How can health systems better handle the next wildfire crisis?

Facing worsening wildfires, healthcare systems need to quickly overcome “continued siloing,” inadequate cash and a lack of specific training.

That’s one of the main conclusions drawn by a group of medical researchers – including an NWT emergency room physician – in a new paper published in the journal Lancet Planetary Health.

Setting out what they call a “practical briefing for leaders and healthcare professionals facing severe wildfire seasons,” the researchers state: “We must break down silos to save lives … Wildfires will worsen, but collective action can mitigate their harms.”

The paper draws on 2023’s NWT wildfires alongside fires in other parts of Canada, Australia and Hawaii.

Among its recommendations, the paper calls for indoor air quality monitoring in healthcare facilities and more work to jointly consider mental and physical health before, during and after wildfires.

More broadly, the paper says climate change adaptation funding is “grossly inadequate” and the health sector needs to develop a “coordinated approach” to compete with the likes of fossil fuel lobbyists. Universities should prioritize climate change in the courses they teach, the paper argues, and governments “must integrate climate considerations into health policy and planning.”

“The disaster medicine community has been response-focused, which is a key reactive skill set. Their lived experience needs now to be proactively and purposefully funnelled back into policy planning in an era of increasing disasters,” the paper states.

Dr Courtney Howard, one of the paper’s eight authors, is a Yellowknife physician who researches the intersection of health and climate.

“My subarctic hospital was evacuated due to wildfires last year after never having anticipated that potential eventuality,” Howard was quoted as saying in a news release. The paper is being published a week before the one-year anniversary of Yellowknife’s evacuation, which involved moving dozens of patients south by air at short notice.

“We had a ‘shelter in place’ plan designed for 20th-century fire,” Howard said.

“We need to move the reality of continued and worsening climate-amplified wildfires into our common vision of the future, train healthcare professionals to keep communities safe, and allocate the resources required to see plans implemented.

“Preparation not only does good – it feels good.”

‘Realistic, regular drills’

In providing the background to their call for more collaborative action, the paper’s authors set out the state of scientific research into wildfires’ effects on humans.

While the immediate mental and physical trauma of fire may feel obvious – particularly to NWT residents with recent lived experience – there are research gaps regarding the longer-term effects of wildfire smoke.

Even so, the authors quote existing research that suggests the “complex and dynamic mixture of pollutants” in that smoke can jeopardize heart health, exacerbate kidney disease, create complications during and after pregnancy, and even possibly increase dementia risk.

In response to the challenges of physical and mental health impacts, the researchers say hospitals must be much better prepared for the chance of an evacuation, including training on wildfire emergency management and how to interpret air quality information – then pass on advice to patients.

“Healthcare staff should be prepared for rapid evacuation and be ready to ensure continuity of operations in the case of loss of power,” the paper states. “Identified vulnerabilities should be stress-tested through realistic, regular drills done by experienced, credentialed emergency and disaster experts.”

As the immediate danger passes and communities recover, the researchers say governments must ensure a “steady stream” of funding is available to maintain health and social services.

“I have been studying the population health effects of wildfires and smoke for more than 20 years. It was a niche issue back then, but now we seem to see record-breaking fire activity somewhere in Canada every summer,” said Sarah Henderson of the BC Centre for Disease Control, another of the paper’s authors.

“Planning, preparation, and collaboration build resilience within individual healthcare facilities and complex healthcare systems.

“We need to do this work to get ready for the next wildfire season and every wildfire season.”