Emergency Care For You

Not the Right Time for a Selfie: A Conversation about Hawaii and Volcano Safety

By Mark Baker, M.D.

Hawaii is a beautiful place to live or visit. The eruption of Kilauea on the Big Island continues to raise questions about the safety and health of residents and visitors.

In this #DocBlog, Mark Baker, MD, president of the Hawaii chapter of the American College of Emergency Physicians (ACEP), discusses the risks and realities for those living near volcanic activity and shares his experience treating patients impacted by the volcano.

Do I need to worry about volcanic eruptions?

The short answer is that you don’t have to worry, you do have to be prepared. In addition to our continual top five ranking as one of the healthiest states in the country, Hawaii has hurricanes, floods, and active volcanoes.

Picture yourself living or owning a home in the East Rift Zone. Maybe you work in an emergency department on the Big Island or nearby. Or, maybe you have a vacation planned to the Aloha state. We, like residents of so many beautiful places in the world, must be educated about and prepared for the health and environmental impact of potential natural disasters.

How often does this happen?

Some Hawaiian volcanos are active – eruptions can cause death and destruction, albeit infrequently. In 1790 Madame Pele exploded with fury and reports detail that about 200 Hawaiian soldiers were killed, making it the deadliest volcanic eruption in what is now the United States. The notorious eruption of Mt. Saint Helen’s in Washington state killed 57 people in 1980.

Hawaiian volcanoes are generally known for being more docile, which historically allows spectators to peer over an edge at the natural wonder of a bubbling caldera. An eruption is not likely to be explosive, but it can happen. Historical evidence points to a massive explosion of Kilauea more than 1000 years ago that dumped up to 30 feet of ash miles away.  

Can I safely see the lava?

While the view is awe inspiring and usually great for your Instagram feed, it is very important to be mindful of all of the rules designed to facilitate safe viewing. Currently, it is against the law to get too close. You will face fines or jail time. No photo opportunity or thrill seeking is worth the health or safety risks right now.

Does the volcano eruption impact the health of Hawaiian residents or visitors? 

The health impact of a massive explosion is frightening but the event is very unlikely. What is happening now is not an explosive eruption. As you read this, molten lava is slowly working its way downhill. Some reports detailed lava flow reaching 15 miles per hour but most of the flow is much slower and relatively contained. There is still danger. Thousands of people have been evacuated and advancing walls of lava have destroyed approximately 600 homes as of early June 2018. More damage is expected.

Volcanic activity is associated with earthquakes. The largest earthquake associated with the current eruption was 6.9 on the Richter Scale in early May. Tsunamis are spawned by these earthquakes and we know they can do major damage. Fortunately, tsunamis are not an issue at this time. 

What about pollutants contaminating the land or the air? 

Some of the most prevalent health risks, like contaminated air, are the hardest to see. Less visible does not mean less important.

When molten lava hits the ocean, it creates a pollutant called “laze,” hydrochloric acid with microscopic particles of glass. Fortunately, laze is only found in the immediate vicinity where lava and ocean meet. Laze can cause eye, skin or lung irritation. The U.S. Coast Guard is enforcing a standoff zone and only permitted vessels are allowed in the vicinity.

More health problems are caused by what we refer to here as “vog,” the smog produced by a volcano. Inhaling volcanic gases can cause choking or suffocation. Even before the recent eruption, vog has been an intermittent nuisance for residents of Hawaii. The sulphur dioxide in the air is a chemical pulmonary irritant, visible as a haze in the air. 

What are you seeing in the emergency department?

My personal observation as an emergency department physician is there have been more asthmatic patients with respiratory complaints since Kilauea began spewing. Sometimes, even patients with no history of asthma can get bronchospasms, wheezing, or a tight feeling in the lungs. While that can be alarming for patients, it is usually not complicated to treat.

When the vog is thick, it impacts the lungs, especially those with respiratory problems. Children and seniors are especially vulnerable. When the Kona winds (from the South) blow, sulphur-laden air makes its way to Oahu, where I live, 200 miles away. 

Are there longer-term risks for Hawaiian residents?

Crops can be damaged and water systems intended to supply homeowners living more remotely can be impacted by sulphur dioxide in the air and rain. 

Losing your home and possessions or being displaced from your home certainly has financial and other consequences, including a major impact on mental health, which unfortunately is not discussed as frequently.  I have the deepest sympathy for those who have lost their belongings or their homes.

What about visitors, should I cancel my trip?

If you are a visitor to the Aloha State, you will avoid these risks as dangerous areas are closed. Don’t change your plans. You can still visit most the Big Island as well as the neighboring islands without fear. 

You can expect to give it some time before you can stand on the edge and look down into the caldera!

What has the eruption shown you about Hawaiians and emergency medical professionals?

I am filled with tremendous pride when I see medical experts and other members of my community all pitching in to help each other.

Emergency care providers, disaster relief agencies, community leaders and others continue to work together to minimize the risk and ease the recovery for Hawaiians - it is truly emblematic of the Aloha Spirit, it’s what we do here. 

What are the best places to go for more information?

For general health information: http://health.hawaii.gov/docd/advisories/big-island-volcanic-eruption/

For more specific information on vog: https://vog.ivhhn.org/health-effects-vog.

Mark Baker M.D. is an emergency physician on Oahu at Pali Momi Medical Center. He is the president of the Hawaii Chapter of the American College of Emergency Physicians.