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In 2014, wildfires ignited a coal mine in Australia, burning for 6 weeks, releasing large amounts of fine particulate matter ≤2.5 μm in diameter (PM 2.5). We investigated the association between individual PM 2.5 exposure and emergency department presentations (EDPs) within 5 years post-fire. Survey and exposure data for 2725 residents from an exposed and unexposed town were linked with ED administrative data from 2009 to 2019. The association between individual PM 2.5 and EDPs was assessed using recurrent survival analysis. A 10 μg/m3 increase in PM 2.5 was associated with a 10% increase in respiratory EDPs (HR = 1.10; 95%CI:1.00–1.22) over 5 years post-fire. Increased risks of EDPs for ischaemic heart disease (HR = 1.39; 95%CI:1.12–1.73), atherothrombotic disease (HR = 1.27; 95%CI:1.08–1.50), and cardiovascular disease (HR = 1.10, 95%CI:0.99–1.22) were evident within 2.5 years. PM 2.5 exposure from a 6-week mine fire increased the 5-year risk of respiratory conditions. An increased risk of CVD within 2.5 years post-fire subsided after this time. • PM2.5 exposure from a 6-week mine fire increased the 5-year risk of respiratory related hospital emergency department presentations (EDPs). • An increased risk of cardiovascular related EDPs in the first 2.5 years post-mine fire, subsided after this time. [ABSTRACT FROM AUTHOR]