Facing Worsening Fire Seasons, California Health Centers Adapt

From implementing new technology to drawing from community networks, community health centers have a major role to play in California’s longer, more severe fire seasons.

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California Wildfires

A firefighter works to quell the flames of the El Dorado Fire burning in California's San Bernardino mountains on Sept. 10, 2020. (Photo courtesy of San Bernardino County Fire Department)
A firefighter works to quell the flames of the El Dorado Fire burning in California's San Bernardino mountains on Sept. 10, 2020. (Photo courtesy of San Bernardino County Fire Department)

Every year for the past four years, Petaluma Health Center has either watched patients evacuate in the face of an emergency – or responded actively to a crisis somewhere else.

Foremost among those emergencies have been wildfires. During the Tubbs and Kincade Fires that hit Sonoma County in 2017 and 2019, the California health center provided care to evacuees sheltering at a local fairground and other facilities.

The devastating 2017 Tubbs blaze “was certainly a difficult fire, but we’ve had this situation in almost every fire,” said Pedro Toledo, the community health center’s chief administrative officer.

During an emergency, such as a wildfire, “we essentially take care of everyone who needs assistance,” Toledo said. That includes filling prescriptions for chronic disease medicines, treating cuts and scrapes, addressing respiratory issues caused by poor air quality, and working with a local hospital to triage patients who need more extensive care.

As California’s wildfire seasons grow longer and more severe – and public safety power shutoffs, designed to keep new fires from sparking, enter the mix – the state’s health centers are working to adapt. They’re designing new plans, implementing new technologies, and thinking about the role they can play during emergencies to come.

New Strategies

More than 100 primary care providers recently joined a call, hosted by the California Primary Care Association (CPCA), on preparing for wildfires and power shutoffs, according to Andie Martinez Patterson, the organization’s senior vice president of strategy, integration, and system impact. “I think there’s a growing acceptance that this is now a statewide yearly phenomenon that we have to get in front of,” she said.

Health centers are beginning to install generators, employ new communications services, and even map their patients, so they know where people who need oxygen or have a disability are located and can get to them – even if they live on a remote dirt road.

During an emergency, “it’s often health centers that are the more mobile health care providers,” Martinez Patterson said, particularly if they have a mobile van or unit that can function as a miniature medical office.

“You learn something after every fire and every emergency,” Toledo said. That includes the importance of employing a mobile unit and geomapping patients and staff members, so they know who’s at risk and can reach out to them. That presents a challenge because many of Petaluma’s patients are homeless – so working with local shelters is a must.

Petaluma has also implemented a new, cloud-based call center that can be set up within half an hour should their facility be evacuated. “We can set it up in a gymnasium,” Toledo said. Once that’s done, Petaluma Health Center can access patient medical records and their geomapping data and get patients quickly in contact with providers.

But not all emergencies are as dramatic as a wildfire. At Winters Health Center in northern California, “yes, we’re in a fire area, and we’re thinking about it all the time,” executive director Christopher Kelsch said. But “I’m more concerned about planned power shutoffs.”

When the power goes out, it threatens refrigerated vaccines and access to vital patient medical records – and is dangerous for patients dependent on oxygen or other medical devices.

When the shutoffs first began taking place, “it was trial by fire. We were not ready,” Kelsch said. “To be honest, I’m small, and I’m lagging behind.” (Winters Health Center serves a small, relatively rural population.)

But that’s changing. The community health center is developing a new system with a diesel generator – and a cooling center where people can escape the brutal heat or use their medical devices should the power go out. “We’re trying to set up to be an ongoing, available place for folks to be because there isn’t really one right now,” Kelsch said.

Established Communities

Since the 1980s, Big Sur Health Center has been responding to the area’s frequent blazes. “This was, I believe, my eighth fire,” said executive director Sharen Carey, speaking of the Dolan Fire, which burned in Big Sur in September of last year.

Emergency supplies and medications from Direct Relief on Sept. 14, 2020, en route to a wildfire base camp in Big Sur, California, where firefighters responded to wildfires in the northern part of the state. (Andrew MacCalla/Direct Relief)
Emergency supplies and medications from Direct Relief on Sept. 14, 2020, en route to a wildfire base camp in Big Sur, California, where firefighters responded to wildfires in the northern part of the state. (Andrew MacCalla/Direct Relief)

For Carey’s staff, fires bring a delicate balance of caring for patients while also providing medical treatment to firefighters in the area. During the Dolan fire, staff members would treat firefighters during a 6 a.m. shift change, see regular patients during business hours, and drive back to care for more firefighters during the next shift change at 6 p.m.

“With every fire, we get a little more sophisticated in what supplies we take with us” to a wildfire site, Carey said.

In Big Sur’s close-knit community, Carey is less reliant on new technologies or plans than she is on long-lasting, widely known local resources. During wildfires, Carey forwards information to the local Chamber of Commerce to put on their Facebook page and sends it to the Big Sur Kate blog because she knows that her patients will check those resources during a wildfire.

When it comes to caring for evacuated patients, Carey explained that most don’t go far. If they’re missing their medications or need other care, “we can often take care of whatever it is over the phone.”

During emergencies like wildfires, Martinez Patterson said, health centers often rely on one another. Local consortia scattered throughout the state allow health centers to share their pharmacy resources when patients evacuate – and even their staff. Staff members from one health center may go to another to help deal with an increased patient load during an emergency.

Health centers also frequently send their mobile units to fires in other parts of the state or help another health center experiencing trauma, she said.

For community health center staff members, in particular, wildfires can be traumatic, Martinez Patterson explained. “They’re the residents but also have to serve people,” she said. “Staff have houses burn down but still have to come into work the next day.”

But despite the challenges, Martinez Patterson is confident that health centers have a major role to play in wildfires and public safety power shutoffs – and that that role will only grow.

“I would venture to say that within five years, health centers will be a central part of the emergency response in California, which they are not today,” she said. “I think all of California is having to come to grips with this. Fires are now part of most of our year.”

In response to wildfires raging across the West in recent weeks, Direct Relief has provided more than $300,000 in medical aid to more than 50 healthcare sites in fire-affected counties across seven western states.

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