Wildfire Approaching a County With One Hospital and 90 Dialysis Patients
A wildfire is 12 km from a county of 240,000 people and moving at about 3 km/h toward populated areas, with a forecast wind shift in 12 hours. The county has a 180-bed hospital inside the evacuation warning zone, four skilled nursing facilities with 310 residents total, and one outpatient dialysis center with 90 patients who need three sessions weekly. The fairgrounds shelter can hold 1,500 people but has no backup power. Two evacuation routes exist: a four-lane highway and a two-lane canyon road that is the only access for 6,000 residents. EMS has 22 ambulances, plus 6 from a neighboring county arriving in 4 hours. Air quality index is 340 and rising. The hospital's generator has 72 hours of fuel and no contract for resupply. The EOC must decide whether to issue an evacuation order for the hospital now or shelter in place.
1. Recommend whether to evacuate the 180-bed hospital now or shelter in place, and define the trigger points that should govern the decision.
Read the worked answer
The decision should be trigger-based rather than made once. Under current wind, 12 km at 3 km/h gives roughly four hours to the warning zone, but a forecast wind shift can send embers well ahead of the front, and an AQI of 340 already stresses cardiac and respiratory patients. Shelter in place is defensible only if the building is defensible (noncombustible construction, cleared space, adequate water) and if power and medical air are assured. The 72-hour fuel supply with no resupply contract is the weakest link: if power fails during the smoke event, ventilation and medical air go with it.
Recommend issuing a prepare-to-evacuate order now, securing a fuel resupply commitment, and evacuating at defined triggers: fire crossing a pre-set distance (for example 8 km), a county evacuation order for the zone, AQI above 500, or loss of safe ambulance transport. Evacuating 180 beds takes roughly 6 to 12 hours; waiting for certainty forces a rushed move. Sequence the 20-30 highest-acuity patients first by ambulance, then step-down, then ambulatory patients by bus. Do not wait for the formal order if fire-behavior modeling shows the trigger will be crossed overnight.
2. Allocate 22 ambulances, plus 6 arriving in 4 hours, across the hospital, four SNFs, and 90 dialysis patients.
Read the worked answer
Triage by time-criticality and dependency, not by facility size. Commit 14 ambulances to the hospital's first high-acuity wave. Send 4 to the SNFs with the highest-acuity residents - oxygen-dependent, non-ambulatory, and dementia residents - and 2 to begin moving dialysis patients due within 24 hours, directly to a receiving dialysis center rather than a shelter. Hold 2 for contingency and inter-facility emergencies. Task the 6 incoming units to the hospital's second wave and the remaining SNFs when they arrive.
Use ambulances for stretcher patients only; use lift-equipped buses and paratransit for ambulatory and wheelchair evacuees. Burning an ambulance on a walking patient is the most common allocation error in wildfire evacuations. Pre-identify receiving facilities with confirmed bed counts and dialysis capability, and record each patient on a manifest with a wristband. Missing manifests are the signature failure of rushed evacuations and drive family reunification problems for weeks.
3. What shelter and access/functional-needs issues must the EOC solve before opening the fairgrounds?
Read the worked answer
The fairgrounds can hold 1,500 but has no backup power, which disqualifies it for anyone with electricity-dependent medical equipment unless a generator is brought in. Before opening: secure a generator and fuel for lighting, refrigeration, and device charging; establish a medical section with a nurse, oxygen, and medication refrigeration; plan for functional needs including mobility, hearing, vision, cognitive, and language access; admit service animals with their handlers; provide sanitation and potable water for 1,500 people; and run a registration desk that captures names and medical needs for reunification.
Access is harder than capacity. The two-lane canyon road is the only route for 6,000 residents and will become the bottleneck. Phase evacuation by zone to avoid a single jam, restrict the canyon road to residents, reserve the highway for EMS and hospital transfers, and pre-position traffic control at the canyon mouth. If the wind shift arrives early, the canyon road may close; identify a secondary route or a shelter-in-place option for those 6,000 people now, not when the order is given.