 Mar 31. PMID: 32244099; PMCID: PMC7275907. ↩︎

Submersion and Non-fatal Drowning

Why we track this?

In Washington County, one way to escape the heat is by going to the beach, rivers, or lakes for water recreation. More hot days can mean more people participating in these activities, so we share data of ED/UC visits by county residents to track potential risks to safety from drowning during the summer.

Access to swim lessons and water safety education can help decrease risk of drowning. In the United States, certain groups have a greater risk of drowning than others. We share percent of visits by age, sex and race as a step towards understanding who drowning and submersion impact the most in Washington County. Unfortunately, existing data does not identify all groups at risk, but below we share some of the known risk factors (CDC, Drowning Risk-factors^[28]:

• Children ages 1-4 years, especially when unsupervised around water
• Males have higher rates of drowning with many factors like increased exposure to water, risk-taking behaviors, and alcohol use that contribute
• People with seizure disorders
• People with heart conditions
• People not able to swim and not wearing life jackets
• Alcohol Use

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information included are detailed below each tab’s image. Data are from May 1 to Sept. 30 and referred to as warm season.

Summer 2025 had the fewest submersion and non-fatal drowning ED/UC visits observed in recent years.

The annual count tab shows the total number of submersion and non-fatal drowning ED/UC care visits each year.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

The Cornelius area zip code of Washington County had the highest rates of submersion and non-fatal drowning ED/UC visits among all-cause visits from 2021 to 2025 warm seasons.

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97113	28.2
97062	16.6
97225	14.9
97007	13.9
97223	11.3
97005	10.1
97224	9.8
97008	9.7
97124	9
97229	6.7

The zip codes of residence tab shows the rate of submersion and non-fatal drowning ED/UC visits among all-cause ED/UC visits by zip code during 2021 to 2025 summer seasons. We use rate of submersion and non-fatal drowning ED/UC visits among all-cause ED/UC visits to adjust for changes over time in number of facilities reporting to ESSENCE. Source: ESSENCE

The percentage of submersion and non-fatal drowning ED/UC visits by people identified as 4 years or younger, between the age of 10-17 years, and male were significantly greater than the percentage observed among all-cause ED/UC visits. Although not statistically significant, a notably larger percent of these visits were by people identifying as Hispanic when compared with all-cause ED-UC visits.

References

^[28] CDC., Drowning Prevention: Risk Factors for Drowning. Accessed April 24, 2026 at https://www.cdc.gov/drowning/risk-factors/index.html ↩︎

Water Recreation

Why we track this?

Extreme heat can increase risk of bacterial and fungal growth as well as the number of people engaging in recreational water activities. This means a greater risk of injury from water related activities and greater risk of disease from fungal or bacterial exposure that includes swimmers’ ear and harmful algal blooms^{[29] [30]}. We reviewed visit details and confirmed evidence of injury/illness related to water recreation for 2024. We share number of water recreation-related ED/UC visits to explore recreational water activity and health impacts in Washington County. These do not include ED/UC visits for submersion and non-fatal drowning.

Access to swim lessons and water safety education can help lower the risk of drowning and water recreation-related injuries. There is less literature on risk factors for water recreation injury, but risk factors are likely similar to those of drowning. We share percent of visits by age, sex and race as a step towards understanding who is most impacted by drowning and submersion in Washington County. Unfortunately, existing data does not identify all groups at risk, but below we share some of the known risk factors for drowning (CDC, Drowning Risk-factors)^[31]:

• Children ages 1-4 years, especially when unsupervised around water
• Males have higher rates of drowning with many factors like increased exposure to water, risk-taking behaviors, and alcohol use that contribute
• People with seizure disorders
• People with heart conditions
• People not able to swim and not wearing life jackets
• Alcohol use

What are you seeing

This section has three tabs. Key takeaways are in the titles and description of information included are detailed below each tab’s image. Data are from May 1 to Sept. 30 and referred to as warm season.

The average number of water recreation-related ED/UC visits by Washington County residents for 2018-2024 summer seasons was 10 but for the past two summers were 16 and 19.

The annual count tab shows the total number of water recreation-related ED/UC visits each year.
Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

All water recreation-related ED/UC visits for 2021-2025 warm seasons have been by Washington County residents in the most southern zip codes (97140, 97224, and 97223).

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

Show data table: rate per 100,000 ED/UC visits by ZIP code

Rate per 100,000 of all emergency department and urgent care (ED/UC) visits, by ZIP code

ZIP code / area	Rate per 100,000 ED/UC visits
97140	40.1
97224	19.6
97062	12.4
97223	6.3
97007	6.3

The zip codes of residence tab shows the rate of water-recreation related ED/UC visits among all-cause ED/UC visits by zip code during 2021 to 2025 warm seasons. We use rate of water recreation-related ED/UC visits among all-cause visits to adjust for changes over time in number of facilities reporting to ESSENCE.
Source: ESSENCE

A greater percent of water recreation-related ED/UC visits than all-cause ED/UC visits were by school age children and people identified as White alone. The percent of ED/UC visits by adolescents from 10-17 years old for water recreation-related ED/UC visits was five times the percent observed among all-cause ED/UC visits for 2021 to 2025 warm seasons. Females also seem to be overrepresented in the water recreation-related ED/UC visits, but the difference is not significant due to small counts.

References

^[29] Kathryn Kuspis MJ, Melissa Powell, and Recca Hillwig, Recognizing Recreational Water Exposure and Habituating HAB Surveillance in ESSENCE. , Paper presented at: International society of disease and surveillance 2019. ↩︎

^[30] Nieratschker M, Haas M, Lucic M, et al., The association between acute otitis externa-related emergency department visits and extreme weather events in a temperate continental climate., International Journal of Hygiene and Environmental Health. 2024;255:114274. ↩︎

^[31] CDC., Drowning Prevention: Risk Factors for Drowning. Accessed April 24, 2026 at https://www.cdc.gov/drowning/risk-factors/index.html ↩︎

Mortality

Why we track this?

In the absence of climate adaptation, the rate of mortality during summer is predicted to increase. People are more likely to be exposed to extreme heat and poor air quality from wildfire smoke. Increased water recreation to escape the heat could also result in more drownings.

As summer weather becomes more severe, it will be important to track deaths related to summer hazards. This can help us find patterns early, so we can take action to save lives.

What you are seeing

This section has four tabs. Key takeaways are in the titles and description of information included, which are detailed below each tab’s image. Data are from May 1 to Sept. 30 and referred to as warm season.

In the most recent summer season one person in Washington County was confirmed to have died from heat related exposure. Before 2021, even one heat-related death was considered more than normal for Washington County.

We show annual number of deaths during warm season months where a primary cause is heat-related, respiratory related, and drowning.
Source: Vital Statistics Deaths

In 2021, there were nearly 40 more respiratory-related deaths than expected. Since that year the number of deaths has gradually decreased. The warm season of 2021 coincides with a peak in COVID as well as a major heat dome event.

We show annual number of deaths during warm season months where a primary cause is heat-related, respiratory related, and drowning.
Source: Vital Statistics Deaths

Each summer season since 2021, there have been at least one Washington County resident who died from drowning, but warm season 2025 there were no deaths from drowning.

We show annual number of deaths during summer months where a primary cause is heat-related, respiratory related, and drowning.
Source: Vital Statistics Deaths

Each summer, there are approximately 1600 people who die in Washington County.

We provide annual counts of all deaths occurring during the summer.
Source: Vital Statistics Deaths

Notes

Common terms and abbreviations:

ED/UC: Emergency Department and Urgent Care Visits

ESSENCE: Electronic Surveillance System for the Early Notification of Community-Based Epidemics

Summer Seasons: In this report we refer to the months from May to September because these often are the months with the warmest weather.

AQI: Air Quailty Index

EPA: Environmental Protection Agencies

CDC: Center for Disease Control and Prevention

Context, Exposures and Conditions

The Washington County Climate data team reviewed triage notes among heat-related illness visits to learn about how people were exposed to heat, and to identify conditions and identities that often appear during extreme heat. Below we share the number and percent of heat-related visits identified. Pregnancy, houselessness, intoxication, and participating in special events are among some of the other factors that appeared multiple times.

Triage Note Context

Most ED/UC Visits for HRI during summer season 2025 included mention of outdoor exposure and existing chronic disease.

The above chart describes the number of Heat-related Emergency Department and Urgent Care visits for heat-related illness where there is mention of specific exposure circumstances, and existing conditions and disability. Data from May-Sept. 2025 by Washington County residents were manually reviewed to identify above exposures, conditions, and disabilities. Data is from Oregon ESSENCE

Risk of heat related illness from occupational exposure is a major concern with warmer summers. Location of work can greatly modify risk and what recommendations may look like, so the below chart includes percent of occupational exposures where outdoor work was specifically mentioned. Also, because chronic illness is a broad category, the proportion and counts of some of the most common conditions mentioned are presented.

Occupation and Chronic Conditions

Cardiovascular disease and diabetes represent a quarter of visits flagged for chronic disease and most visits flagged for occupational exposure were outdoor

The left bar shows the distribution of chronic condition subtypes among ED/UC visits where a chronic condition is mentioned. The right bar shows outdoor exposure status among occupational Emergency department and Urgent Care (ED/UC) visits. Note that these are likely undercounts because themes are not systematically tracked.

Notes

Common terms and abbreviations:

ED/UC: Emergency Department and Urgent Care Visits

ESSENCE: Electronic Surveillance System for the Early Notification of Community-Based Epidemics

Summer Seasons: In this report we refer to the months from May to September because these often are the months with the warmest weather.

AQI: Air Quailty Index

EPA: Environmental Protection Agencies

CDC: Center for Disease Control and Prevention

Washington County partnered with Rede on three phases of community engagement that informed public health modernization plans that include:

• Climate Action Plan
• Emergency Operations Plan
• In the context of Climate and health during three phases of community engagement with intentional recruitment of diverse populations, participants were asked about climate preparedness, needs and sources of resilience. A total of 939 Washington County residents participated over the three phases and responses include discussion of summer hazards.

What we learned from community:

Climate Change and Health Engagement

Key Takeaways

Participant Quotes

• Participants felt least prepared for smoke and wildfires • Personal experiences with heat dome as well as events living abroad motivated participants’ preparedness • • They were most concerned about health impacts from heat and wildfires, including, stress, anxiety, fear, loneliness and exacerbated conditions like migraines • Participants expressed need for tailored support for different populations, especially older adults, infants, homebound populations, people with disabilities, people with chronic conditions, agricultural workers, people experiencing houselessness, people learning/speaking English as a second language, and people experiencing food insecurity • Identified a need for home AC, as well as wildfire evacuation routes and resources

“There’s a difference between heat exhaustion and heat stroke, and that’s something most people here don’t know, even though we experience extreme heat a lot. In 2021, we had a heat dome, and several hundred people died because we were unprepared for that.” “We want to see a plan for immediate action during a climate event with outreach to priority populations.” “Over the summer, I was living in a little house with no AC, and so when it was in the hundreds…I felt this kind of weight, lethargicness, and I didn’t have an appetite.”

Emergency Preparedness Engagement

Key Takeaways

Participant Quotes

• Major community strengths mentioned were community information sharing, trusted emergency service professionals and community events as platforms for preparedness • Participants highlighted need for sharing preparedness as a collective responsibility with improved infrastructures and outreach efforts that break down language barriers and build trust • Individual preparedness was described as inconsistent and highly dependent on personal resources or knowledge • Identified accessible emergency preparedness information and resources as a major need, especially for non-English speakers and people experiencing financial hardships. • Participants mentioned community leaders and community health workers as effective messengers to improve access. • Recommendations included establishing year-round emergency support centers, providing financial assistance for emergency supplies and enhancing multilingual and accessible preparedness materials.

“I think one of the strengths in the community is that a lot of us are willing to at least share the information.” “Those who should know all this are the community leaders, not the population, because the population, I say it with all due respect, does not understand what a disaster is until they experience it.” “People who don't speak English need more proactive outreach.” “Getting ready for disaster is not cheap at all. Are there subsidies for the less spoken-for communities who have less of the economic power?” “So we can have as many things as we want online and as many flyers as we can, but the messenger is equally as important as the message. So I think about how it is that some CBOs who have been pushed to provide emergency preparedness materials, how and why they are doing it with either limited or no funding, without the support of government in some instances. And that happens because oftentimes, community health workers, public health leads within underserved communities are the trusted messengers, it's not emergency preparedness leaders”

Energy Efficiency Engagement

Key Takeaways

Participant Quotes

• Most survey participants were very concerned about climate change impacting their or their community’s health. • During focus groups when heat was discussed, people shared four main topics:   - Noticing more hot days than before   - Describing health impacts of warmer weather, and connecting it with respiratory issues   - Describing the impacts of warmer weather on crops and animals   - Sharing resources they are aware of for adapting to heat like cooling centers and free transport during declared emergencies and support with installation of solar panels and HVAC

“I was born [locally]...Anyway. And I don't know, maybe it's because I'm getting older, but it seems like the summers are hotter. And I can remember walking to school, and the snow was almost above my knees, between my knees and my waist. But we don't have that kind of weather anymore.” “And I'm listening as people around the table are talking about the temperature going up and it being hotter, so my mind is thinking what that results in, oftentimes, is increased forest fires. And so you're dealing with smoke. And so we're starting to get more health issues when it comes to respiratory issues. More asthma, more bronchitis, more COPD. …And I think what we're seeing in the younger generation is not just respiratory things, but also skin things.” “And so where the weather would affect what's going on at the garden, that could definitely take a toll on our community too, because they can feel the fight to keep it alive, and try and do things to help with fighting depression and stuff like that.”

Notes

Common terms and abbreviations:

ED/UC: Emergency Department and Urgent Care Visits

ESSENCE: Electronic Surveillance System for the Early Notification of Community-Based Epidemics

Summer Seasons: In this report we refer to the months from May to September because these often are the months with the warmest weather.

AQI: Air Quailty Index

EPA: Environmental Protection Agencies

CDC: Center for Disease Control and Prevention