On the first day of the school year, children in Lolo, Montana, woke to a smoke-filled sky. Ash fell on their parents’ cars, and choking air, muted by the late-August sun, cast the world in sepia tones. A few miles away, the Lolo Peak Fire was still burning, one of 35 large fires in the state last summer, prompting evacuations in northwestern towns. “The air is bad, and it’s bad pretty much everywhere,” the Missoula County air report said. “The places that aren’t bad will be bad soon.”

Parents dropped their children off at school, glad to be finished with a miserable summer of long hot days spent inside the house, windows closed against the thick smoke. But the school was not a haven. The fires burned through the fall, and smoke seeped into the school, an acrid haze that hung in the hallways, the cafeteria, the gym. As the days wore on, more and more kids began visiting the school nurse, acting out or going home. This fire season, says Dale Olinger, superintendent of the Lolo School District, was “like living inside the bad side of a campfire.”

Montana has long experienced wildfire and smoke. But this season was notable for the number of large, intense fires near populated areas and the unrelenting length of the season. The long-term human health effects of breathing wildfire smoke daily are largely unknown. But it is clear from this year that the state is not prepared to respond to wildfire smoke as an annual public health threat.

Historically, Montana’s fire season has stretched from July to September. Fires are mostly managed through suppression, primarily by the U.S. Forest Service and the state. Big fires aren’t unusual; both 2007 and 2012 were notable for their wildfire seasons, when 778,000 acres and 1.2 million acres burned, respectively. This year saw 1.3 million acres burning into October, fires that cost up to $1.5 million dollars a day to fight. The fires burned close to places like Hamilton, Seeley Lake and Frenchtown, filling them with smoke. By the end of the season in mid-September, 53 of Montana’s 56 counties had been declared disaster areas.

And this summer’s fire season is unlikely to prove unique, thanks to the state’s changing climate. The average temperature in Montana has warmed by 3 degrees since 1950. Last winter’s snowpack was high, and the spring was wet, which should have meant a calmer wildfire season. But starting in July, Montana was hit by a so-called “flash drought,” and the new growth swiftly dried into fuel. “That’s exactly the kind of situation that’s projected for the future,” says Cathy Whitlock, professor of earth sciences at Montana State University. While individual fires can’t be directly linked to climate change, the conditions that make them larger and hotter can be. Whitlock, who recently worked with a team of researchers to produce Montana’s first climate assessment, says the state needs to be prepared for more seasons like the last one. “We’re seeing more large, and often more severe, fires in the last few decades than we’ve seen in anybody’s memory,” Whitlock says. “Living with fire is something we really need to think about.”

In Montana, that means learning to live with smoke as well. In northwestern Montana, a phenomenon called inversion occurs, where cold air becomes trapped between valleys under a cap of warm air. Cold air “acts like water, and will flow downhill and settle on the valley floor,” says Sarah Coefield, air quality specialist for Missoula County. Inversions that trap clouds and air pollutants in the valleys lift only when the sun is able to heat the ground enough to warm the air. Such inversions contributed to Missoula County’s “hazardous” air warning, the most extreme category, as wildfire smoke caught in the inversion hugged the valley floor. Seeley Lake, a small community hit hardest by smoke from the Rice Ridge Fire, had just five days in August that were not categorized as hazardous. “From a public health perspective, it’s: ‘Get out,’ ” Coefield says. “But the reality is some people don’t have anywhere to go, or don’t have the money to take off and leave. They have jobs, they have kids.”

Some days, the air monitors were unable to accurately read the air quality because it was beyond their measuring capacity. “It’s unprecedented, is my understanding,” says Paul Smith, one of just two pediatric lung specialists in Montana. Smith sees children with asthma and lung diseases whose conditions are further complicated by the formaldehyde, benzene and carbon monoxide in wildfire smoke. Lungs are akin to a “raw open wound,” easily harmed by smoke exposure, Smith says. Long after the smoke is gone, inflammation and scarring remain. Across Montana, emergency rooms saw an increase of respiratory-related problems this wildfire season compared to last year, which was calm. In Missoula and Powell counties, for example, ER visits more than doubled.

Anecdotal evidence aside, our understanding of the long-term health impacts of smoke is thin. A study led by researchers at the Georgia Institute of Technology this summer found that the Environmental Protection Agency has significantly underestimated the amount of noxious emissions wildfires create. It found that hazardous particulates released into the air by wildfires are three times higher than previously thought. The only way to truly protect people from smoke is to avoid it entirely. But for Montanans, as smoke infiltrates their daily lives, that’s not always feasible.

Two weeks into the school year, the Lolo School District got its first high-efficiency particulate air, or HEPA, purifiers, the only mechanisms capable of filtering out fine particulates from wildfire smoke. But there weren’t enough HEPA purifiers for every classroom. That left district officials with the task of choosing which children would get clean air. After consulting the county health department, the district decided to put the purifiers in classes with the youngest students. “Those tiny little lungs are working even harder to get the oxygen they need,” Olinger says. “It was the logical group to start with.” The school worked its way up through grade levels as more purifiers became available, but the triage system wasn’t enough to help all the classes and communal spaces. At night, teachers set the purifiers to their highest setting, and continued running them on low throughout the school day.

The purifiers came from a program put together by Climate Smart Missoula, a climate resiliency nonprofit, in cooperation with Missoula County’s health department. HEPA purifiers are the only air purifiers able to filter out the micro-particulate matter from smoke; bandannas or other facemasks do nothing. The program began last year, a relatively calm year for wildfires, and was originally meant for Meals on Wheels recipients: elderly residents with low incomes who often have respiratory illnesses. But this year, the program became an ad hoc emergency response. “It’s amazing how clean air isn’t something you think about until you don’t have it,” says Amy Cilimburg, executive director of Climate Smart Missoula.

Working with the American Lung Association, schools and other groups, Cilimburg and Coefield were able to place around 500 purifiers across western Montana. Both Cilimburg and Coefield fielded a surge of calls from families, health clinics and organizations — people who had heard of the program and desperately needed the filters. “It felt frantic,” Coefield says, her voice wavering as she describes how hard it was to turn people down when they ran out of air filters. “I can’t say how frustrating it was that there were not funds for this, that it hadn’t been looked at before.”

Climate Smart and Missoula County are continuing an education campaign to impress upon people the need for clean air, and how important it is to have purifiers and to avoid smoke inhalation. At this point, people should think of a HEPA purifier as a necessary appliance, like a fridge, Coefield says. “Breathing is important.” But not everyone can afford filters, and a sustainable way forward to face the next season has yet to emerge.

Although nonprofits helped spackle the gaps in the public health emergency this summer, the fact is that federal, state and local governments lack the infrastructure to deal with acute wildfire smoke. Assistance is not available in the same way that it is for something like water pollution. The Federal Emergency Management Agency, for example, doesn’t have a dedicated program to distribute air purifiers, nor does Montana’s Department of Public Health and Human Services. Faced with another wildfire season like this one, spokesman Chuck Council said in an email that the department would work with partners and coordinate donations as it did this year. But that would come alongside department budget cuts impacting the entire state, in part because of the overwhelming $74 million price tag that came with fighting this year’s fires. “Any potential cuts could impact our staffing levels and ability to respond to local needs,” Council wrote. This year’s fires are creating a feedback loop, and fires are now another public health issue added to the state’s management burden.

After the worst of the fires passed, the county health department put the HEPA purifiers in storage, for what Olinger calls the “inevitable next time” they’ll be needed. But the effects of the fires linger. In September, after the rains came, Olinger traveled to a conference in Bozeman, away from the northwestern fires. In his hotel room, Olinger opened his suitcase, and only then realized his clothes still reeked of smoke. “It really permeates everything, not just the air,” Olinger says. “It was here long enough it got inside homes, people’s carpets. And it takes a while for that to go away.” 

Anna V. Smith is an assistant editor for HCN. Follow @annavtoriasmith