Editor’s note: This article is part of a series on the impacts of climate change and climate events on hospitals and health care facilities and related planning, preparedness and response efforts.

A recently released assessment from the UN Environment Programme reports a concerning increase in the severity and intensity of wildfires globally, a trend that shows no signs of easing up. The likelihood of catastrophic wildfires is projected to increase by 14% by 2030, 30% by 2050 and 50% by the end of the century. In the United States, the 2019-2020 fire season saw record-breaking outcomes — 10,000 fires burned 4.2 million acres in California alone in 2020 — under extremely hot, dry and windy conditions.

“We don’t see wildfires as a standalone issue,” says Skip Skivington, vice president of healthcare continuity and support services at Kaiser Permanente. “It’s connected to the radical climate change that we’ve experienced. As early as 2001, we realized that climate change was going to be a risk to not just the planet and society, but specifically in health care as an increase in wildfires [continues]. We didn’t see it right away, but it certainly started to play out around 2010 when there were some significant wildfires in Southern California that impacted our operations.”

The immediate threat of wildfires to facilities is clear, but the direct damage to buildings is just one outcome. In fact, a region far from an active wildfire can experience severe impacts, says Rick McGuffey, director of facilities management at Sky Lakes Medical Center, Klamath Falls, Ore. The location of his facility in a basin in Klamath County in southern Oregon has made it especially vulnerable to smoke from wildfires hundreds of miles away.

“The smoke from all those devasting fires in California the last couple of years is blown up from the southwest and comes right over and sits in the basin,” McGuffey says. “Last year was probably one of our worst years where we had heavy smoke in the basin over three weeks straight. We try to use HEPA filters wherever we can, but we also add or change out to charcoal filters. Along with that, we also do a daily testing inside and outside.”

The impacts of wildfires on communities and regions can continue long after the event itself is over. For example, poor air quality due to wildfire smoke can result in long-term public health consequences. Vulnerable populations, including children and the elderly, are especially susceptible to secondary effects from smoke such as cardiovascular and respiratory diseases.

“Another problem that happens with wildfires is that on a preemptive basis, utility companies shut down the power grid to not spark additional fires or make a bad situation worse,” Skivington says. “For patients dependent on equipment, we have to make sure that we’re prepared. It’s almost like a spiderweb, and you have to touch so many points to make sure that everyone is as safe as they possibly can be.”

In addition to smoke and ash, wildfires cause environmental damage that can contribute to water and soil contamination, erosion and flooding — potentially intensifying the impacts of other natural disasters. It is a cascading effect that also exacerbates climate change.

The post-fire cleanup work related to smoke can also be substantial, Skivington says.

“For instance, during a wildfire in 2017, we had to replace basically every piece of disposable equipment and supplies at the hospital,” he explains. “Even though the hospital wasn’t directly destroyed by flames of fire, the smoke damage was incredibly impactful. I cannot describe the aggressive cleaning that had to be done to make sure that the systems could operate when they came back up online.”

Preparation for wildfires starts with a risk assessment of the facility, McGuffey says.

“Clear away debris from buildings, don’t let garbage build up, don’t let plants over grow,” he says. “Make sure irrigation systems are working properly, and keep it moist during the summertime. Check the building envelope but not only the outside of the building. Make sure there’s no damage up on the roof that could cause problems. Don’t forget about outbuildings and other properties.”

Another crucial factor in preparing for wildfires is to stay ahead of supply and equipment needs.

“We always take an inventory, usually about March, of the filters that we have on hand to see if we need to order more charcoal and HEPA filters in advance of the wildfire season,” McGuffey says. “Especially now with supply chain delays in getting materials, we want to make sure that we have what we need so we’re not waiting for that last-minute arrival of supplies.”

In wildfire situations, the possibility of evacuation is also a reality for health care facilities. The 2017 evacuation of the Kaiser Permanente Santa Rosa facility in Northern California during the Tubbs Fire provided useful lessons learned that informed planning for future evacuations, Skivington says.

“We learned based on that experience, and in a subsequent fire [in 2019] we began to evacuate the hospital ahead of any warning orders,” Skivington says. “The key ingredient is our very robust and very rehearsed command center structure. It has become a core competency of our organization and our leadership. We assume that a wildfire could happen today and because of that awareness, we are able to implement an evacuation at a moment’s notice.”

Skivington believes that every hospital should have a staff person whose primary responsibility is emergency management. He acknowledges that establishing a specific position might pose staffing challenges for smaller facilities. Still, he thinks all health care facilities can take important steps to bolstering their planning and response capabilities.

“Look for someone at your facility with an awareness of and interest in emergency management because they’re there,” he says. “A dedicated person keeps everything moving in a uniform way and can respond to changes because there’s incredible change in the threat landscape. Wildfires are just one of those threats. No matter where we live in the country, there’s something going on from a disaster management perspective.”

But most important is to not underestimate the threat of wildfires, Skivington stresses. The biggest mistake, he says, is when people assume a wildfire will not happen where they are located. He always anticipates the worst case scenario — not if a wildfire will happen, but rather when it will happen.

“We have had to deal with wildfires up close and personally for the benefit of our members, our patients, our staff and the communities that we serve,” Skivington says. “Once that started, the intensity only grew, and so we now are in a perpetual state of awareness that a wildfire could break out at any moment and we have to be ready to respond.”

Learn More

The Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) offers a collection of articles and resources about health care facilities and wildfires, including lessons learned, wildfire threats and impacts, and planning and response tools.

A 2020 issue of the ASPR TRACIE publication The Exchange focused on the impacts of wildfires on hospitals through interviews with experts from emergency medicine, emergency management and the federal government.

The Centers for Disease Control and Prevention’s Public Health Emergency Preparedness cooperative agreement program provides funding, guidance and technical support and has helped hospitals in California prepare for and respond to wildfires.

The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) has developed a planning framework and guidance to protect occupants of commercial buildings from smoke during wildfire events.

Spreading Like Wildfire: The Rising Threat of Extraordinary Landscape Fires is a February 2022 publication from the UN Environment Programme that looks at the changing pattern of wildfires, impacts on people and the environment, and risk mitigation and wildfire management.