Nearly 20 percent of all healthcare systems in California are located within wildfire-risk areas, according to researchers studying wildfire patterns across the state.

In a three-part research series, data scientists have detailed public health considerations to better support medically vulnerable people during wildfires. What was once a defined “fire season,” with a peak in activity during late summer and early fall, wildfires are now occurring year-round in many parts of the western United States, including California.

Those fires are increasingly close to vulnerable people in medical settings. Those findings, currently under peer review, are outlined in a paper titled “Proximity of Wildfires to Inpatient Healthcare Facilities in California, 2001-2023.” The paper was authored by Direct Relief’s Vice President of Research and Analysis Andrew Schroeder, as well as Caleb Dresser, Neil Singh Bedi, Eric Sergienko, and Satchit Balsari.

By conducting a spatial analysis with annual data from the California Department of Health Care Access and Information and CAL-FIRE’s Fire and Resource Assessment Program, researchers detailed an increase in the number of inpatient beds and acute care facilities within five miles of a wildfire zone.

“The distance from inpatient healthcare facilities in California to nearby wildfires is decreasing by an average of 628 feet per year, while close approaches are increasing,” the paper states.

A research timeline from 2001 to 2023 was reviewed given high year-over-year variation, and found that inpatient healthcare facilities are significantly exposed in California to wildfires and that long-term care facilities, specifically nursing homes, are most at risk.

Direct Relief’s Andrew Schroeder, a co-author on the paper, said he hopes the data and analysis will be used for future policy implications regarding disaster medicine and public health to better support medically underserved people.

Schroeder said these healthcare facilities aren’t given guidance on the site selection process and the healthcare facility’s proximity to previous wildfires.

“Tier one hospitals have a whole set of requirements, and as you go down the scale of size and centrality of the facility, those requirements get looser and looser,” he said. “But at the same time, they’re also getting more and more exposed to fire, and disproportionately the patients that are then served at those facilities are also more medically vulnerable.”

Schroeder and others worked on two other recent papers involving wildfires and health, one of which details the medical implications of the state’s power outages on medically underserved populations. Residents who rely on electricity-dependent equipment to keep medicines refrigerated medications or power machines that provide oxygen therapy are at an increased risk of harm during hours and days-long power shut-offs.

A third paper, expected to be released later this year, analyzes a survey of medically vulnerable people in Mariposa County, California, on their communication habits during a wildfire.

Schroeder said the idea for that paper came from a former Mariposa County Public Health Director. They questioned the safety of medically vulnerable residents during a wildfire.

‘There’s a lot of evidence that people hesitate quite a lot when taking actions to protect their health,” Schroeder said.

Even though the health department provides safety guidance information during a wildfire, researchers found that many rely on word-of-mouth conversations from people they know for information and will listen to a direct call to their phone from the health department to determine whether to evacuate or not during a fire. Schroeder said the data revealed that residents were not likely to change their behavior after seeing information only on social media.

“There can be extreme reluctance to evacuate if you have mobility impairment problems or other medical vulnerabilities—it’s just harder,” he said.