Responding to Wildfires and Other Weather-Related Crises

Climate change has led to a growing number of weather-related crises. Wildfires have been particularly problematic and pose serious health concerns because they can cause many health issues, such as burns, smoke-inhalation injuries, and even death. For instance, research by Paglino and colleagues indicated that 440 excess deaths could be attributed to the Los Angeles County fires in January 2025. Excess deaths include those directly related to wildfire, partially attributable deaths (such as those from lung or heart conditions exacerbated by smoke or stress), and indirect deaths (for example, those due to disruptions to health systems and mental health impacts).


Wildfires stress organizations and staff. For example, emergency staffing needs can take a toll on nurses both physically and psychologically. Nurses may also be personally affected by fire. When weather-related crises, such as wildfires, occur, nurses must prioritize self-care and maintain high standards of care to avoid liability. It’s also important for nurses to be involved in preparing for these events. Although this article focuses on wildfires, many principles apply to other weather-related emergencies, such as flooding or hurricanes.
 

Nature of Wildfire Smoke

Barría notes that temperature changes and lower precipitations due to climate change have caused an increase in weather-related emergencies such as wildfires. One of the most serious adverse effects of these fires is smoke, which can significantly increase levels of particulate matter in the air. Haymond writes that PM10 (10 micrometers in diameter) can irritate the eyes, nose, throat, and skin; PM2.5 is smaller, so it can reach the lungs and avoid alveolar cleaning mechanisms. Inflammation occurs, which can then cause damage to the epithelium.

Wildfire smoke can have many adverse effects, including exacerbations of respiratory conditions, deleterious effects on the cardiovascular system, and a negative impact on the global climate because of changes in rain patterns. These effects can extend beyond the immediate area of the fire. Smokepolluted air, which contains volatile compounds such as nitrogen dioxide, sulfur dioxide, carbon monoxide, carbon dioxide, and ozone, can travel hundreds of miles.

Barría adds that those who are particularly vulnerable to the effects of wildfire smoke include children, adolescents, the elderly, pregnant women, people with chronic conditions, and cigarette smokers. In addition, to affecting people directly, poor visibility caused by smoke can lead to accidents on roads and in the air.
 

Effects of Wildfire on Health

Health effects of wildfires can be categorized by health systems, patients, and staff.

Health systems. Some hospitals and clinics may burn down, lose power, become overwhelmed by patients in the emergency department, close because of wildfire damage, or need to evacuate patients as the fire nears. All of these situations place a strain on other facilities. Furthermore, road closures may hamper patient transfers and impede staff from reaching the facility.

Patients. Burns are the most obvious effect, but as noted earlier, smoke can cause serious problems. In addition to exacerbation of respiratory conditions such as asthma, chronic obstructive pulmonary disease, bronchitis, and pneumonia, Haymond notes that poor air quality can cause rhinitis, itchy and watery eyes, nonproductive cough, and throat and skin irritation. Haymond adds that inflammatory responses can lead to increased risk for thrombosis, myocardial infarction, and stroke. Patients may
also experience eye injuries, such as corneal abrasions from ash and debris. In addition to these physical effects, patients often experience psychological distress such as anxiety and depression due to loss of family, friends, pets, and property. Haymond notes that individuals with preexisting behavioral health issues may experience a decline.

Staff. Nurses and other staff typically need to work long hours during a wildfire event, leading to exhaustion. In addition, shortages of medical equipment can hinder care.
Like patients, nurses may suffer psychological distress. For example, they may have had to evacuate their own homes or worry about family members who are unaccounted for. Preparedness is key to reducing the burden of the health effects of wildfires and other weatherrelated crises.
 

Organizational Readiness

Organizations need to adhere to state and federal requirements related to disaster preparedness. For example, the Centers for Medicare and Medicaid Services (CMS) has specific requirements related to planning, including policies and procedures that need to be in place. Hospitals also need to meet requirements by accrediting agencies such as The Joint Commission.

Hospitals should identify weather-related disasters their region is most vulnerable to. For example, earthquakes in California, flooding in coastal areas, and hurricanes in Florida. A Hazard Vulnerability Assessment can assist with this; assessment resources are available at https://nspa1.org/hva/. One resource is a tool that utilizes data from categories such as the probability of the event, human, property, and business impact, preparedness, and internal resources (such as staff availability) to calculate a threat risk percentage.

The assessment provides the baseline for creating an emergency operations plan (EOP) that includes staffing plans and training for how to respond to weather-related crises.
 

Planning for staffing for weather-related crisis

  • Preparedness for a weather-related crisis should contain staffing plans. Items to consider include:
    • Assigning responsibilities for each person who will be involved in staffing activities (e.g., who will be responsible for evaluating staffing needs)
    • Possible sources of external supplemental staff and how this staff will be integrated with existing staff
    • Possible sources of internal supplemental staff
    • Protocol for revising staffing patterns and duties
    • How support services can be modified to support clinical services
    • A plan for cancelling nonessential services if needed

Source: California Hospital Association. Incident response guide: staff shortage. 2025. https://calhospital.org/wpcontent/uploads/2025/05/IRG_Staff-Shortage.pdf
 

Organizational Response

In the case of a wildfire threat (or another weather-related crisis), the first step is to activate the EOP. When mobilizing staff, organizations should utilize shared decision-making (between staff and leaders) for staffing and resource allocation.

Organizations should set up triage centers as needed and prepare for possible evacuation by assessing patients’ care needs. Specific strategies will be based on the nature of the crisis. For example, Jimenez reported that during the California wildfires, hospitals tried to prevent smoke infiltration by sealing windows and switching to internal air filtration systems.
 

Nursing Practice Considerations

Nurses can take several steps to prepare for a weather-related crisis and respond when one occurs. A first step is to improve their competencies for disaster response. The International Council of Nurses has a list that may be helpful. Nurses should familiarize themselves with their organization’s disaster response plans and participate in drills and training.

Nurses facing a weather-related crisis should consider the types of injuries likely to occur based on the event, such as smoke inhalation for wildfires. In this situation, nurses can follow the Air Quality Index provided by the Environmental Protection Agency. The index describes air quality and tells who may be at risk from a health
standpoint.

It’s also important to document care completely. It can be easy to overlook this step given the stressful situation, but documentation is essential to protect the nurse from liability.

Another way nurses can protect themselves is to continue to function within their scope of practice and adhere to standards of care. In rare cases, the degree of patient surge may cause an organization to determine a need to shift from conventional standards of care to crisis standards of care. A discussion of crisis standards of care is beyond the scope of this article; more information can be found at Crisis Standards of Care | ASPR TRACIE.
 

Self-care

Self-care actions such as these can help nurses affected by a wildfire.

  • Have a personal plan in place in case you need to evacuate your home.
  • While hospitals offer essential services, if you believe traveling to work poses a danger due to driving through a wildfire, inform the hospital about your situation. You may also share photos of your surroundings to illustrate the threat. Keep a record of whom you speak with. It’s also important to understand state law regarding employees’ responsibilities during emergencies, as essential workers like nurses may be required to report to work.
  • Find out what support the hospital will provide in case you need temporary lodging due to fire damage.
Above all, do not hesitate to take advantage of mental health resources and stay connected with others so you feel supported. 
 

Advocacy

Nurses can advocate for effective disaster response by taking action in each element of the disaster management cycle. They also can work to ensure optimal collaboration among hospitals, emergency services, and other healthcare delivery sites in the event of a weather-related crisis. That includes serving on disaster
preparedness committees in their own hospital.

On a broader level, nurses can promote actions that reduce humans’ negative impacts on the environment, which could help mitigate weather-related crises. For example, a position statement from the Emergency Nurses Association states that emergency nurses can lead initiatives to help reduce carbon emissions from healthcare facilities.
 

Nurses and the disaster management cycle

Nurses can act in each of the four phases of disaster management. Here are some examples from Barría and
Haymond:
  • Mitigation. Nurses can learn about the health implications of wildfires and teach the public about the health effects of wildfires.
  • Preparation. Nurses can help individuals, families, and communities understand what they need to do to stay safe and protect themselves during a wildfire. They can also help assess whether supplies are sufficient (e.g., enough nebulizers) and counsel patients about preparing “to go” bags in case of evacuation.
  • Response. Nurses can respond to wildfires in their professional role, including engaging in triage and providing resources for those who have lost their homes. They can also reinforce that patients should limit time outdoors when the air quality is low.
  • Recovery. Nurses can help communities return to functional levels as quickly as possible. They can be especially alert to signs and symptoms of depression and anxiety.
  • Sources: Barría RM. Wildfires as a public health problem: a setting for nurses in disasters. Educ Enferm. 2019;37(3):e01; Haymond R, Jesrani L. Wildfires: implications for nurses. Nursing. 2022;52(8):17-21.
 

Preparation and Protection

Many nurses have already been affected by a wildfire or other weather-related crisis. Those who have not will likely experience a crisis in the future. Preparation is key to an effective response that keeps nurses and their patients safe and protects nurses from liability.

Article by: Lynn Pierce, FNP-C, Senior Risk Consultant, NSO

References Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is
applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.

This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.
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