July 10, 2019

Wildfires are getting worse. Are hospitals ready?

Daily Briefing

    U.S. hospital infrastructure is underprepared for mass casualty burn events, which may become more common as destructive wildfires grow in frequency, Adam Rogers writes for WIRED.

    From wildfires to hurricanes: How can hospitals prepare for disasters?

    A harbinger of what's to come?

    Last November, the Camp Fire spread through Northern California, ripping through the town of paradise and killing at least 85 people. The fire passed through the local hospital, Adventist Feather River Hospital, largely destroying the facility and leaving health care workers scrambling to evacuate patients while tending to the injured, according to Rogers.

    The experience "made real a moment that specialists had been warning about for years," Rogers writes.

    According to Tina Palmieri, director of the Firefighters Burn Center at the University of California, Davis, "There were four beds immediately available in the entirety of Northern California for a burn patient. Everyone else was going to have to wing it."

    Rogers reports that those four beds were part of a total of 53 burn beds in the entire state of California. Throughout the United States, there are only about 1,800 dedicated burn beds, Rogers reports. 

    In addition to bed shortage, Rogers reports the United States also has a shortage of providers fully trained in burn treatment. James Jeng, a burn surgeon at Mt. Sinai Hospital, said he estimates there are only about 300 burn surgeons and 300 burn nurses in the entire country. "There are a lot of trauma surgeons, a lot of trauma nurses, a lot of [ED] doctors," Jeng said. He added, "But the burn cognoscenti, it's a small village of mad monks."

    The situation wasn't always like this, Rogers reports. When there was a fire in the Oakland, California, in 1991, three of the nine regional hospitals that received patients had dedicated burn units. Today, two of those hospitals no longer have burn units while the third hospital is completely closed.

    Part of the reason for the decline, Rogers reports, is that there are fewer burn injuries today and hospitals like to operate at capacity or near capacity, meaning having spare beds for the possibility of burn patients means paying for beds that aren't often used, Rogers reports.

    Wildfires are getting worse

    But experts say the prevalence and severity of burn injuries may rise as wildfires grow worse each year. According to Rogers, wildfires are increasing in frequency and intensity in part because of climate change-related heat and human beings moving closer to areas that were previously wilderness. The area where the "wildland" meets human civilization is where wildfires commonly start, according to Rogers.

    Further, more wildfires means the potential for more serious burns—and possibly mass casualty incidents, Rogers reports. "Unlike an explosion or a house fire where you catch on fire and the fire is put out immediately, in a wildfire you're surrounded by heat, and then you can also catch fire," Palmieri said.

    In addition, she explained that people who are stuck in a wildfire "usually can't get to medical care for a while, so you get delayed treatment," Palmieri said. "That causes them to be more dehydrated, and that dehydration exacerbates the wound." 

    Burn surgeons team up with federal officials

    With all this in mind, the American Burn Association has teamed up with HHS to determine how to incorporate burn injuries into regional and local disaster plans to help hospitals exchange knowledge and build emergency supply chains, Rogers reports.

    In addition, HHS is requiring the 361 health care coalitions—which consist of hospitals and health agencies— in the United States to add burn casualty plans to their disaster response plans by June 2021. If they fail to do so, they risk losing federal grant money dedicated to disaster preparedness.

    In the meantime, HHS is working with Massachusetts General Medical Center and the University of Nebraska Medical Center to test state response plans. Melissa Harvey, director of the National Healthcare Preparedness Program at HHS, explained that the goal of the exercises is to "figure out the criteria for how to determine which patients go where, triage them, and how they would get the right resources to those patients" (Rogers, WIRED, 6/19).

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